The American College of Gastroenterology Guidelines:Management of Acute Pancreatitis(referred to as the"2024 guidelines"),released in March 2024,presents 11 recommendations and 23 key concepts for the management of acute pancreatitis(AP)based on different levels of evidence quality.The 2024 guidelines provide detailed explanations regarding the diagnostic criteria,etiology,initial assessment,severity stratification,initial management,endoscopic retrograde cholangiopancreatography,antibiotic use,nutritional support,and surgical interventions for AP.Compared to the 2023 edition of the American College of Gastroenterology Guidelines,the 2024 edition offers more detailed recommendations and comprehensive evidence-based medical data,which is of great significance in optimizing the diagnosis and treatment process for AP patients and improving patient outcomes.

Objective:To investigate the influencing of high sodium donor liver transplan-tation from the death of a citizen′s organ donation (DCD) on the prognosis of recipients.Methods:The retrospective cohort study was constructed. The clinicopathological data of 125 pairs of donors and recipients who underwent DCD liver transplantation in Xijing Hospital of Air Force Military Medical University from January 2015 to June 2021 were collected. Of the 125 donors, there were 93 males and 32 females. Of the 125 recipients, there were 92 males and 33 females, aged 48(41,55)years. According to the last time of serum sodium level of donor liver in the 125 recipients, 9 donor livers with serum sodium level ≥170 mmol/L were divided into group 1 (extremely high sodium), 33 donor livers with serum sodium level ≥150 mmol/L and <170 mmol/L were divided into group 2 (moderate high sodium), and 83 donor livers with serum sodium level <150 mmol/L were divided into group 3 (normal sodium), respectively. Observation indicators: (1) postoperative recover situations; (2) follow-up and survival analysis. Measurement data with normal distribution were represented as Mean± SD. Repeated measures were analyzed by repeated measures ANOVA. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Kruskal-Wallis test. Count data were described as absolute numbers, and Pearson chi-square test or Fisher exact probability were used for data test. The Kaplan-Meier method was used to draw survival curves and Log-rank test was used for survival analysis. Results:(1) Postoperative recover situations. The changes of alanine transaminase (AlT), aspartate aminotransferases (AST), total bilirubin (TBil), alkaline phosphatase (ALP), prothrombin time (PT), international normalized ratio (INR), albumin (Alb) and creatinine (Cr) from the first day to the 14th day after operation were (736±972)IU/L to (75±46)IU/L, (1 290±1 651)IU/L to (38±20)IU/L, (102±98)μmol/L to (33±11)μmol/L, (66±34)IU/L to (104±54)IU/L, (19.9±3.3)seconds to (11.3±1.0)seconds, 1.76±0.31 to 1.00±0.08, (34±5)g/L to (38±3)g/L and (91±41)μmol/L to (76±19)μmol/L, respectively, in the recipients of group 1. The above indicators were (505±377)IU/L to (48±46)IU/L, (855±727)IU/L to (24±17)IU/L, (64±42)μmol/L to (32±22)μmol/L, (68±51)IU/L to (91±46)IU/L, (16.8±3.5)seconds to (11.9±1.2)seconds, 1.47±0.30 to 1.04±0.09, (33±4 g/L) to (40±5)g/L and (106±32)μmol/L to (97±27)μmol/L in the recipients of group 2 and (637±525)IU/L to (65±60)IU/L, (929±1 193)IU/L to (33±27)IU/L, (66±48)μmol/L to (33±36)μmol/L, (64±28)IU/L to (125±64)IU/L, (17.2±4.7)seconds to (13.3±12.8)seconds, 1.51±0.42 to 1.05±0.13, (35±6)g/L to (39±4)g/L, (105±44)μmol/L to (94±40)μmol/L in the recipients of groups. Results of overall effect showed there were significant differ-ences in the change trend of TBil (time effect, inter-group effect, interaction effect) in recipients among the three groups after liver transplantation ( Fgroup=5.42, Ftime=22.78, Finteraction=3.85, P<0.05). There were significant differences in the time effect of ALT, AST, ALP, PT, INR, Alb, Cr in recipients among the three groups after liver transplantation ( Ftime=50.17, 36.24, 19.24, 10.55, 59.61, 41.94, 10.82, P<0.05). (2) Follow-up and survival analysis. All recipients were followed up. Cases with early postoperative liver dysfunction, cases with donor liver failure 1 year after operation, cases with biliary complica-tions 1 year after operation, cases with vascular complications 1 year after operation, cases with rejection 1 year after operation were 2, 1, 0, 0, 0 in the recipients of group 1. The above indicators were 2, 1, 3, 0, 1 in the recipients of group 2 and 10, 8,20, 1, 6 in the recipients of group 3. There was no significant difference in the above indicators among the three groups ( χ2=1.58, 0.60, 5.19, 1.62, 0.97, P>0.05). The 1-year and 3-year cumulative survival rates of the donor liver were 100.00% and 100.00% in the recipients of group 1 after liver transplantation. The above indicators were 94.74% and 77.16% in the recipients of group 2 and 91.57% and 89.30% in the recipients of group 3. There was no significant difference in the cumulative survival rate of donor liver among the three groups ( χ2=2.69, P>0.05). The 1-year and 3-year cumulative survival rates were 100.00% and 100.00% in the recipients of group 1 after liver transplantation. The above indicators were 93.74% and 77.16% in the recipients of group 2 and 89.40% and 86.00% in the recipients of group 3. There was no significant difference in the cumulative survival rate among the three groups ( χ2=1.94, P>0.05). Conclusion:Donor livers with high serum sodium level can be used in the DCD liver transplantation.

Objective    To evaluate the effect of smoking and drinking status on the prognosis of patients with esophageal squamous cell carcinoma (ESCC). Methods    The clinical data of 483 patients with ESCC who underwent surgical treatment in Shannxi Provincial People's Hospital from 2007 to 2016 were retrospectively analyzed. Among them, 352 patients were male and 131 were female, with a median age of 64 (37-80) years. There were 311 smokers and 172 drinkers. The relationship between preoperative drinking or smoking status and the clinicopathological characteristics of patients with ESCC was analyzed. Log-rank method and Cox risk regression were used to conduct univariate and multivariate survival analysis, respectively. Results    The preoperative smoking status was related to the patient's tumor location (P=0.030). Drinking status was associated with tumor location (P=0.001), degree of differentiation (P=0.030), pathological T stage (P=0.024) and pathological N stage (P=0.029). Univariate survival analysis showed that smoking status did not affect the disease-free survival (DFS) (P=0.188) and overall survival (OS) (P=0.127) of patients with ESCC. However, patients who drank alcohol had worse PFS than non-drinking patients (29.37 months vs. 42.87 months, P=0.009). It was further proved that alcohol consumption was an independent risk factor affecting patients' recurrence and metastasis by using multivariate analysis (RR=1.28, P=0.040). Alcohol consumption also reduced the OS of patients by 21.47 months (P=0.014), however, multivariate analysis did not yield significant results. Conclusion    Preoperative drinking status is related to the stage and differentiation of patients with ESCC. It is an independent risk factor affecting the recurrence and metastasis of ESCC.

Objective To investigate the application prospect of the most extensive genome engineering pig internationally in preclinical xenotransplantation. Methods Porcine endogenous retrovirus (PERV) knockout combined with 3 major heterologous antigen gene knockouts and 9 humanized genes for inhibition of complement activation, regulation of coagulation disorders, anti-inflammatory and anti-phagocytosis were transferred into a pig (PERV-KO/3-KO/9-TG) as a donor, and the heart, liver and kidney were obtained and transplanted to 3 Rhesus macaque recipients respectively to establish a preclinical research model of pig-to-Rhesus macaque xenotransplantation. The functional status of xenografts after blood flow reconstruction was observed and the survival of recipients was summarized. The hemodynamics of xenografts were monitored. The change of hematological indexes of each recipient was compared. The histopathological manifestation of xenografts was observed. Results After the blood flow was reconstructed, all xenografts showed ruddy color, soft texture and good perfusion. The transplant heart, liver and kidney showed full arterial and venous blood flow and good perfusion at 1 d after operation. The postoperative survival time of heart, liver, and kidney transplant recipients was 7, 26, and 1 d, respectively. The levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase increased in heart transplant recipient at 1 d after operation, and gradually recovered to near normal levels at 6 d after operation. All indexes increased sharply at 7 d after operation. The level of aspartate aminotransferase increased in liver transplant recipients at 2 d after operation, and the alanine aminotransferase basically returned to normal at 10 d after operation, but the total bilirubin continued to increase. Both aspartate aminotransferase and alanine aminotransferase increased at 12 d after operation, and reached a peak at 15 d after operation. The kidney transplant recipient developed mild proteinuria at 1 d after operation, and died of sudden severe arrhythmia. Histopathology showed that the tissue structure of cardiac and renal xenografts was close to normal, and liver xenografts presented with patchy necrosis, the liver tissue structure was disordered, accompanied by inflammatory damage, interstitial hemorrhage and thrombotic microangiopathy. Conclusions PERV-KO/3-KO/9-TG pig shows advantages in overcoming hyperacute rejection, mitigating humoral rejection and coagulation dysregulation. However, whether it can be used as potential donor for clinical xenotransplantation needs further evaluation.

Non-alcoholic fatty liver disease (NAFLD) is characterized by increased fat depositions in the liver while the patients do not have drinking history.NAFLD has a prevalence of 10％ ～40％ in global,25％ ～26％ in Western populations.From 2004 to 2013,the numbers of new patients on the waitlist who had NASH increased by 170％ in America.The prevalence of NAFLD in China is 20％.With the decrease of HBV and HCV and the increase of diabetes mellitus type 2 and obesity,NAFLD will become the most common chronic liver disease in China over the next 20 years.NAFLD related end-stage liver disease will become the most common indication of liver transplantation.In this paper,the epidemiological features,pathogenesis,indication and prognosis of liver transplantation are reviewed.

Objective To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital (PUMCH) in 2017. Methods A total of 9 515 non-duplicate clinical isolates were collected from January 1 to December 31, 2017. Disc diffusion test (Kirby-Bauer method) and E-test method were employed to determine antimicrobial susceptibility. Results Gram-negative bacilli and gram-positive cocci accounted for 68.2％ and 31.8％, respectively among the 9 515 clinical isolates. Methicillin-resistant strains in S. aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) accounted for 25.6％ and 73.3％, respectively. Extended-spectrum β-lactamases (ESBLs) -producing strains accounted for 47.6％ (877/1 842), 27.6％ (335/1 213) and 33.0％ (59/179) in E. coli, Klebsiella spp (K. pneumoniae and K. oxytoca) and P. mirabilis, respectively. Enterbacteriaceae strains were still highly susceptible to carbapenems, with an overall resistance rate of ≤ 3.8％. The resistance rates of K. pneumoniae to imipenem and meropenem were 8.5％ and 8.2％, respectively. About 72.7％ and 70.4％ of A. baumannii isolateswere resistant to imipenem and meropenem. The resistance rate of P. aeruginosa to imipenem and meropenem was 14.8％ and 10.0％, respectively. The prevalence of extensively drug-resistant strains in A. baumannii, P. aeruginosa and K. pneumoniae was 31.7％ (239/753), 1.0％ (10/1 035), and 3.0％ (33/1 117), respectively. Conclusions The common bacterialisolates show various level of resistance to antimicrobial agents. Laboratory staff should improve communication with clinicians to prevent the spread of resistant strains.

Objective To analyze the epidemiology and clinical characteristics of patients with Brucella endocarditis in order to improve the understanding and treatment of Brucella endocarditis.Methods The clinical data including demographic characteristics,clinical features,laboratory data,echocardiography,treatment and clinical outcome of 6 patients with Brucella endocarditis were collected and analyzed.Results In our database consisting of 211 brucellosis patients with positive blood culture,6 patients (2.8％) with Brucella endocarditis were selected from May 2007 to December 2016 in Peking Union Medical College Hospital.The age range was 25-55 years,among whom 5 patients were men.The majority were farmers and all patients reported the history of closely contact with livestock.All of them had fever and 3 of them had arthralgia.Four patients had aortic involvement (4/6) and 2 of them presented with symptoms of left ventricular failure at admission.Blood culture of Brucella and serum agglutination test of Brucella were positive in all of them.Combined antibiotics treatments were given to all patients.Valve replacement surgery was performed in four patients,among them,three patients well recovered,one lost.Among all the patients,four were followed up continually and other two were lost.Conclusions Brucella endocarditis has a predominance of aortic involvement and is prone to left ventricular failure.Early antibiotic treatment combined with valve-replacement surgery is effective to improve the prognosis.

Objective    To investigate the efficacy of Docetaxel injection and Capecitabine tablets combined with Oxaliplatin injection in chemotherapy for patients after esophageal cancer surgery. Methods    We retrospectively analyzed the clinical data of 101 patients with esophageal cancer who underwent radical surgery from June 2010 to December 2012, including 58 males and 43 females. According to the different treatment methods they were divided into a study group (58 patients, 32 males and 26 females, postoperatively receiving Docetaxel injection, Capecitabine tablets, Oxaliplatin injection and chemotherapy) and a control group (43 patients, 26 males and 17 females, taking Docetaxel injection and Capecitabine tablets for 4 consecutive courses). We compared the difference in the outcomes between the two groups. Results    There was no significant difference in the level of serum anticancer antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199) and squamous cell carcinoma antigen (SCC) before chemotherapy between two groups (P>0.05). After chemotherapy, the level of serum CEA, CA125, CA199, SCC in the study group was significantly lower than that in the control group (P<0.05). The 1-year survival rate of the study group was 92.59% and the 2-year survival rate was 70.37%, which were not significantly different from those of the control group  (P>0.05). The 3-year survival rate of the study group was significantly higher than that of the control group (57.41 % vs. 32.43%, P<0.05). The mean survival time of the study group was longer than that of the control group (31 months vs. 22 months, P=0.001). Conclusion    Docetaxel injection and Capecitabine tablets combined with Oxaliplatin injection for the treatment of esophageal cancer surgery can significantly reduce levels of tumor markers in serum after esophageal cancer surgery, and is favorable for the long-term survival of patients, but adverse reactions should be noted.

Objective To investigate the antimicrobial resistance proifle in the clinical bacterial strains isolated from Peking Union Medical College Hospital during 2014.Methods A total of 8 295 nonduplicate clinical isolates were collected. Disc diffusion test (Kirby-Bauer method) and automated systems were employed to study the antimicrobial susceptibility. The data were analyzed by using WHONET 5.6 software according to CLSI 2014 breakpoints.Results Of the 8 295 isolates, 67.4% were gram-negative, and 32.6% were gram-positive. The top 10 most frequently isolated bacteria were:E. coli(18.1%),P. aeruginosa (10.8%),K. pneumoniae (10.2%),S. aureus (9.8%),
A. baumannii(9.2%),E. faecalis (6.3%),E. faecium (4.1%), coagulase-negativeStaphylococcus (4.1%),E. cloacae (3.1%) andS. maltophilia (2.9%). Methicillin resistant strains inS. aureus (MRSA) and coagulase negativeStaphylococcus (MRCNS) accounted for average of 28.4% and 66.5%, respectively. The resistance rates of MR strains to β-lactams and other antimicrobial agents were much higher than those MS strains. Overall, 81.3% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 81.1% of MRCNS strains were susceptible to rifampin. No staphylococcal strains were resistant to vancomycin, teicoplanin or linezolid. The resistance rate ofE. faecalis strains to most of the drugs tested (except chloramphenicol) was much lower than those ofE. faecium. Several strains of bothE. faecium andE. faecalis were found resistant to vancomycin and teicoplanin, which were Van-A and Van-B types based on their phenotype. No linezolid resistant enterococcal strains were found. Data showed that 90.8% ofβ-hemolyticStreptococcus strains were susceptible to penicillin. ESBLs-producing strains accounted for 54.2%, 31.0% and 28.9% inE. coli,Klebsiella spp (K. pneumoniae andK. oxytoca) andP. mirabilis, respectively.Enterobacteriaceae isolates were still highly susceptible to carbapenems. Overall, no more than 3.3% of these strains were resistant to carbapenems. A few extensively drug-resistant strains ofK. pneumoniae (1.3%, 11/842) were identiifed. The resistance rates ofP. aeruginosa to imipenem and meropenem were 17.5% and 11.8%, respectively.P. aeruginosa isolates showed the lowest resistance rate (5.9%) to amikacin. And 69.0% and 67.4% ofA. baumanniiisolates were resistant to imipenem and meropenem.A. baumannii isolates showed the lowest resistance rates to cefoperazone-sulbactam and minocycline (47.8% and 28.7%), respectively. The prevalence of extensively drug-resistant strains was 32.3% inA. baumannii and 1.8% inP. aeruginosa. The prevalence of β-lactamase inH. inlfuenzae was 33.7%. More than 93.0% ofS. pneumoniae strains were resistant to erythromycin and clindamycin.Conelusions Bacterial resistance is still increasing in this hospital, especially carbapenem resistantEnterobacteriaceae. It is necessary to take effective hospital infection control measures and use antibiotics rationally.

Objective To investigate the profile of antimicrobial resistance in clinical isolates from the patients in Peking Union Medical College Hospital during 2012.Methods A total of 6 662 nonduplicate clinical isolates were collected.Disc diffusion test or Kirby-Bauer method and automated systems were employed to study the antimicrobial resistance.The data were analyzed by WHONET 5.6 software according to CLSI 2012 breakpoints.Results Of the 6 662 bacterial strains included in this analysis, gram negative organisms and gram positive cocci accounted for 66.7% (4 446/6 662)and 33.3% (2 216/6 662),respectively. The top 10 most frequently isolated microorganisms were E.coli (17%),P .aeruginosa (11.4%),A.baumannii (11.4%), S.aureus (11.2%),K.pneumoniae (9.2%),E.faecalis (8.4%),E.faecium (4.1%),coagulase negative Staphylococcus (3.3%),E.cloacae (3.1%)and S.maltophilia (3.1%).About 39.9% of the S.aureus strains and 73.4% of the coagulase negative Staphylococcus were methicillin-resistant.No staphylococcal strains were found resistant to vancomycin,teicoplanin or linezolid.A few of vancomycin-or teicoplanin-resistant strains were identified in both E.faecium and E.faecalis.No lin-ezolid resistant strains were found.ESBLs-producing strains accounted for 53.0%,25.7% and 27.0% in E.coli,Klebsiella spp.(K.pneumoniae and K.oxytoca)and P .mirabilis, respectively.The Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 2.6% of these strains were resistant to carbapenems.A few pan-re-sistant strains of K.pneumoniae (0.7%,4/615)were iden-tified.About 20.3% and 13.6% of the P .aeruginosa isolates were resistant to imipenem and meropenem,respectively.P . aeruginosa isolates showed the lowest resistance rate (7.2%)to amikacin.And 72.8% and 75.2% of A.baumannii strains were resistant to imipenem and meropenem.A.baumannii isolates showed relatively low resistance rate to cefoperazone-sulbac-tam (51.2%)and minocycline (30.2%).The prevalence of pan-resistant strains was 43.5% in A.baumannii and 1.4% in P . aeruginosa.Conclusions Bacterial resistance is still increasing,especially pan-resistant A.baumannii strains.It is mandatory to take effective measures to control hospital infections and improve rational antibiotic use.