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Acute pancreatitis, an acute inflammatory injury of the pancreas, lacks a specific treatment. The circulatory protein renalase is produced by the kidney and other tissues and has potent anti-inflammatory and prosurvival properties. Recombinant renalase can reduce the severity of mild cerulein pancreatitis; the activity is contained in a conserved 20 aa renalase site (RP220). Here, we investigated the therapeutic effects of renalase on pancreatitis using two clinically relevant models of acute pancreatitis. The ability of peptides containing the RP220 site to reduce injury in a 1-day post-endoscopic retrograde cholangiopancreatography (ERCP) and a 2-day severe cerulein induced in mice was examined. The initial dose of renalase peptides was given either prophylactically (before) or therapeutically (after) the initiation of the disease. Samples were collected to determine early pancreatitis responses (tissue edema, plasma amylase, active zymogens) and later histologic tissue injury and inflammatory changes. In both preclinical models, renalase peptides significantly reduced histologic damage associated with pancreatitis, especially inflammation, necrosis, and overall injury. Quantifying inflammation using specific immunohistochemical markers demonstrated that renalase peptides significantly reduced overall bone marrow-derived inflammation and neutrophils and macrophage populations in both models. In the severe cerulein model, administering a renalase peptide with or without pretreatment significantly reduced injury. Pancreatitis and renalase peptide effects appeared to be the same in female and male mice. These studies suggest renalase peptides that retain the anti-inflammatory and prosurvival properties of recombinant renalase can reduce the severity of acute pancreatitis and might be attractive candidates for therapeutic development. NEW & NOTEWORTHY: Renalase is a secretory protein. The prosurvival and anti-inflammatory effects of the whole molecule are contained in a 20 aa renalase site (RP220). Systemic treatment with peptides containing this renalase site reduced the severity of post-endoscopic retrograde cholangiopancreatography (ERCP) and severe cerulein pancreatitis in mouse models. [ABSTRACT FROM AUTHOR]

This study explored the mechanism of action of Sargent gloryvine extract in treating severe pancreatitis. We used the PubChem and SwissTargetPredicton databases to predict the potential targets. The database for Annotation, Visualization, and Integrated Discovery was used to perform Gene Ontology. The Kyoto Encyclopedia of Genes was used to perform Genomes enrichment analyses. These analyses, visualized via Cytoscape software followed by molecular docking validation, identified Salidroside, Lignans, Emodin, and Physcion as key active compounds in the extract. The protein-protein interaction network analysis highlighted tumor necrosis factor, interleukin-6, and nuclear factor κB as critical targets with 42 signaling pathways identified as relevant. The nuclear factor κB pathway emerged as especially significant in the extract's effect on severe pancreatitis. Enrichment analysis screened 42 related signaling pathways, among which the nuclear factor κB pathway may play a vital role in treating severe pancreatitis with Sargent gloryvine extract. The molecular docking results indicated an excellent binding activity between Sargent gloryvine extract and nuclear factor κB. In conclusion, the therapeutic approach of Sargent gloryvine extract in severe pancreatitis involves a complex interaction of multiple components, targets, and pathways, with a potential mechanism linked to the downregulation of the nuclear factor κB signaling pathway. [ABSTRACT FROM AUTHOR]

Severe acute pancreatitis (SAP) is a common pathology requiring critical care input. Patients often present with evidence of physiological dysfunction that may require organ support for optimization. Various scoring systems are available which can help in identifying those most at risk of morbidity and mortality. Complications can be significant, and may require surgical intervention for management. As such these patients should be managed with full multidisciplinary input to ensure appropriate targeted treatment. Underlying causes for SAP should be aggressively investigated to reduce the potential for recurrent episodes and where appropriate allow for secondary preventative measures. These patients often require prolonged and recurrent intensive care stays. Of those who are discharged, ongoing issues with chronic pain and nutrition are not uncommon and can lead to significant psycho-social challenges in the community. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis is a common diagnosis which requires a prompt diagnosis and management by a multidisciplinary team with often general surgeons as the initial provider. Morbidity and mortality from an acute pancreatitis can be very high, especially in patients with a progressive worsening acute pancreatitis developing into pancreatic necrosis in the setting of multiple underlying medical comorbidities. Purpose: In this review paper, we discuss all aspects of acute pancreatitis and its potential complications, as well providing updates in the modern management of necrotizing pancreatitis. Practicing general surgeons need to be aware of the evolution in the diagnosis and treatment of this disease. Research Design: We conducted a review of literature of evidence and management options for acute pancreatitis, including all published manuscripts from 2012 to 2022. Results: Diagnosis and management of this disease can vary among specialiaties. The decision to utilize a percutaneous or endoscopic techniques are relevant points of discussion within general surgery and gastroenterology societies. In the past decade, the use of advanced endoscopic interventions has slowly replaced conventional open surgery in managing complications of acute severe pancreatitis. Conclusion: Acute pancreatitis is a disease which requires multidisciplinary approach with evolving treatment options to less invasive nonsurgical methods. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of high-dose versus conventional-dose continuous hemodiafiltration on treatment efficacy and inflammatory markers in athletes with severe pancreatitis. Methods: A total of 112 athletes with severe pancreatitis, admitted to our hospital from May 2019 to August 2021, were randomly divided into two groups. The control group received conventional-dose continuous hemodiafiltration, while the study group was treated with high-dose continuous hemodiafiltration. Results: The clinical efficacy in the high-dose group was significantly better than the control group (P<0.05). After treatment, the high-dose group showed significant improvements in clinical indicators, with lower levels of CRP, TNF-α, PCT, AMY, and Scr compared to the control group (P<0.05). Serum phosphorus, albumin, and cholesterol levels improved more in the high-dose group post-treatment (P<0.05). Vital signs such as body temperature, heart rate, and respiratory rate also showed greater improvement in the high-dose group, with significant differences noted compared to the control group (P<0.05). Both groups experienced a significant decrease in APACHE II scores post-treatment. Conclusion: High-dose continuous hemodiafiltration is more effective in treating severe pancreatitis in athletes, enhancing clinical indicators and reducing inflammatory markers. This treatment approach also positively impacts vital blood parameters, contributing to a quicker recovery and restoration of physical functions in athletes with severe pancreatitis [ABSTRACT FROM AUTHOR]

Introduction: The research investigates the mechanism, diagnosis, treatment, and subsequent endocrine therapy of severe pancreatitis induced by tamoxifen treatment in patients who have undergone breast cancer surgery. Case presentation: We studied two cases of breast cancer in whom severe acute pancreatitis developed after taking tamoxifen for endocrine therapy in our hospital. A brief literature review was provided to analyze the causes, clinical manifestations, treatment process, and prognosis of severe acute pancreatitis. Both cases involved patients with severe hyperlipidemic pancreatitis. After conservative treatment, none of them died. Pancreatitis did not recur after changing endocrine therapy drugs. Discussion/conclusion: Endocrine therapy with tamoxifen in breast cancer patients can induce hyperlipidemia, which can subsequently cause severe pancreatitis. The treatment of severe pancreatitis should strengthen the regulation of blood lipids. The application of low-molecular-weight heparin combined with insulin therapy can rapidly lower blood lipids. Involved treatments, including acid suppression, enzyme suppression, and peritoneal dialysis, can accelerate the recovery of pancreatitis and reduce the occurrence of serious complications. Patients with severe pancreatitis should not continue to use tamoxifen for endocrine therapy. To complete follow-up endocrine therapy, switching to a steroidal aromatase inhibitor is better if the situation allows it. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) is a common inflammatory condition of the pancreas, often caused by gallstones or alcohol. However, drug-induced acute pancreatitis (DIAP) is a rare and challenging diagnosis that requires thorough medication reconciliation and a high degree of clinical suspicion. This case report describes a 58-year-old African-American female patient who presented to the emergency department on two occasions with severe epigastric pain, elevated lipase levels, and imaging findings consistent with AP. After excluding common causes of AP, hydrochlorothiazide (HCTZ) was identified as the likely trigger. Discontinuation of HCTZ resulted in symptom resolution, with no recurrence during follow-up. This case underscores the importance of considering DIAP, particularly in patients on HCTZ who present with unexplained, recurrent AP., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Linkous et al.)

This paper presents an in-depth study and analysis of evidence-based care in continuous renal replacement therapy for severe pancreatitis and examines the effects of serum procalcitonin (PCT), C-reactive protein (CRP) levels, and CYP2C19 genotyping. Eighty patients with severe pancreatitis who met the inclusion criteria were randomly assigned to the medium metabolic group and the slow metabolic group according to their CYP2C19 gene test results, and then the two groups were randomly divided into the control group and the observation group according to the different treatment regimens. Group 1 was CYP2C19 gene intermediate metabolism and was given to the control group; group 2 was CYP2C19 gene intermediate metabolism and was given to the observation group; group 3 was CYP2C19 gene slow metabolism and was given to the control group; group 4 was CYP2C19 gene slow metabolism and was given to the observation group. The number of cases in each group was 20, and follow-up was taken, but enteral nutrition also has some complications, such as feeding intolerance, if clinicians and nursing staff actively give effective care, it can significantly reduce the incidence of complications, and improve the value of enteral nutrition, shorten the hospitalization time, and improve the clinical prognosis. The relationship between serum CRP and PCT levels and Spatially Oriented Format for Acoustics (SOFA) score and the type of Virtual Access Point (VAP) pathogens and prognosis was investigated by Spearman correlation analysis. Finally, Pearson correlation analysis was used to investigate the relationship between serum CRP and PCT levels and SOFA scores in VAP patients. Based on the above analysis, the clinical value of CRP, PCT levels, and SOFA scores in VAP was evaluated. Several evidence-based guidelines were developed to provide clear recommendations and guidance for the preventive management of enteral nutrition feeding intolerance, but there is a gap between clinical care practice and the best evidence, so the best evidence was introduced. We compare the analysis of the test results with previously reported similar tests, and our results show good accuracy and higher efficiency.

Severe acute pancreatitis (SAP) is associated with substantial morbidity and mortality. Several cytokines have been identified to have pathophysiological significance in SAP, but studies characterizing their early trajectories are lacking. Here we characterize the early trajectories of seven key cytokines associated with SAP and compare them with non-SAP subjects. Five proinflammatory cytokines (angiopoietin-2, interleukin-6, interleukin-8, monocyte chemoattractant protein-1, resistin) and two anti-inflammatory cytokines (hepatocyte growth factor, and soluble tumor necrosis factor-a receptor-1A) were measured in a prospective cohort of acute pancreatitis subjects (2012-2016) at the time of enrollment and then every 24 h for 5 days or until discharge. The cytokines' levels and trajectories were calibrated based on date of pain onset and were compared between healthy controls and three severity categories (mild, moderate, and severe). The cohort (n = 170) consisted of 27 healthy controls, 65 mild, 38 moderate, and 40 SAP. From day 1 of symptom onset, SAP subjects exhibited significantly higher levels of both pro- and anti-inflammatory cytokines compared with non-SAP and healthy subjects. But in SAP subjects, all proinflammatory cytokines' levels trended downward after day 2 (except for a flat slope for angiopoeitin-2) whereas for non-SAP subjects, the trajectory was upward: this trajectory difference between SAP versus non-SAP subjects resulted in narrowing of the differences initially seen on day 1 for proinflammatory cytokines. For anti-inflammatory cytokines, the trajectories were uniformly upward for both SAP and non-SAP subjects. Proinflammatory cytokine response is an early and time-sensitive event in SAP that should be accounted for when designing future biomarker studies and/or therapeutic trials. [ABSTRACT FROM AUTHOR]

Objective:To explore and analysis the efficacy of early fluid resuscitation and intervention of protein plasma products in severe pancreatitis. Methods: From July 2018 to April 2021, 94 cases of patients with severe pancreatitis were selected to be diagnosed and treated in this hospital. All the cases were divided into the study group and control group with 47 cases each groups accorded to the random number 1:1 grouping method. The control group were given conventional early fluid resuscitation treatment, and the study group were given protein plasma product treatment on the basis of the treatment of the control group. All patients were treated and observed for 5 days. Compared and recorded the changes in the prognosis of the two groups of patients. Results: The incidence of complications and mechanical ventilation in study group was different with control group(P<0.05); The blood lactate value of the two treatment groups after treament were lower than before treatment, and the lactate clearance rate were higher than before treatment, the difference between the study group and the control group were also significance (P<0.05); The SOFA score and APACHE Ⅱ score after treatment in the two groups were lower than before treatment, and the study group were lower than the control group (P<0.05); The levels of platelets and hemoglobin after treatment in the group were lower than before treatment, and the levels of the study group were different with control group(P<0.05). Conclusion: The application of early fluid resuscitation combined with protein plasma product intervention in severe pancreatitis can improve the patient's condition and blood lactic acid status, help the platelet and hemoglobin levels to return to normal, thereby reducing the incidence of complications and mechanical ventilation in patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of low molecular weight heparins (LMWHs) and ulinastatin on soluble myeloid cells and intestinal mucosal function (IMF) in patients with severe pancreatitis. Methods: A total of 107 patients with severe pancreatitis were divided into two groups: control group (CG, n = 53) and study group (SG, n = 54). The CG was treated with LMWH while SG was similarly treated but in addition received ulinastatin simultaneously. The following parameters were evaluated in the two groups: treatment effects, IMF, time for various indicators to normalize, vascular endothelial function, complication symptoms, T lymphoid subgroup indicators, inflammatory factors, antiinflammatory factors, soluble B7-H2, and soluble myeloid cell receptor-1 level changes. Results: After treatment, SG showed lower levels of L/M value, DAO and D-lactic acid than in CG (p < 0.05). Gastrointestinal function, leukocytes, amylase, and body temperature in SG had a shorter time to return to normal than in CG (p < 0.05). The levels of IL-10 in SG were higher than in CG, while sB7-H2, TNF-α, sTREM-1 and IL-1 levels were lower than those in the CG (p < 0.05). After treatment, NO levels in SG were higher, but TXB2, vWF and ET levels were lower than in CG (p < 0.05). In addition, CD4+, CD4+/CD8+ indicators were higher and CD8+ lower in SG than in CG (p < 0.05). Conclusion: Ulinastatin + LMWHs improves IMF in patients suffering from severe pancreatitis, shortens the time for various indicators to normalize, and reduces incidence of complications. However, further clinical trials are required to ascertain this therapeutic strategy for the management of severe pancreatitis. [ABSTRACT FROM AUTHOR]

Abstract Objectives The purpose of this study was to comprehensively assess the heterogeneity of procedures in the diagnostic guidelines for acute pancreatitis and to identify gaps limiting knowledge in diagnosing this disease. Methods A systematic search of a number of databases was performed to determine the guidelines for the diagnosis of acute pancreatitis in patients with severe pancreatitis. The guidelines for the diagnosis of severe pancreatitis were evaluated by AGREE II. The Measurement Scale of Rate of Agreement (MSRA) was used to assess the guidelines (2015–2020) and extract evidence supporting these recommendations for analysis. Results Seven diagnostic guidelines for acute pancreatitis were included. Only the 2019 WSES Guidelines for the Management of Severe Acute Pancreatitis and the Japanese Guidelines for the Management of Acute Pancreatitis: Japanese Guidelines 2015 had a total score of more than 60%, which is worthy of clinical recommendation. The average scores of the Scope and Purpose domain and the Clarity and Expression domain were the highest at 71.62% and 75.59%, respectively, while the average score of the Applicability area was the lowest at 16.67%. The included guidelines were further analyzed to determine the heterogeneity of the diagnosis of acute pancreatitis. The main reasons for the heterogeneity were the citation of low-quality evidence, the presence of far too many indicators for the classification of acute pancreatitis, unclear depictions of the standard, and poorly comprehensive recommendations for the diagnosis of the aetiology in the primary diagnosis of acute pancreatitis, the severity classification, the aetiological diagnosis, and the diagnosis of comorbidities. Conclusions The quality of different diagnostic guidelines for severe pancreatitis is uneven. The recommendations are largely based on low-quality evidence, and the guidelines still have much room for improvement to reach a high level of quality. The diagnostic procedures for acute pancreatitis vary widely in different guidelines. There are large differences between them, and resolving the abovementioned reasons would be a very wise choice for guideline developers to revise and upgrade the guidelines in the future.

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An 18-year-old male, diagnosed with urethritis and treated with minocycline for six days, presented to our hospital complaining of abdominal pain and nausea. Blood tests and contrast-enhanced computed tomography (CT) showed severe acute pancreatitis. Based on his medical history, blood tests, and imaging studies, common etiologies of acute pancreatitis were excluded, including alcohol intake, anatomical abnormalities of the pancreas and biliary tract, stones, malignancy, autoimmune diseases, and lipid abnormalities. The patient was diagnosed with drug-induced acute pancreatitis due to minocycline. Upon admission, minocycline was discontinued, and the patient was treated symptomatically. His symptoms improved steadily, and he was discharged on day 14 of hospitalization. A follow-up CT scan on day 8 of hospitalization revealed a 4-cm cyst at the pancreatic tail; however, since the patient was asymptomatic, he was monitored with imaging studies. The cyst gradually shrank and was no longer visible on a CT scan 12 weeks after discharge. Most cases of drug-induced acute pancreatitis caused by tetracycline have been reported as mild to moderate, and there are no documented cases of severe pancreatitis with cyst formation in the literature. This case illustrates that minocycline-induced acute pancreatitis can lead to severe pancreatitis and cyst formation, warranting careful use., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This work was partly supported by Grants-in-Aid for Research from the National Center for Global Health and Medicine (23A 3002). Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Odaka et al.)

Necrotizing gallstone pancreatitis is a rare and severe form of pancreatitis, particularly uncommon in the pediatric population. While gallstone pancreatitis is increasingly recognized in children, necrotizing cases remain exceptional. We report a four-and-a-half-year-old Pakistani American male presenting with generalized weakness, abdominal pain, and vomiting. Initial symptoms followed a recent upper respiratory infection. Clinical evaluation revealed an intermittently drowsy-appearing patient with a Glasgow Coma Scale (GCS) of 15 when fully alert, hypotension, diffuse abdominal tenderness, and signs of possible sepsis. Laboratory tests showed elevated lipase levels and conjugated hyperbilirubinemia. Ultrasound identified gallstones and necrotizing changes in the pancreas, which were later confirmed by CT imaging. The patient was admitted to the pediatric intensive care unit for aggressive management of necrotizing pancreatitis, including fluid resuscitation, antibiotic therapy, and nutritional support. He underwent laparoscopic cholecystectomy and developed Clostridium difficile colitis, which was managed with targeted antibiotics. The patient had a 26-day hospital stay and was followed up with negative results from clinical exome sequencing for related disorders. This case underscores the diagnostic and management complexities associated with pediatric necrotizing gallstone pancreatitis. The need for a multidisciplinary approach and adherence to clinical guidelines is emphasized. This report contributes valuable insights into the rare presentation of necrotizing pancreatitis in children and highlights the importance of early and comprehensive intervention., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities., (Copyright © 2024, Farsani et al.)

Olanzapine is an antipsychotic medication that is used in the management of schizophrenia and bipolar disorder, but it is not without any adverse effects. We present the following case of a 24-year-old man with a history of schizoaffective disorder, obesity, and anxiety, who developed hypertriglyceridemia-induced acute pancreatitis after six months on olanzapine. Despite his adherence to the medication, routine metabolic monitoring was not performed leading to a delayed diagnosis of hypertriglyceridemia and subsequent complications. The case underscores the critical need for regular metabolic monitoring in patients prescribed olanzapine to prevent severe adverse effects and guide timely intervention. Enhanced adherence to monitoring guidelines and consideration of alternative treatments may help mitigate such risks., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Espiridion et al.)

Hemorrhagic pancreatitis is a rare cause of hypovolemic shock. It presents as silent bleeding, with signs of hypovolemic shock and abdominal pain eventually culminating in life-threatening bleeding. This case study delves into a case of hemorrhagic pancreatitis in a 49-year-old male. Notably, he has a history of recurrent lower extremity (LE) deep vein thrombosis (DVT) and atrial fibrillation (AF) on Coumadin. He came in with shortness of breath (SOB) and was admitted for acute hypoxic respiratory failure secondary to Influenza A. A few days into admission, the patient developed acute cardiogenic shock, septic shock, and acute respiratory distress syndrome (ARDS). The patient developed rectal bleeding with a decrease in hemoglobin and hematocrit. A computed tomography (CT) of the chest, abdomen, and pelvis (CAP) without (w/o) contrast was performed to find a source. It showed hemorrhagic pancreatitis in the head/tail region. The bleeding resolved on its own without interventions or blood transfusion. Hemorrhagic pancreatitis carries a high mortality rate. In this case, it had an insidious onset with self-resolution, a rare case. Physicians should make quick referrals for surgical resection in hopes of better outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sodoma et al.)

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are essential in managing type 2 diabetes mellitus, promoting glucose regulation, weight reduction, and cardiovascular protection. Here, we report a unique case of semaglutide-induced pancreatitis complicated by distributive shock and death after four years of use. A 74-year-old male with type 2 diabetes, atrial fibrillation, coronary artery disease, and obesity (BMI 31.7) presented with severe epigastric pain and was diagnosed with severe pancreatitis. He reported no recent alcohol, drug use, or abdominal trauma. His workup showed normal triglyceride and calcium levels, and abdominal ultrasound was negative for gallstones or choledocholithiasis. He had been on semaglutide for four years, with a dose increase from 0.25 to 0.5 mg weekly about four weeks prior to admission, which was associated with worsening side effects such as severe nausea and constipation. He was admitted to the intensive care unit for severe pancreatitis, which was complicated by distributive shock requiring vasopressors, renal failure requiring continuous renal replacement therapy, Acute respiratory distress syndrome (ARDS) requiring intubation, and subsequently, cardiac arrest. In this case, the patient developed severe acute pancreatitis leading to death after four years of GLP-1RA use, with a dose increase occurring four weeks prior to admission. The absence of typical risk factors suggests a potential link between long-term use and dose changes of GLP-1RAs and severe pancreatitis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dagher et al.)

IntroductionSARS-CoV-2 is fundamentally a respiratory pathogen with a wide spectrum of symptoms. The COVID-19 related pancreatitis is less considered than other clinical features. The purpose is to describe two cases of pancreatitis associated with COVID-19.MethodologyPatients' demographics, clinical features, laboratory, and instrumental findings were collected.ResultsTwo patients admitted to the hospital were diagnosed with COVID-19 and severe acute pancreatitis, according to the Atlanta criteria. Other causes of acute pancreatitis were excluded. Treatment included broad-spectrum antibiotics, proton pump inhibitors, and low molecular weight heparin. Steroids, oxygen, antifungal treatment, and pain killers were administered when appropriate. Both patients were asymptomatic, with normal vital parameters and blood exams, and were discharged in a good condition.ConclusionIt is recommendable to include lipase and amylase on laboratory routine tests in order to evaluate the need for the abdominal CT-scan and specific therapy before hospital admission of the patients with COVID-19 related life-threatening acute pancreatitis.

Introduction: There is an upsurge in the incidence of acute pancreatitis over the last few decades; although the case fatality rate has remained unchanged. This may either be due to increased incidence of gallstone disease or improvement in diagnostic modalities. It is a potentially life threatening disease with varying severity of presentation. Methods: This observational analytical study was conducted in the Department of General Surgery in our hospital for a period of one year. All patients of acute pancreatitis were included in the study as per inclusion & exclusion criteria. Observations and Results: Total 62 Patients were included in the study. Gall stones disease is the most common cause of acute pancreatitis. The mean age of the patients in the study was 39 years. 28 females and 34 male patients were present. 22 patients of the patients had severe disease as per Atlanta classification. Four out of these 22 severe pancreatitis patients expired. All patients in the severe pancreatitis group had mild to life threatening complications and pleural effusion was the most common followed by necrosis. There was notable difference in terms of hospital stay between mild group and severe group of AP. Conclusion: The clinician should be aware that acute pancreatitis can occur in any age group and gender due to different etiology. The severity of AP does not depend on etiology, age or gender and it is associated with significant morbidity and mortality. SAP can be diagnosed on clinicoradiological basis and appropriate management can be done in those patients.

Background: Literature on acute pancreatitis (AP) outcomes in patients with cirrhosis is limited. We aim to investigate the mortality and morbidity of AP in patients with cirrhosis. Methods: We conducted a retrospective cohort study, and propensity score matching was done to match cirrhotic with non-cirrhotic patients on a 1:2 basis. Outcomes included inpatient mortality, organs failure, systemic inflammatory response syndrome, and length of hospital stay. We performed subgroup analysis of cirrhotics according to Child–Pugh and MELD scores. Multivariable logistic regression models were tested. Results: From 819 AP patients, cirrhosis prevalence was 4.9% (40). There was no significant difference between cirrhotics and non-cirrhotics for inpatient mortality (7.5% vs. 1.3%, p = 0.1), severe AP (17.5% vs. 7.5%), shock (7.9% vs. 3%), respiratory failure (10% vs. 3.8%), need for intensive care unit (15% vs. 6.3%), systemic inflammatory response syndrome (SIRS) on admission (22.5% vs. 32.5%), and SIRS on day 2 (25% vs. 15%). Cirrhotics had similar rates of pancreatic necrosis, ileus, BISAP score, Marshall score, admission hematocrit, BUN, and hospital length of stay. Finally, cirrhotics who had severe AP, required ICU, and/or die in-hospital appeared to have more severe liver diseases (Child-C, higher MELD score > 17) and had lower AP severity scores (BISAP < 3, Marshall scores < 2). Conclusion: In our study, cirrhotics hospitalized with AP had similar morbidity and mortality when compared to non-cirrhotics. [ABSTRACT FROM AUTHOR]

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Heterotopic ossification (HO) refers to the development of extra-skeletal bone in muscle and soft tissues, following tissue insult secondary to surgery or trauma. This pathological process is considered as the result of severe inflammatory cell cascade initiated after local trauma and subsequent attempt at tissue repair involving resident mesenchymal cells. We present a series of 12 cases of abdominal HO (AHO), over 8 years, following damage control laparotomies (DCLs). Methods: Medical records of 50 patients who underwent DCLs at Alice Springs Hospital between 2010 and 2018 were retrospectively reviewed for AHO. Demographic data were extracted. Abdominal X-rays and computed tomography scans of 47 patients were reviewed for AHO. Results: Twelve patients (25%) developed AHO of varying diversity ranging from small insignificant lesions to clinically palpable lesions in the abdominal wall. Data revealed relatively younger male preponderance. DCL for severe acute pancreatitis (SAP) was associated with AHO (P < 0.1, 90% CI). Longer periods of ventilation, intensive care unit stay and admission to hospital were strongly associated with AHO (P < 0.01, 95% CI). Occurrence of AHO with SAP was significantly higher compared to patients without SAP (relative risk 3.54, P < 0.001). Only two patients required surgical excision of HO prior to definitive closure of the abdomen. Conclusion: The authors conclude that AHO occurred more frequently in younger males. DCL for SAP was a significant risk factor. Extended periods of ventilation, intensive care unit stay and hospital admission were strongly associated with the development of AHO. Preoperative detection of HO is essential prior to planning definitive closure of the abdomen. [ABSTRACT FROM AUTHOR]

(1) Background: Identifying early pancreas parenchymal changes remains a challenging radiologic diagnostic task. In this study, we hypothesized that applying artificial intelligence (AI) to contrast-enhanced ultrasound (CEUS) along with measurement of Heat Shock Protein (HSP)-70 levels could improve detection of early pancreatic necrosis in acute pancreatitis. (2) Methods: Acute pancreatitis (n = 146) and age- and sex matched healthy controls (n = 50) were enrolled in the study. The severity of acute pancreatitis was determined according to the revised Atlanta classification. The selected severe acute pancreatitis (AP) patient and an age/sex-matched healthy control were analysed for the algorithm initiation. Peripheral blood samples from the pancreatitis patient were collected on admission and HSP-70 levels were measured using ELISA. A CEUS device acquired multiple mechanical index contrast-specific mode images. Manual contour selection of the two-dimensional (2D) spatial region of interest (ROI) followed by calculations of the set of quantitative parameters. Image processing calculations and extraction of quantitative parameters from the CEUS diagnostic images were performed using algorithms implemented in the MATLAB software. (3) Results: Serum HSP-70 levels were 100.246 ng/ml (mean 76.4 ng/ml) at the time of the acute pancreatitis diagnosis. The CEUS Peek value was higher (155.5) and the mean transit time was longer (40.1 s) for healthy pancreas than in parenchyma affected by necrosis (46.5 and 34.6 s, respectively). (4) Conclusions: The extracted quantitative parameters and HSP-70 biochemical changes are suitable to be used further for AI-based classification of pancreas pathology cases and automatic estimation of pancreatic necrosis in AP. [ABSTRACT FROM AUTHOR]

Currently, risk stratification calculators for acute pancreatitis (AP) can at best predict acute pancreatitis mortality at 12 hours from the presentation. Given the severe morbidity associated with AP, the identification of additional prognostic indicators, which may afford earlier prediction in length of stay (LOS) and mortality, is desired. Metabolic acidosis can be a prognostic marker for the severity of AP, and venous bicarbonate can reliably and accurately be substituted for arterial base deficit to detect metabolic acidosis. Since serum bicarbonate, anion gap (AG), and corrected AG (CAG) are routinely obtained upon presentation to the emergency department and often daily in the hospital, we conducted a retrospective analysis of 443 patients, evaluating if venous bicarbonate could predict the severity of pancreatitis as well as mortality, admission to the ICU, ICU LOS, and hospital LOS. The inclusion of venous bicarbonate, AG, and CAG in the first 12 hours only slightly improved the predictive capabilities of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score for these secondary outcomes. None of our incorporations of acidemia improved severity predictions more than the BISAP alone. Adding CAG to BISAP scoring had the largest effect on predicting ICU admission and hospital LOS (area under the curve (AUC): 1.12 (confidence interval (CI) 95%: 1.06-1.19), p <.001 and AUC 1.02 (CI 95% 1.01-1.04), p <.001; respectively). ICU LOS was not impacted by the addition of AG, CAG, or venous bicarbonate. In-hospital death (n=12) was too small to be determined., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board at Creighton University issued approval N/A. The study was approved as exempt research by the Institutional Review Board at Creighton University (InfoEd record number: 1433425). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Checketts et al.)

Severe acute pancreatitis (SAP) is a common pathology requiring critical care input. Patients often present with evidence of physiological dysfunction that may require organ support for optimization. Various scoring systems are available which can help in identifying those most at risk of morbidity and mortality. Complications can be significant, and may require surgical intervention for management. As such these patients should be managed with full multidisciplinary input to ensure appropriate targeted treatment. Underlying causes for SAP should be aggressively investigated to reduce the potential for recurrent episodes and where appropriate allow for secondary preventative measures. These patients often require prolonged and recurrent intensive care stays. Of those who are discharged, ongoing issues with chronic pain and nutrition are not uncommon and can lead to significant psycho-social challenges in the community. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of continuous blood purification and enteral nutrition in the treatment of patients with severe pancreatitis and their influence on the levels of inflammatory factors. Methods: A total of 82 patients with severe pancreatitis who were treated in our hospital from January 2018 to December 2019 were selected as the research objects, and they were divided into a study group (49 cases) and a control group (33 cases) according to different treatment methods. Patients in the control group received only continuous blood purification, and patients in the study group received enteral nutrition support on the basis of patients in the control group. The patients in the two groups were compared with abdominal pain relief time, infection incidence, hospital stay, and blood urea nitrogen before and after treatment. BUN), creatinine (SCr), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF-α), Changes in the scores of acute physiology and chronic health evaluation (APACHE Ⅱ). Results: The time to relieve abdominal pain, the incidence of infection, and the length of stay in the study group were shorter than those in the control group (P<0.05). After treatment, the APACHE Ⅱ score, serum CRP, IL-6, TNF-α, BUN and SCr levels in the study group were lower than those in the control group (P<0.05). Conclusion: Continuous blood purification combined with enteral nutrition support has a good therapeutic effect on patients with severe pancreatitis, which can significantly accelerate the outcome of patients with severe pancreatitis, and improve the renal injury and inflammation of the body. [ABSTRACT FROM AUTHOR]

Purpose of review: There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. Recent findings: Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tube-feeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., "step-up approach") is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. Summary: SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis. [ABSTRACT FROM AUTHOR]

Introduction: There is an upsurge in the incidence of acute pancreatitis over the last few decades; although the case fatality rate has remained unchanged. This may either be due to increased incidence of gallstone disease or improvement in diagnostic modalities. It is a potentially life threatening disease with varying severity of presentation. Methods: This observational analytical study was conducted in the Department of General Surgery in our hospital for a period of one year. All patients of acute pancreatitis were included in the study as per inclusion & exclusion criteria. Observations and Results: Total 62 Patients were included in the study. Gall stones disease is the most common cause of acute pancreatitis. The mean age of the patients in the study was 39 years. 28 females and 34 male patients were present. 22 patients of the patients had severe disease as per Atlanta classification. Four out of these 22 severe pancreatitis patients expired. All patients in the severe pancreatitis group had mild to life threatening complications and pleural effusion was the most common followed by necrosis. There was notable difference in terms of hospital stay between mild group and severe group of AP. Conclusion: The clinician should be aware that acute pancreatitis can occur in any age group and gender due to different etiology. The severity of AP does not depend on etiology, age or gender and it is associated with significant morbidity and mortality. SAP can be diagnosed on clinicoradiological basis and appropriate management can be done in those patients. [ABSTRACT FROM AUTHOR]

With the rising prevalence of obesity, there is a plethora of literature discussing the relationship between obesity and acute pancreatitis (AP). Evidence has shown a possible correlation between visceral adipose tissue (VAT) and AP incidence and severity. This systematic review explores these associations. Eligible articles were searched and retrieved using Medline and Embase databases. Clinical studies evaluating the impact of VAT as a risk factor for AP and the association of the severity of AP and VAT were included. Eleven studies, with a total of 2529 individuals were reviewed. Nine studies showed a statistically significant association between VAT and the severity of AP. Only four studies found VAT to be a risk factor for acute pancreatitis. Two studies showed VAT to be associated with an increased risk of local complications and two studies showed a correlation between VAT and mortality. This is the first systematic review conducted to study the association between VAT and AP. The existing body of evidence demonstrates that VAT has a clinically relevant impact and is an important prognostic indicator of the severity of AP. However, it has not shown to be an independent risk factor to the risk of developing AP. The impact of VAT on the course and outcome of AP needs to be profoundly explored to confirm these findings which may fuel earlier management and better define the prognosis of patients with AP. VAT may need to be incorporated into prognostic scores of AP to improve accuracy. [ABSTRACT FROM AUTHOR]

Abdominal pain secondary to chronic pancreatitis (CP) is difficult to manage and often requires chronic oral opioid therapy (OOT). Targeted drug delivery (TDD) allows for a diminished dose of opioid intake and improved pain levels. TDD has been used in different pain syndromes with only limited reports in CP., Objective: The objective of this article is to perform a retrospective review of CP patients treated with TDD versus OOT to compare chronic pain control and consumed morphine-equivalent doses., Methods: Patients receiving TDD between September 2011 and August 2018 were included. All patients were weaned off oral opioids one week before intrathecal trial and pump implantation. Patients with intrathecal trials providing at least 50% pain relief underwent pump implantation. Data were collected while on OOT and at two weeks, three months, and nine months post-implant. Data were analyzed with Microsoft Excel 365 MSO using means and standard deviations. P-values were calculated using a two-tailed student's t-test with paired two-sample means., Results: Twenty-three patients were analyzed. Pre-trial average pain score was 6.5/10 with a mean improvement with trials greater than 71%. The mean chronic baseline oral morphine milligram equivalents (MME) was 188. The mean MME on TDD at two weeks (0.36), three months (1.39), and nine months (2.47) were significantly lower than OOT. Mean pain scores were 6, 4.9, and 5.6 at two weeks, three months, and nine months, respectively, compared to 6.5 on OOT., Discussion: The results of this study indicate that TDD provides improved pain control with significantly lower opioid doses., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Cooper et al.)

Background/objectives: The epidemiology of exocrine pancreatic insufficiency (EPI) after acute pancreatitis (AP) is uncertain. We sought to determine the prevalence, progression, etiology and pancreatic enzyme replacement therapy (PERT) requirements for EPI during follow-up of AP by systematic review and meta-analysis.Methods: Scopus, Medline and Embase were searched for prospective observational studies or randomized clinical trials (RCTs) of PERT reporting EPI during the first admission (between the start of oral refeeding and before discharge) or follow-up (≥ 1 month of discharge) for AP in adults. EPI was diagnosed by direct and/or indirect laboratory exocrine pancreatic function tests.Results: Quantitative data were analyzed from 370 patients studied during admission (10 studies) and 1795 patients during follow-up (39 studies). The pooled prevalence of EPI during admission was 62% (95% confidence interval: 39-82%), decreasing significantly during follow-up to 35% (27-43%; risk difference: - 0.34, - 0.53 to - 0.14). There was a two-fold increase in the prevalence of EPI with severe compared with mild AP, and it was higher in patients with pancreatic necrosis and those with an alcohol etiology. The prevalence decreased during recovery, but persisted in a third of patients. There was no statistically significant difference between EPI and new-onset pre-diabetes/diabetes (risk difference: 0.8, 0.7-1.1, P = 0.33) in studies reporting both. Sensitivity analysis showed fecal elastase-1 assay detected significantly fewer patients with EPI than other tests.Conclusions: The prevalence of EPI during admission and follow-up is substantial in patients with a first attack of AP. Unanswered questions remain about the way this is managed, and further RCTs are indicated. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of adjuvant raw rhubarb enema therapy on systemic inflammatory stress response and intestinal mucosal barrier function in patients with severe pancreatitis. Methods: A total of 78 patients with severe pancreatitis treated in the Second People's Hospital of Neijiang, Sichuan, China between December 2016 and September 2018 were included in the study. The patients were divided into control group (n=39) and raw rhubarb group (n=39) by simple randomization. The control group of patients received conventional treatment of severe pancreatitis with western medicine, while the raw rhubarb group of patients received raw rhubarb enema on the basis of the treatment of control group, and the efficacy was evaluated after continuous treatment for 1 week. The differences in serum levels of inflammatory mediators (high mobility group protein B1, C-reactive protein, prostaglandin E2 and tumor necrosis factor α), stress hormones (cortisol and epinephrine) as well as intestinal mucosal barrier function indicators (D-lactate, endotoxin and diamine oxidase) were compared between the two groups of patients before and after treatment. Results: Before treatment, there was no statistically significant difference in serum levels of inflammatory mediators, stress hormones and intestinal mucosal barrier function indicators between the two groups (P>0.05). After treatment, serum high mobility group protein B1, C-reactive protein, prostaglandin E2 and tumor necrosis factor α levels of the observation group were significantly lower than those of the control group; cortisol and epinephrine levels were significantly lower than those of the control group; D-lactate, endotoxin and diamine oxidase levels were significantly lower than those of the control group (P<0.05). Conclusions: Adjuvant raw rhubarb enema therapy on the basis of western medicine can help alleviate the inflammatory stress response and optimize the intestinal mucosal barrier function in patients with severe pancreatitis. [ABSTRACT FROM AUTHOR]

Dyslipidemia constitutes a well-known factor that can lead to acute pancreatitis. Hypertrigliceridemia and hypercholesterolemia are part of dyslipidemia. In a prospecitve study, we analyzed the role of hypercholesterolemia in triggering episodes of acute pancreatitis and the capacity of cholesterol blood level to predict the severity and the evolution of acute pancreatitis. In our prospective study, a preexistent cholesterol blood level above 240 mg/dl proved to be a trigger for pancreatitis and an increasing cholesterol level in evolution predicts a pancreatitis with organ failure (moderately-severe or severe). [ABSTRACT FROM AUTHOR]

Pancreatitis is an obvious but rare event in pregnancy. From mild disease to multiorgan failure and sepsis, acute pancreatitis has numerous causes and often an unpredictable outcome. The authors present a case of a 22-year-old pregnant woman with severe pancreatitis due to biliary sludge. The unusual clinical manifestation of pancreatitis in our patient is worth emphasizing: massive bleeding from the upper alimentary tract and two concomitant pancreatic fistulas. The bleeding was a manifestation of pancreatic juice-induced injury to the splenic artery, whereas the fistulas were a consequence of disconnected duct syndrome and superficial necrosis of the pancreatic head. After two and a half years of treatment, the patient was on a regular oral diet with supplementation of pancreatic enzymes, and showed normal glycaemia levels. She returned to full physical activity. [ABSTRACT FROM AUTHOR]

To investigate the changes of tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) in the serum and their effects on organ function in patients with severe acute pancreatitis (SAP) during infected stage, aiming to provide a reference to individual treatment. 32 patients with SAP during infected stage admitted to the Digestive Department of The Second Affiliated Hospital of Zhengzhou University from April 2014 to May 2015 and also 30 volunteer normal people were recruited in this study. And 26 patients detected with positive pathogenic bacteria were grouped into group A and another 6 patients with negative pathogenic bacteria into group B and 30 normal people into group C. And TNF-α and PCT level in the serum and the liver, kidney and lung function and the relationship between them of all the included people were compared and analyzed. the serum TNF-α level detected in the bile, urine and the surface of wound in group A was much higher than that in group B (P<0.05); and there was no significant difference in PCT between group A and group B; and TNF-α and PCT level in the serum in group A and group B were remarkably higher than group C (P<0.05). In addition, the organ function (the liver, kidney and lung) in the patients with high TNF-α level (High TNF-α group) was significantly different from the patients with low TNF-α level (Low TNF-α group) (P<0.05). And various organ functional indexes increased significantly in the patients with high PCT level (P<0.05). There were two kinds of TNF-α level (high level and low level) in the patients during SAP general infection stage, and the high level may reduce various organ function, the low level can contribute to the regular inflammatory response. And there is a high PCT level in the early SAP infection stage, which can be used to predict the patients’ condition. [ABSTRACT FROM AUTHOR]

Background: Currently, both the step-up approach, combining percutaneous drainage (PD) and video-assisted retroperitoneal debridement (VARD), and endoscopic transgastric necrosectomy (ETN) are mini-invasive techniques for infected necrosis in severe acute pancreatitis. A combination of these approaches could maximize the management of necrotizing pancreatitis, conjugating the benefits from both the experiences. However, reporting of this combined strategy is anecdotal. This is the first reported case of severe necrotizing pancreatitis complicated by biliary fistula treated by a combination of ETN, PD, VARD, and endoscopic biliary stenting. Moreover, a systematic literature review of comparative studies on minimally invasive techniques in necrotizing pancreatitis has been provided. Case presentation: A 59-year-old patient was referred to our center for acute necrotizing pancreatitis associated with multi-organ failure. No invasive procedures were attempted in the first month from the onset: enteral feeding by a naso-duodenal tube was started, and antibiotics were administered to control sepsis. After 4 weeks, CT scans showed a central walled-off pancreatic necrosis (WOPN) of pancreatic head communicating bilateral retroperitoneal collections. ETN was performed, and bile leakage was found at the right margin of the WOPN. Endoscopic retrograde cholangiopancreatography confirmed the presence of a choledocal fistula within the WOPN, and a biliary stent was placed. An ultrasound-guided PD was performed on the left retroperitoneal collection. Due to the subsequent repeated onset of septic shocks and the evidence of size increase of the right retroperitoneal collection, a VARD was decided. The CT scans documented the resolution of all the collections, and the patient promptly recovered from sepsis. After 6 months, the patient is in good clinical condition. Conclusions: No mini-invasive technique has demonstrated significantly better outcomes over the others, and each technique has specific indications, advantages, and pitfalls. Indeed, ETN could be suitable for central WOPNs, while VARD or PD could be suggested for lateral collections. A combination of different approaches is feasible and could significantly optimize the clinical management in critically ill patients affected by complicated necrotizing pancreatitis. [ABSTRACT FROM AUTHOR]

Acute pancreatitis often results in life-threatening situations, making a prompt and accurate diagnosis cardinally important. To achieve these, it is crucial to correctly identify characteristic symptoms and test findings. However, when patients do not exhibit distinctive symptoms during a physician's examination, in addition to limited resources, these can become challenging. In this manuscript, we present an instructive case. A male in his twenties, who complained of generalized malaise, was admitted to our hospital. Unfortunately, however, he passed away within two days prior to undergoing detailed examinations or receiving therapeutic interventions. We performed an autopsy in order to ascertain the reasons for this outcome. The findings revealed that pulmonary edema and diffuse alveolar hemorrhage were the causative factors of his demise, with acute pancreatitis observed in the background. The occurrence of acute pancreatitis leading to death in youths is infrequent. Where could we have intervened to halt such an unfortunate course in a young individual? This patient probably had diabetic ketoacidosis and hyperlipidemia, both of which are known to be closely associated with acute pancreatitis. In retrospect, we should have noticed this point. In this case, the condition progressed too rapidly for appropriate therapeutic interventions. We believe that this case would provide educational instruction for similar situations that could arise in the future., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hosaka et al.)

Objective: This study was designed to explore the effects of ulinastatin combined with somatostatin on disease control and serum inflammatory factors in patients with severe pancreatitis., Methods: The data of 80 patients with severe pancreatitis treated in the First Affiliated Hospital of Jiangxi Medical College from May 2020 to April 2022 were analyzed retrospectively. Among them, 36 patients treated with somatostatin alone (3 mg somatostatin added in 50 mL normal saline) on the basis of standard treatment were assigned to a control group, and the other 44 patients treated with both ulinastatin (100,000 U of ulinastatin injection added in 250 mL 5% glucose solution) and somatostatin (3 mg somatostatin added in 50 mL normal saline) were enrolled into a study group. The levels of serum inflammatory factors (interleukin-1β (IL-1β), interleukin-6 (IL-6), and soluble intercellular adhesion molecule-1 (sICAM-1)), biochemical indexes (C-reactive protein, white blood cell count, and serum amylase) and gastrointestinal function indexes (motilin and gastrin) in the two groups were analyzed and compared before and after treatment. Additionally, the alleviation of clinical symptoms, treatment response and occurrence of adverse reactions were compared between the two groups. The mortality rate of patients within 1 month after the treatment was evaluated, and the risk factors affecting the prognosis were analyzed through logistics regression., Results: Before treatment, there was no significant difference between the two groups in the levels of IL-1β, IL-6 and sICAM-1 (P>0.05), while after treatment, the levels of all three factors decreased significantly in both groups (P<0.0001), with more notable decreases in the study group than those in the control group (P<0.0001). Before treatment, the two groups were not significantly different in the levels of C-reactive protein, white blood cell count, and serum amylase (P>0.05), while after treatment, all the three levels decreased notably in both groups (P<0.0001), with notably lower levels in the study group than those in the control group (P<0.0001). Before treatment, the levels of motilin and gastrin in the two groups were not significantly different (P>0.05), while after treatment, motilin increased significantly and gastrin decreased significantly in both groups (P<0.0001), and the study group showed a notably higher motilin level and a notably lower gastrin level than the control group (P<0.0001). The study group experienced a significantly earlier disappearance time of abdominal distension and abdominal pain and a significantly shorter hospitalization time than the control group (P<0.0001). Moreover, the study group showed a notably higher overall response rate than the control group (P=0.029), and presented a notably lower incidence of adverse reactions than the control group (P=0.036). According to univariate analysis, age, onset time, Acute Physiology and Chronic Health Evaluation II score and therapeutic regimen were the factors impacting the patients' prognosis. According to logistics regression analysis, therapeutic regimen was an independent risk factor affecting the prognosis., Conclusion: Compared with somatostatin alone, ulinastatin combined with somatostatin is more effective in the treatment of severe pancreatitis. The combination can substantially alleviate the inflammatory response and improve the gastrointestinal function and clinical symptoms of patients, without increasing adverse reactions. Therefore, ulinastatin combined with somatostatin is worthy of clinical promotion., Competing Interests: None., (AJTR Copyright © 2023.)