Association between morphological features of necrotizing pancreatitis on endoscopic ultrasound and outcomes of the endoscopic transmural step-up approach

OBJECTIVE

To investigate the association between necrotic collections on endoscopic ultrasound (EUS) and outcomes of the endoscopic transmural step-up approach in necrotizing pancreatitis (NP).

METHODS

Adult NP patients who had undergone endoscopic transmural step-up approach, endoscopic transmural drainage or endoscopic transmural necrosectomy, were retrospectively enrolled, and divided into groups 1, 2 and 3 based on the amount of solid necrotic debris (quantified as a percentage of the total collection size of <30%, 30%-50%, and >50%).

RESULTS

A total of 134 patients were included, of whom 52, 59 and 23 patients were categorized into groups 1, 2 and 3. Patients with more solid necrotic debris required more necrosectomy sessions (group 3 vs group 2 vs group 1: 2.0 vs 1.0 vs 1.0, P < 0.001), were more likely to experience stent occlusion (group 3 vs group 2 vs group 1: 34.8% vs 16.9% vs 9.6%, P = 0.011), and had a longer hospitalization (group 3 vs group 2 vs group 1: 40.0 d vs 28.0 d vs 25.5 d, P = 0.015). High procalcitonin level (adjusted odds ratio [aOR] 6.14, 95% confidence interval [CI] 1.40-26.94, P = 0.016) and any organ failure (aOR 11.51, 95% CI 2.42-54.78, P = 0.002) were independently associated with clinical failure of endoscopic transmural step-up approach.

CONCLUSIONS

More solid necrotic debris on EUS is related to more necrosectomy sessions, higher incidence of stent occlusion and longer hospitalization. A nomogram combining procalcitonin and any organ failure performs well in predicting clinical failure of endoscopic transmural step-up approach.

[Retinal image quality in northern rural Chinese adult population]

Objective: To assess the retinal image quality of the normal northern rural Chinese adult population. Methods: A normal population-based, cross-sectional study. From Oct, 2012 to Jan 2013, a clustered, random sampling procedure was used to select normal population who visual acuity≤ 0(LogMAR) and 30-69 years old from 2 villages. All eligible subjects were invited to undergo a comprehensive eye examination, and the retinal image quality related index were examined with pupil 4 mm using objective optical quality analysis systemⅡ(OQAS Ⅱ, Visiometrics, Spain), including MTFcutoff, VA20, VA9, PSF50, PSF10, OSI, SR. And describe the retinal image quality of different age group, including 30-39y, 40-49y, 50-59y, 60-69y. Results: Among 1 108 participants (61.9%) that completed examinations in our center, 681 participants (1 362 eyes) were recruited. There were 146, 586, 440 and 190 eyes in each group. The spherical equivalent refraction of each group was (-0.35±0.84), (-0.19±0.50), (-0.03±0.54) and (0.20±0.71) D. The best corrected vision acuity of each group was -0.02±0.04, -0.01±0.03, -0.01±0.02 and -0.00±0.01. The MTFcutoff of each group was (37.06±9.31), (36.69±8.93), (36.52±9.05) and (32.61±10.08) c/deg. Retinal imaging parameters were significantly different(MTFcutoff: MD=4.45, SR:MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, A9:MD=0.09, OSI:MD=-0.41, P<0.001)between aged 30-39 group and aged 60-69 group. Objective scattering index (OSI) were significantly different(MD=-0.13, P=0.004)between aged 30-39 group and aged 50-59 group. Retinal imaging parameters were significantly different(MTFcutoff:MD=4.45, SR:MD=0.03, PSF50:MD=-0.45, PSF10:MD=-2.87, VA20:MD=0.13, VA9: MD=0.09, OSI: MD=-0.41, P<0.001)between aged 40-49 group and aged 60-69 group. Retinal imageing parameters were significantly different(MTFcutoff: MD=4.45, SR: MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, VA9:MD=0.09, OSI:MD=-0.41,P<0.001)between aged 50-59 group and aged 60-69 group. Conclusion: Retinal image quality was gradually worse over time in the northern rural Chinese adult population. (Chin J Ophthalmol, 2018, 54:593-598).

Study of the sludge reduction in an oxic-settling-anaerobic activated sludge process based on UNITANK

An oxic-settling-anaerobic process (OSA) can effectively reduce sludge production, but most of the research studies on the OSA process have been either under laboratory test conditions or based on synthetic wastewater, which cannot fully reflect the performance and sludge reduction efficiency in existing OSA process. Thus, aiming at examining the sludge reduction efficiency and the stability of the OSA process, UNITANK and UNITANK-OSA processes were performed in a 120 m(3)/d pilot-scale system using actual sewage. The results indicate that UNITANK-OSA achieved a 48% reduction of the sludge compared to the reduction due to UNITANK, not considering the accumulation of the effluent-suspended solids. The effluent quality was not found to change significantly, except that the total phosphorus concentration increased slightly. The extracellular polymeric substances metal floc theory may, to some extent, explain this reduction in this study. The OSA process could be used to reform the classic wastewater treatment process to get lower sludge mass.

[Changes of glucocorticoid receptor in cerebral and hepatic cytosol during decompression stress injury in rats]

Objective. To observe the changes of glucocorticoid receptor (GR) in cerebral and hepatic cytosol during decompression stress injury in rats. Method. 30 rats were divided into 5 group. They were placed into the compression chamber for compression and decompression. The binding capacity of GR of cerebral and hepatic cytosol were measured by the exchange assay, using 3H dexamethasone as the ligand. Meanwhile, decompression bubbles on pericardial area were measured using Doppler ultrasonic method. Result. The binding capacity of GR of cerebral and hepatic cytosol reduced after decompression stress injury in the animals, especially cerebral cytosol (P<0.01, P<0.05). The result also showed that the binding capacity of cerebral and hepatic GR should have further decreased, if the therapeutic measure had not been used in animals suffered from decompression sickness (DCS). Conclusion. The changes of the binding capacity of GR of cerebral and hepatic cytosol were proved to be related to decompression stress injury, which might be taken as one of the indices for evaluating injury degree of DCS.

Regulation of glucocorticoid receptor by glucocorticoids (II)--The studies on rat liver, brain and spleen

The concentration of glucocorticoids (GC) in plasma was maintained at stress level, 20-40 micrograms/dl, for 3 days by subcutaneous injection of hydrocortisone (F) in polyvinyl alcohol (PVA) into rats, and the specific binding of [3H]Dexamethasone (Dex) in liver, spleen and brain was determined before and after injection. The binding capacity of glucocorticoid receptor (GR) in liver and spleen was decreased significantly 1 h after injection and maintained at low level for several days after the concentration of GC in plasma had returned to the normal level. The Kd was not altered. The changes of GR in brain was not significant. Thus it may be concluded that GC can down-regulate GR in rats, but with different characteristics in various target organs.

Down-regulation of glucocorticoid receptor and its relationship to the induction of rat liver tyrosine aminotransferase

Administration of polyvinyl alcohol containing hydrocortisone (F-PVA) to rats twice caused a rapid increase of plasma glucocorticoids (GCs) around 30 micrograms/dl for 3 days. This rise led to decrease of glucocorticoid receptor (GR) in rat liver cytosol and spleen cells 1 h post F-PVA and remained at low level for more than 10 days. Two hours after administration of hydrocortisone 5 mg/100 g b. wt, the liver tyrosine aminotransferase (TAT) activity in normal rats increased from 13.5 +/- 2.9 to 50.7 +/- 8.9 units, while in rats injected with F-PVA 3 days ago it increased only from 13.9 +/- 2.3 to 21.0 +/- 6.3 U. The inductivity of rat liver remained low at 7, 11 and 20 days after the injection of F-PVA and recovered 30 days later. This study demonstrates the presence of down-regulation of GR in intact animal, and shows that the decrease of GR is accompanied by reduction of target organ response to GCs.

A study of the glucocorticoid receptor of the cytosol and nuclei in nonlethally and lethally scalded rats

The glucocorticoid receptor (GCR) of the cytosol of liver and brain was studied by radioligand binding assay, using [3H] dexamethasone (Dex) as the ligand in lethally and nonlethally scalded rats. As compared with controls, the binding capacity (R0) was decreased and the apparent Kd of [3H] Dex specific binding was increased in both scalded groups. In the lethal group, the R0 is much lower than that in the nonlethal group. In order to determine whether the decrease of R0 was due to the translocation of [3H] Dex-GCR complex into the cell nuclei, the [3H] corticosterone (B) specific binding of the hepatic nuclei was measured by the exchange assay. There was no significant difference between the control and scalded groups. The possible mechanisms and the clinical significance of these changes were discussed.