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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.

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OBJECTIVE: The study aimed at analyzing the serum expression of Immature Granulocyte percentage (IG %) and D-Dimer (D-D) in patients with severe pancreatitis and exploring their clinical diagnostic value. METHODS: Eighty-four cases with severe pancreatitis received in Shengjing Hospital, China Medical University from July 2020 to July 2023 were regarded as the study group and conducted for retrospective analysis. They were divided into a survival group (n = 62) and a death group (n = 22) based on the prognosis. Another 80 patients diagnosed with mild and moderate pancreatitis were selected as the control group. Serum IG % and D-D levels of all subjects were analyzed and the value of IG % and D-D in the evaluation of severe pancreatitis and its prognosis was conducted by Receiver Operating Characteristic (ROC) curve. RESULTS: The IG % and D-D levels in the study group were markedly higher than the control group (p < 0.05). The IG % and D-D level in the death group were observably higher than the survival group (p < 0.05). The Area Under the Curve (AUC) of IG % and D-D combined assessment for severe pancreatitis was 0.963, and the sensitivity and specificity were 98.75 %, 82.14 %, respectively. The AUC of IG % and D-D combined assessment for prognosis of severe pancreatitis was 0.814 with a sensitivity of 79.03 % and a specificity of 77.27 %. The efficiency of joint evaluation of the two indicators is superior to the individual evaluation. CONCLUSION: Serum IG % and D-D are highly expressed in patients with severe pancreatitis, which has important clinical value for the evaluation of severe pancreatitis and its prognosis.

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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.

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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.

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Introducción: la necrosis pancreática se presenta entre 10 y 20 % de los pacientes con pancreatitis aguda, tiene una mortalidad de 10 a 25 % y si se agrega infección a la necrosis entre 40 y 70 %. Objetivo: describir el manejo clínico quirúrgico de la necrosis pancreática infectada en el Servicio de Cirugía General del Hospital Nacional entre el periodo 2021-2022. Metodología: estudio observacional descriptivo de corte temporal transversal. En pacientes internados en el Servicio de Cirugía General del Hospital Nacional por pancreatitis aguda grave con necrosis pancreática infectada. Resultados: se analizaron un total de 30 pacientes. La media de edad fue de 39 años. Predominó en nuestra población pacientes de sexo masculino en el 56.67 %. En cuanto a las comorbilidades asociadas un 33.3 % los pacientes presentaron principalmente Diabetes mellitus tipo 2 e Hipertensión arterial; en menor medida Obesidad en un 23.3 %. De la población en estudio 76.6 % recibieron tratamiento quirúrgico y 23.33% tratamiento médico principalmente antibiótico terapia. De los pacientes sometidos a tratamiento quirúrgico 9 fueron a necrosectomia abierta, 7 a drenaje percutáneo, y en menor medida drenaje biliar y endoscópico. En cuanto a la mortalidad por necrosis pancreática infectada encontramos un 10 % de mortalidad. Discusión: la mayor parte de los pacientes con pancreatitis aguda grave sufren de necrosis pancreática; la necrosis pancreática infectada se asocia con mayor riesgo de mortalidad y en su mayoría requieren tratamientos invasivos. Conclusión: el manejo mínimamente invasivo en el tratamiento inicial de la necrosis pancreática infectada podría resolver la mayoría de los casos sin necesidad de realizar necrosectomia; reservando esta última solo a los que fracasan en el tratamiento inicial.

Introduction: pancreatic necrosis occurs between 10 and 20 % of patients with pancreatitis, has a mortality of 10 to 25 % and if infection is added to the necrosis between 40 and 70 %. Objective: to describe the surgical and clinical management of infected necrotizing pancreatitis in patients admitted to the General Surgery Service of the Hospital Nacional between the period 2021-2022. Methodology: this was an observational, descriptive and cross-section study with a temporal cut. We included patients admitted to the general surgery service of the National Hospital with severe acute pancreatitis with infected necrotizing pancreatitis. Results: a total of 30 patients were included. The mean age was 39 years. Male patients prevailed in our population in 56.67 %. Regarding the associated comorbidities, 33.3 % of the patients presented mainly type 2 diabetes mellitus and arterial hypertension; to a lesser extent Obesity in 23.3 %. In the study population, 76.6 % received surgical treatment and 23.33 % medical treatment, mainly antibiotic therapy. Of the patients who underwent surgical treatment, 9 were open necrosectomy, 7 had percutaneous drainage, and to a lesser extent biliary and endoscopic drainage. Regarding mortality due to infected necrotizing pancreatitis, we found a 10% mortality. Discussion: most of the patients with severe acute pancreatitis suffer from necrotizing pancreatitis; infected necrotizing pancreatitis is associated with increased risk of mortality and most require invasive treatment. Conclusion: minimally invasive management in the initial treatment of infected necrotizing pancreatitis, which could resolve most cases without the need to perform necrosectomy; the latter should be reserved for those who fail the initial treatment.

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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.

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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-1ß (IL-1ß), 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-1ß, 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.

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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 (AU)

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Angiotensin-converting enzyme inhibitors (ACE-I), such as lisinopril, are used as first-line therapy in the treatment of hypertension, heart failure with reduced ejection fraction, and proteinuric chronic kidney disease due to their beneficial effects on reducing morbidity and mortality. Commonly cited adverse effects of lisinopril include hyperkalemia, acute kidney injury, and angioedema, and while uncommon, there have been reports of lisinopril-induced necrotizing pancreatitis in the literature. The true incidence of drug-induced pancreatitis is unknown since establishing a causal relationship between medication's adverse effects and disease occurrence is difficult; however, there are validated tools such as the Adverse Drug Reaction Probability Scale that can aid in determining causality. Here, we present a case of a 63-year-old man with a history of hypertension who was being treated with lisinopril for eight months and developed a fatal case of lisinopril-induced severe necrotizing pancreatitis.

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Drug-induced pancreatitis occurs rarely but should be considered when more common causes have been ruled out. While simple to treat, mortality increases should it progress to a necrotizing process. Here, we present the case of a patient simultaneously using two drugs associated with pancreatitis, which we considered acted synergistically and consequently worsened the patient's outcome.

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OBJECTIVE: To develop binary and quaternary classification prediction models in patients with severe acute pancreatitis (SAP) using machine learning methods, so that doctors can evaluate the risk of patients with acute respiratory distress syndrome (ARDS) and severe ARDS at an early stage. METHODS: A retrospective study was conducted on SAP patients hospitalized in our hospital from August 2017 to August 2022. Logical Regression (LR), Random Forest (RF), Support Vector Machine (SVM), Decision Tree (DT), and eXtreme Gradient Boosting (XGB) were used to build the binary classification prediction model of ARDS. Shapley Additive explanations (SHAP) values were used to interpret the machine learning model, and the model was optimized according to the interpretability results of SHAP values. Combined with the optimized characteristic variables, four-class classification models, including RF, SVM, DT, XGB, and Artificial Neural Network (ANN), were constructed to predict mild, moderate, and severe ARDS, and the prediction effects of each model were compared. RESULTS: The XGB model showed the best effect (AUC = 0.84) in the prediction of binary classification (ARDS or non-ARDS). According to SHAP values, the prediction model of ARDS severity was constructed with four characteristic variables (PaO2/FiO2, APACHE II, SOFA, AMY). Among them, the overall prediction accuracy of ANN is 86%, which is the best. CONCLUSIONS: Machine learning has a good effect in predicting the occurrence and severity of ARDS in SAP patients. It can also provide a valuable tool for doctors to make clinical decisions.

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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.

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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.

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Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can be a plausible trigger for both disseminated intravascular coagulopathy (DIC) and acute pancreatitis. We present an 85-year-old male patient who presented with altered mental status and tested positive for COVID-19 infection. He was hypoxic with an incremental need for oxygen. He had clinical as well as imaging evidence of acute pancreatitis. Clinical evidence of bleeding was noted and lab findings were suggestive of DIC. Despite aggressive initial management, his clinical status continued to deteriorate and comfort care was sought eventually. This case highlights COVID-19 infection as a possible trigger for acute pancreatitis as well as DIC. It also highlights some of the differences in COVID-19-induced DIC, which fulfills the diagnostic criteria of DIC but has atypical findings.

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AIM: To investigate the interactive effects of blood glucose and blood calcium on the prognostic impact of patients with acute severe pancreatitis (SAP) and to analyze their predictive efficacy on prognosis. METHODS: One hundred and seven patients with SAP admitted to our hospital from September 2019 to October 2022 were selected for the study and were divided into poor and good groups according to their prognosis within 28 d. The blood glucose, blood calcium, modified Marshall score, bedside acute pancreatitis severity score (BISAP) were compared between the two groups before treatment, after 3 d of treatment, and after 7 d of treatment, and the correlation between blood glucose, blood calcium and modified Marshall score and BISAP score was analyzed. The blood glucose levels of patients with different blood calcium were compared. Cox regression was used to analyze the factors associated with prognosis. The presence and type of interaction between blood glucose and blood calcium on prognosis were analyzed using the interaction coefficient γ and relative risk (RR) values. The subject operating characteristic curve (ROC) was used to analyze the predictive efficacy of blood glucose and blood calcium on prognosis. RESULTS: The blood glucose, modified Marshall score, and BISAP score of the adverse group after treatment were higher than those of the good group, while the blood calcium was lower than that of the good group (P<0.05). After 3 and 7 days of treatment, blood glucose was positively correlated with improved Marshall score and BISAP score (P<0.05). The blood glucose level in patients with decreased blood calcium was higher than that in patients with normal blood calcium (P<0.05). The decrease of blood calcium had positive interaction with the increase of blood glucose (P<0.05). After 3 and 7 days of treatment, the AUC of blood glucose combined with blood calcium was greater than that predicted by single index (P< 0.05). CONCLUSION: Blood glucose and blood calcium are related to the severity of the disease in SAP patients. There is an interaction between blood glucose and blood calcium in predicting the prognosis of SAP patients. The combined detection of blood glucose and blood calcium has a certain predictive effect on the prognosis of SAP patients.

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Background Management of acute necrotising pancreatitis is often challenging for clinicians. Secondary infection of the necrotic collections leads to sepsis and warrants intervention. Minimally invasive techniques like catheter drainage have recently been proposed over more risky and morbid traditional open procedures. Factors that can predict successful catheter drainage of the necrotic pancreatic collection are still unclear and not well established. Materials and methods This study is designed as a retrospective cross-sectional observational study to investigate the association of 21 factors in predicting successful catheter drainage. Data from 30 patients admitted with acute necrotising pancreatitis treated with catheter drainage were collected and analysed. Twenty-one factors, including demographic variables, disease severity factors, drainage criteria, and morphological criteria on imaging, were studied for their predictive association with successful outcomes. Univariate analysis was done for each variable against the outcome. The study was conducted between December 2012 to March 2017. P-value <0.05 was considered statistically significant. Results Patients with no organ involvement responded better to primary catheter drainage. Patients with BMI>25 and multi-organ failure were poor candidates for primary catheter drainage. Clinically unwell patients with a Bedside Index for Severity in Acute Pancreatitis (BISAP) score of ≥4 had a negative outcome on catheter drainage and usually ended up in a surgical procedure or eventually succumbed to the disease. Other variables included in our study did not statistically associate with the success or failure of percutaneous catheter drainage. Conclusion BMI >25, multiple organ failure, and BISAP score ≥ 4 are independent negative predictors for the success of catheter drainage in infected necrotising pancreatitis. No organ failure showed a positive predictor for successful catheter drainage. Further studies are required to explore these predictive factors in a larger sample size to predict the success of catheter drainage in infected pancreatic necrosis.

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Anomalies of the pancreas organ, especially congenital anomalies, are very uncommon, and can involve the pancreatic ductal as well as the pancreatic extra-ductal systems. While these anomalies usually present as an incidental radiological finding during adulthood, sometimes, they can present as recurrent upper abdominal pain as a presentation of recurrent episodes of acute idiopathic pancreatitis. Thus, these anomalies should be regarded in the differential diagnosis list, as a cause, for recurrent idiopathic pancreatitis, especially in the adult age group of patients. Multiple different variations, mainly in duct course and configuration of the pancreatic ductal system have been reported. In addition, duplication anomalies and cystic dilatation of the pancreatic duct are well known anomalies as well. A combined anomaly of the aforementioned anomalies is even rarer. Herein, we present the case of a male patient, 47 years old, with recurrent admissions to different hospitals due to upper abdominal pain and episodes of severe idiopathic acute pancreatitis. Imaging tests, mainly abdomino-pelvic computed tomography (CT) scan and magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) showed a dominant duct of Santorini without divisum along with cystic dilation of the proximal portion of the Santorini duct. Being a very rare pancreatic duct anomaly, the patient was treated by a multidisciplinary team (MDT) of physicians, including pancreas surgeons, gastroenterologists and radiologists. A surgical resection in the form of total pancreatectomy with Roux-en-Y gastrointestinal reconstruction was contemplated. Perioperative and postoperative periods were uneventful. The previously mentioned anomaly is unknown in the English literature and is introduced as new anomaly known as "Kluri".

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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-α 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.NEW & NOTEWORTHY In this study, we showed that the proinflammatory cytokine response in SAP is an early event, with subsequent downregulation of proinflammatory cytokines beginning at day 1 of symptom onset. Our findings underscore the importance of enrolling subjects very early in the disease course when conducting studies to investigate early immune events of SAP; this current study also serves as an important reference for the design of future biomarker studies and therapeutic trials in SAP.

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OBJECTIVE: Severe acute pancreatitis (SAP) is a highly morbid condition in general population as well as in solid organ transplant (SOT) recipients. The present study aimed to investigate the effect of continuous renal replacement therapy (CRRT) with different anticoagulation methods on the expression levels of cytokines in SAP. METHODS: A total of 120 patients with SAP, admitted into our hospital between September 2017 and July 2020, were enrolled as the research subjects and randomly divided into a control group (60 cases) and a study group (60 cases). CRRT with low molecular weight (LMW) heparin­calcium anticoagulation was conducted on patients in the control group, and CRRT with topical citrate + low-dose LMW heparin­calcium anticoagulation was conducted on patients in the study group. The expressions of cytokines in the two groups were compared after treatment. RESULTS: There was no significant difference in white blood cells (WBC), C-reactive proteins (CRP), and procalcitonin (PCT) before treatment between the two groups (P > 0.05). After treatment, the levels of WBC (P = 0.006), CRP (P < 0.001), and PCT (P < 0.001) were significantly lower in the study group when compared with those in the control group. There was no significant difference in the concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) between the two groups before treatment (P > 0.05). After treatment, the concentrations of IL-6, IL-8, and TNF-α were significantly lower in the study group when compared with those in the control group. The APACHEII, SOFA and Ranson scores of the two groups were analyzed, and there was no difference between the two groups before treatment (P > 0.05). After treatment, the score of the study group was lower than that of the control group (P < 0.05). CONCLUSION: CRRT with topical citrate + low-dose LMW heparin­calcium anticoagulation in the treatment of patients with SAP reduces the levels of WBC, CRP, and PCT and the concentrations of cytokines, including IL-6, IL-8, and TNF-α. This inhibits the release of inflammatory mediators in patients with SAP and reduces damage to the body caused by the inflammatory response, thus effectively improving the patients' condition.

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