Risk factors and their interactive effects on severe acute pancreatitis complicated with acute gastrointestinal injury

BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.

Spectral Domain Optical Coherence Tomography of Vogt-Koyanagi-Harada Disease: Novel Findings and New Insights into the Pathogenesis

Objective To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Methods Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Results Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Conclusions Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

A single nucleotide polymorphism in the IL1RL1 gene is associated with Behcet's disease in a Chinese Han population

AIM:To explore the association of single nucleotide polymorphisms(SNPs)in the IL33/IL1RL1 gene region with the susceptibility to Behcet’s disease(BD)in a Chinese Han population.METHODS:A total of eight SNPs in the candidate gene region(rs11792633,rs7025417,rs10975519 and rs1048274 in IL33;rs2310220,rs12712142,rs13424006 and rs3821204 in IL1RL1)were genotyped in783 BD patients and 701 healthy controls by the Sequenom Mass Array i PLEX platform.RESULTS:A statistically significant association was observed between IL1RL1 rs12712142 and BD patients.The frequency of IL1RL1 rs12712142 variant allele A was significantly lower in BD patients than that in controls(OR=0.8,95%CI:0.69-0.94,Pc=0.039);the genotype distribution(Pc=0.043)and additive and dominant genetic model analyses(OR=0.8,95%CI:0.69-0.94,Pc=0.040 and OR=0.72,95%CI:0.58-0.88,Pc=0.011)also indicated a strong association between rs12712142 and BD patients.CONCLUSION:This is the first study to reveal the association between IL1RL1 rs12712142 variant allele A and the decreased risk of BD in the Chinese Han population,indicating a protective role of IL1RL1 in the pathogenesis of BD.

Methotrexate for chronic non-necrotizing anterior scleritis in Chinese patients

AIM:To evaluate the effectiveness and corticosteroidsparing capabilities of methotrexate(MTX)in the treatment of chronic non-necrotizing anterior scleritis in Chinese patients.METHODS:A retrospective chart review of all patients with active anterior scleritis between January 2015 and June 2019 was conducted.All patients received 10 to 15 mg/wk MTX orally,and corticosteroids(10 to 40 mg/d prednisolone or equivalent methylprednisolone)with slow tapering.Topical corticosteroid eye drops(1%prednisolone actate,0.1%dexmathosone or 0.1%fluoromethalone)were applied to control comorbid anterior uveitis at presentation or during follow up.The main outcomes were inflammation control and corticosteroid-sparing success,and secondary outcomes were reduction of immunosuppression load and best-corrected visual acuity(BCVA).RESULTS:Thirty-two eyes(22 patients)were included.The proportion of patients who achieved corticosteroidsparing success was 50.0%at 3mo and 77.3%at 12mo[8(36.4%)patients discontinued corticosteroid].The proportion of eyes that achieved inflammation control was 59.4%at 3mo and 78.1%at 12mo.The immunosuppression load was 5.14±0.87 at presentation and 2.76±2.34 at 12mo(P<0.01).BCVA maintained unchanged or improved in 29(90.6%)of all affected eyes.One patient discontinued MTX treatment because of an abnormal liver function test,and no other serious adverse effects were observed.CONCLUSION:According to this pilot study,low dose MTX appear to be a well-tolerated and effective treatment for chronic non-necrotizing anterior scleritis patients in the Chinese population.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery:a Meta-analysis

AIM:To compare the clinical efficacy and safety of non-penetrating glaucoma surgery(NPGS)plus phacoemulsification(Phaco-NPGS)and NPGS-alone.METHODS:We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma.Primary outcomes included postoperative intraocular pressure(IOP)and the number of postoperative antiglaucoma medications.Secondary outcomes were the prevalence of complications,incidence of needling or goniopuncture,and surgical success rate.RESULTS:In total,380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included.Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group[weighted mean difference(WMD)=-1.12,95%confidence interval(CI):-2.11 to-0.12,P=0.03;WMD=-0.31,95%CI:-0.53 to-0.09,P=0.006].Moreover,Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone,while no significant difference existed for surgical success.CONCLUSION:Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications.Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy,fewer complications,and postoperative procedures.

Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema

AIM:To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide(TA)injections for treating uveitic macular edema(UME).METHODS:This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6 mo.The main outcome measure was central macular thickness(CMT).The secondary outcome measures included best-corrected visual acuity(BCVA),recurrence rate and intraocular pressure(IOP).RESULTS:In total,65 patients(80 eyes),mainly including idiopathic uveitis in 33 patients(50.77%)and VogtKoyanagi-Harada(VKH)syndrome in 19 patients(29.23%),were enrolled in this study.The mean CMT decreased from 457.6±173.0μm at baseline to 325.9±176.8,302.7±148.2,332.2±177.3 and 270.6±121.6μm at 1-,2-,3-and 6-months postinjection,respectively(all P<0.001).BCVA increased from log MAR 0.5±0.3 at baseline to log MAR 0.4±0.3,0.4±0.3,0.4±0.4 and 0.4±0.3 at the 1-,2-,3-and 6-months postinjection visits,respectively(all P<0.001).Twenty-one(21/80,26.25%)eyes underwent relapse of UME within 6 mo.A total of 20/80(25%)eyes exhibited elevated IOPs,of which 13 eyes were controlled with topical IOP-lowering agents and 7 eyes underwent surgical removal of subconjunctival TA deposit.CONCLUSION:Subconjunctival TA injections appear to be safe and effective for UME.