Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis:A retrospective single-center study

BACKGROUND The incidence of hypertriglyceridemic acute pancreatitis(HTG-AP)has increased yearly,but updated population-based estimates on the incidence of HTG-AP are lacking.Reducing serum triglyceride(TG)levels quickly is crucial in the early treatment of HTG-AP.Decreased serum TG levels are treated by non-invasive methods,which include anti-lipidemic agents,heparin,low-molecular weight heparin,and insulin,and invasive methods,such as blood purification including hemoperfusion(HP),plasmapheresis,and continuous renal replacement therapy.However,authoritative guidelines have not been established.Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.AIM To evaluate the effect between patients treated with intravenous insulin(INS)and HP to guide clinical treatment.METHODS We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021.The inpatient medical and radiologic records were reviewed to determine clinical features,severity,complications,mortality,recurrence rate,and treatment.Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP.Propensity score matching was used to compare the clinical outcomes of INS and HP.RESULTS A total of 371 patients met the HTG-AP criteria.The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years(8.4%in April 2012-March 2013 and 22.3%in April 2020-March 2021).The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years.The amylase level was elevated in 80.1%of patients but was only three times the normal value in 46.9%of patients.The frequency of severe acute pancreatitis(26.9%),organ failure(31.5%),rate of recurrence(32.9%),and mortality(3.0%)of HTG-AP was high.Improved Marshall score,modified computed tomography severity index score,baseline TG,baseline amylase,C-reactive protein(CRP),albumin,aspartate aminotransferase,low-density lipoprotein cholesterol,urea nitrogen,creatinine,calcium,hemoglobin,free triiodothyronine,admission to intensive care unit,and mortality were significantly different between patients with different grades of severity(P<0.050).Multivariate logistic regression analysis confirmed that high CRP[P=0.005,odds ratio(OR)=1.011,95%CI:1.003-1.019],low calcium(P=0.003,OR=0.016,95%CI:0.001-0.239),and low albumin(P=0.023,OR=0.821,95%CI:0.693-0.973)were risk factors of severe HTG-AP.After propensity score matching adjusted by sex,age,severity of HTG-AP,and baseline TG,the serum TG significantly decreased in patients treated with INS(P<0.000)and HP(P<0.000)within 48 h.However,the clearance rate of TG(57.24±33.70%vs 56.38±33.61%,P=0.927)and length of stay(13.04±7.92 d vs 12.35±6.40 d,P=0.730)did not differ between the two groups.CONCLUSION The incidence of HTG-AP exhibited a significant increase,remarkable severity,and recurrent trend.Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

The first data release(DR1) of the LAMOST regular survey

The Large sky Area Multi-Object Fiber Spectroscopic Telescope（LAMOST） general survey is a spectroscopic survey that will eventually cover approximately half of the celestial sphere and collect 10 million spectra of stars, galaxies and QSOs. Objects in both the pilot survey and the first year regular survey are included in the LAMOST DR1. The pilot survey started in October 2011 and ended in June 2012, and the data have been released to the public as the LAMOST Pilot Data Release in August 2012. The regular survey started in September 2012, and completed its first year of operation in June 2013. The LAMOST DR1 includes a total of 1202 plates containing 2 955 336 spectra, of which 1 790 879 spectra have observed signalto-noise ratio（SNR） ≥ 10. All data with SNR ≥ 2 are formally released as LAMOST DR1 under the LAMOST data policy. This data release contains a total of 2 204 696 spectra, of which 1 944 329 are stellar spectra, 12 082 are galaxy spectra and 5017 are quasars. The DR1 not only includes spectra, but also three stellar catalogs with measured parameters： late A,FGK-type stars with high quality spectra（1 061 918 entries）, A-type stars（100 073 entries）, and M-type stars（121 522 entries）. This paper introduces the survey design, the observational and instrumental limitations, data reduction and analysis, and some caveats. A description of the FITS structure of spectral files and parameter catalogs is also provided.

Iatrogenic lipogranuloma of the penis

Dear Editor,Lipogranuloma of the penis is defined as a foreign body reaction to lipids,hydrocarbons(paraffin tumors),silicones,methacrylate,hyaluronic acid,or collagen fillings.1 According to literature reports,some individuals attempt to augment their genitals with injections of illegal liquid paraffin oil.2,3 In recent years,increased reports of complications associated with lipogranuloma have led to a decline in the use of these paraffin oil injections.

Recurrent testicular undifferentiated pleomorphic sarcoma

Dear Editor,Undifferentiated pleomorphic sarcoma(UPS)is a subtype of soft tissue sarcoma first reported by O’Brien and Stout in 1964.1 It is a common soft tissue sarcoma in adults,commonly occurring in the extremities and retroperitoneum.2,3 However,the incidence of testicular UPS is extremely rare in China and the rest of the world.In addition,radical orchiectomy is the preferred treatment for this disease,but the role of postoperative radiotherapy and chemotherapy remains unclear.This paper reports the diagnosis,treatment process,and prognosis of a case of recurrent testicular UPS.After performing a literature review,it was found that postoperative radiotherapy and chemotherapy may prolong the progression-free survival of the patient,so we present this paper to raise clinicians’understanding of the disease.This study was approved by the Ethics Committee of The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine(Baiyin,China;approval No.YL-X2-2020-018).The patient was informed of the content and significance of the study and signed an informed consent form.

Analysis of the efficacy of a modified posteromedial approach for Klammer III posterior Pilon fractures

Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019.Before the surgery,the patients were fully relieved of swelling and pain,and a comprehensive examination was carried out.The posteromedial approach exposed the posterior and medial fracture block of the distal tibia.According to the fracture of external malleolus,it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor,and then perform a fracture reduction and internal fixation.Postoperatively,the patients were treated with analgesia,detumescence,anticoagulation and rehabilitation exercise.The American orthopaedic foot and ankle society(AOFAS)score and visual analogue score were recorded at regular follow-up after surgery.A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female(n=20)included in the study,aged 22 to 88 years(average age 54.2 years).The injury mechanisms were falling from a height(n=7),traffic accident(n=6),walking injury(n=2)and heavy injury(n=5).The postoperative follow-up duration was 12—24 months(mean 16.95 months).The AOFAS score of the 20 patients before and after surgery were compared.The preoperative AOFAS score was 38.90±3.91,and the final AOFAS score was 80.55±4.20,(p<0.001).The mean final visual analogue scores at rest,active and weight-bearing walking were 0.30,0.85 and 1.70,respectively.One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures,the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus,achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves,and have a better prognosis.