Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis

BACKGROUND In recent decades,an increasing number of patients have received minimally invasive intervention for infected pancreatic necrosis(IPN)because of the benefits in reducing postoperative multiple organ failure and mortality.However,there are limited published data regarding infection recurrence after treatment of this patient population.AIM To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.METHODS Medical records for 193 IPN patients,who underwent minimally invasive treatment between February 2014 and October 2018,were retrospectively reviewed.Patients,who survived after the treatment,were divided into two groups:one group with infection after drainage catheter removal and another group without infection.The morphological and clinical data were compared between the two groups.Significantly different variables were introduced into the correlation and multivariate logistic analysis to identify independent predictors for infection recurrence.Sensitivity and specificity for diagnostic performance were determined.RESULTS Of the 193 IPN patients,178 were recruited into the study.Of them,9(5.06%)patients died and 169 patients survived but infection recurred in 13 of 178 patients(7.30%)at 7(4-10)d after drainage catheters were removed.White blood cell(WBC)count,serum C-reactive protein(CRP),interleukin-6,and procalcitonin levels measured at the time of catheter removal were significantly higher in patients with infection than in those without(all P<0.05).In addition,drainage duration and length of the catheter measured by computerized tomography scan were significantly longer in patients with infection(P=0.025 and P<0.0001,respectively).Although these parameters all correlated positively with the incidence of infection(all P<0.05),only WBC,CRP,procalcitonin levels,and catheter length were identified as independent predictors for infection recurrence.The sensitivity and specificity for infection prediction were high in WBC count(≥9.95×109/L)and serum procalcitonin level(≥0.05 ng/mL)but moderate in serum CRP level(cut-off point≥7.37 mg/L).The catheter length(cut-off value≥8.05 cm)had a high sensitivity but low specificity to predict the infection recurrence.CONCLUSION WBC count,serum procalcitonin,and CRP levels may be valuable for predicting infection recurrence following minimally invasive intervention in IPN patients.These biomarkers should be considered before removing the drainage catheters.

Establishment of RT-LAMP Assay for Infectious Pancreatic Necrosis Virus

The purpose of this study was to establish a method for the rapid detection of infectious pancreatic necrosis virus(IPNV,Jasper serotype)using reverse transcription loop-mediated isothermal amplification(RT-LAMP).Four groups of specific primers were designed,according to the genome sequence of a Chinese IPNV isolate ChRtm213.The results showed that primer set B2 had the best amplification effect.When the final concentration of Mg2+was 6 mmol·L-1,dNTPs were 1 mmol·L-1 and betaine was 0.4 mol·L-1,the reaction could be completed in a 63℃water bath within 60 min.This RT-LAMP assay for the detection of IPNV had no cross-reactivity with infectious hematopoietic necrosis virus,viral hemorrhagic septicemia virus,grass carp reovirus and spring viremia of carp virus.The detection limit was 3.2×10-12 ng·μL-1.The sensitivity of this method was 10-fold higher than that of a previously published RT-LAMP assay for detecting the Spajarup(Sp)serotype of IPNV.This method,aimed at detecting IPNV isolates that were currently prevalent in China,possessed the characteristics of strong specificity,high sensitivity and direct interpretation by the naked eyes.The IPNV RT-LAMP was successfully applied to determine the clinical samples,which indicated the IPNV RT-LAMP assay was suitable for the rapid and large-scale detections of IPNV in China.

Comparison of safety,efficacy,and long-term follow-up between“one-step”and“step-up”approaches for infected pancreatic necrosis

BACKGROUND Although the“Step-up”strategy is the primary surgical treatment for infected pancreatic necrosis,it is not suitable for all such patients.The“One-step”strategy represents a novel treatment,but the safety,efficacy,and long-term follow-up have not yet been compared between these two approaches.AIM To compare the safety,efficacy,and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent“One-step”or“Step-up”necrosectomy at Xuan Wu Hospital,Capital Medical University,from May 2014 to December 2020.The primary outcome was the composite endpoint of severe complications or death.Patients were followed up every 6 mo after discharge until death or June 30,2021.Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0,and statistical significance was set at P<0.05.RESULTS One-hundred-and-fifty-eight patients were enrolled,of whom 61 patients underwent“One-step”necrosectomy and 97 patients underwent“Step-up”necrosectomy.During the long-term follow-up period,40 patients in the“Onestep”group and 63 patients in the“Step-up”group survived.The time from disease onset to hospital admission(53.69±38.14 vs 32.20±20.75,P<0.001)and to initial surgical treatment was longer in the“Step-up”than in the“One-step”group(54.38±10.46 vs 76.58±17.03,P<0.001).Patients who underwent“Step up”necrosectomy had a longer hospitalization duration(65.41±28.14 vs 52.76±24.71,P=0.02),and more interventions(4.26±1.71 vs 3.18±1.39,P<0.001).Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group.Although the incisional hernia incidence was higher in the“One-step”group,no significant difference was found in the composite outcomes of severe complications or death,new-onset organ failure,postoperative complications,inflammatory indicators,long-term complications,quality of life,and medical costs between the groups(P>0.05).CONCLUSION Compared with the“Step-up”approach,the“One-step”approach is a safe and effective treatment method with better long-term quality of life and prognosis.It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.