Efficacy of intramuscular diclofenac and fluid replacement in prevention of post-ERCP pancreatitis

AIM： TO assess the efficacy of intramuscular diclofenac and fluid replacement for prevention of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis.METHODS： A prospective, placebo-controlled study was conducted in 80 patients who underwent ERCP. Patients were randomized to receive parenteral diclofenac at a loading dose of 75 mg followed by the infusion of 5-10 mL/kg per hour isotonic saline over 4 h after the procedure, or the infusion of 500 mL isotonic saline as placebo. Patients were evaluated clinically, and serum amylase levels were measured 4, 8 and 24 h after the procedure.RESULTS： The two groups were matched for age, sex, underlying disease, ERCP findings, and type of treatment. The overall incidence of pancreatitis was 7.5% in the diclofenac group and 17.5% in the placebo group （12.5% in total）. There were no significant differences in the incidence of pancreatitis and other variables between the two groups. In the subgroup analysis, the frequency of pancreatitis in the patients without sphincter of Oddi dysfunction （SOD） was significantly lower in the diclofenac group than in the control group （ρ = 0.047）.CONCLUSION： Intramuscular diclofenac and fluid replacement lowered the rate of pancreatitis in patients without SOD.

Effects of different flui replacements on serum HSP70 and lymphocyte DNA damage in college athletes during exercise at high ambient temperatures

Purpose：The aim of this study was to investigate the effects of flui replacement by water or sports drinks on serum heat shock protein 70（HSP70） levels and DNA damage during exercise at a high ambient temperature.Methods：Ten male college athletes with an athletic career ranging from 6 to 11 years were recruited from Yonsei University.The subjects ran on a treadmill at 75% of heart rate reserve during 4 different trials：thermoneutral temperature at 18℃（T）,high ambient temperature at 32℃ without flui replacement（H）,high ambient temperature at 32℃ with water replacement（HW）,and high ambient temperature at 32℃ with sports drink replacement（HS）.During each condition,blood samples were collected at the pre-exercise baseline（PEB）,immediately after exercise（IAE）,and60 min post-exercise.Results：Skin temperature significant y increased during exercise and was significant y higher in H compared to T and HS at IAE.Meanwhile,serum HSP70 was significant y increased in all conditions at IAE compared to PEB and was higher in H compared to T at the former time point.Significant y increased lymphocyte DNA damage（DNA in the tail,tail length,tail moment） was observed in all trials at IAE compared to PEB,and attenuated DNA damage（tail moment） was observed in HS compared to H at IAE.Conclusion：Acute exercise elevates serum HSP70 and induces lymphocyte DNA damage.Fluid replacement by sports drink during exercise at high ambient temperature can attenuate HSP response and DNA damage by preventing dehydration and reducing thermal stress.

Experimental study of the relationship between fluid density and saturation and sonic wave velocity of rock samples from the WXS Depression,South China Sea

The relationship between fluid density and saturation and sonic wave velocity of rock samples taken from the WXS Depression in the South China Sea was studied by an oil-water replacement experiment under simulated in-situ temperature and pressure conditions.Two kinds of low-density oils（0.691 and 0.749 g/cm^3） and two kinds of high-density oils（0.834 and 0.873 g/cm^3） were used to saturate the rock samples at different oil-saturation states,and the saturated P- and S-wave velocities were measured.Through Gassmann＇s equation,the theoretical P- and S-wave velocities were also calculated by the fluid replacement method.With the comparison of the measured values and the theoretical values, this study comes to the following conclusions.（1） With the increase of oil saturation and the decrease of water saturation,the P-wave velocity of rock samples saturated by low-density oil increases and the changing rule is in accord with the effective fluid theory;the P-wave velocity of rock samples saturated by high-density oil decreases and the changing rule goes against the theory.（2） With the increase of oil density（namely 0.691→0.749→0.834→0.873 g/cm^3） when oil saturation is unchanged,P-wave velocity increases gradually.（3） The S-wave velocity is always stable and is not affected by the change of oil density and saturation.The results can be used to constrain pre-stack seismic inversion,and the variation rule of sonic wave velocity is valuable for hydrocarbon identification in the study area.

Management of Rhabdomyolysis and Acute Renal Failure Following Strenuous Exercise in Young Adult: A Case Report

Introduction: Rhabdomyolysis is severe and life threating condition in which skeletal muscles are damaged by dissolution of striped muscles. Acute kidney injury (AKI) has been widely reported (13% - 50%) as a complication of Rhabdomyolysis in which the main pathophysiological mechanisms are intra-renal vasoconstriction, intraluminal cast formation (Tamm-Horsefall) and direct myoglobin toxicity. In this report we are going to describe the management of Acute Kidney Injury due to Rhabdomyolysis that is not responding to vigorous rehydration. Objective: Reporting about acute renal failure induced by Rhabdomyolysis due to Excessive Exercise and dehydration in young patient. Case Report: A 20 years male came to the outpatient clinic complaining of sever lower limb pain, back pain and vomiting. He was anuric and hypertensive (BP = 150/90 mmHg) with serum creatinine and urea levels of 15.72 mg/dl and 235 mg/dl, respectively. The diagnosis was based on the laboratory finding of creatine kinase = 3127 IU/l. The patient, then, has been referred to the emergency department. The Management plan was based on two arms: Emergency Management with Urgent Hemodialysis for AKI and high fluid replacement therapy. Patient started to recover after three hemodialysis sessions but the peak of recovery was noted after starting manual fluid replacement therapy with a target urine output of greater than 2 ml/kg, a urine pH of greater than 6. Manual fluid replacement therapy consisted of loop diuretics, intravenous fluids and intravenous sodium bicarbonate 1.26%. Full recovery was noted after one month of hospital admission with inpatient care and regular follow-up. A follow-up after one month has been set to assess the patient progression and monitor his kidney functions. Relevance and Impact: Home messages and lessons are;Firstly, young adults are vulnerable to Rhabdomyolysis, second, the diagnosis of Rhabdomyolysis can be made on the clinical bases but a confirmatory laboratory test of Creatine Kinase is mandatory, and lastly’ acute kidney injury needs to be treated urgently. Also, reducing the risk of infection is one of the management objectives to achieve recovery.

Severe acute pancreatitis: Clinical course and management

Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.