How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification

AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis(AP).METHODS Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery,Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE Ⅱ scale. Clinical course was re-evaluated after 24,48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild,moderately severe,and severe.Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.RESULTS Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol(42.7%) followed by alimentary(26.2%),biliary(26.2%) and idiopathic(4.9%). Under Atlanta 1992 classification 56(54.4%) cases were classified as "mild" and 47(45.6%) as "severe". Using the revised classification(Atlanta 2012),the patient stratification was different: 49(47.6%) mild,27(26.2%) moderately severe and 27(26.2%) severe AP cases. The two severe groups(Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters,including ICU stay,need for interventional treatment,infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients(according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP(according to Atlanta 1992) with lower incidence of necrosis and sepsis,lower APACHE Ⅱ(P = 0.002) and MODS(P = 0.001) scores,shorter ICU stay,decreased need for interventional and surgical treatment.CONCLUSION Study shows that Atlanta 2012 criteria are more accurate,reduce unnecessary treatments for patients with mild and moderate severe pancreatitis,potentially resulting in health costs savings.

Atlanta

亚特兰大是美国东南部最大城市,也是现在美国东南部商业、运输业和工业中心。这里气候温暖,环境优美,春季盛开的洁白的山茱萸花,使其有了"山茱萸城"的美称。

The revised Atlanta criteria 2012 altered the classification,severity assessment and management of acute pancreatitis

BACKGROUND： The Atlanta criteria for acute pancreatitis （AP） has been revised recently. This study was to evaluate its practical value in classification of AP, the severity assessment and management. METHODS： The clinical features, severity classification, out- come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria （RAC） and the original Atlanta criteria （OAC）.

美国名城Atlanta

亚特兰大位于密西西比河(The Missi- ssippi River)的东部,是佐治亚洲(Geor-gia)首府和最大的城市。这里人烟阜盛,气候宜人,风景优美,水陆交通便利,为美国东南部最大的内陆交通枢纽,同时她还是东南部重要的商业、工业和销售中心,其工业产品制造和质量在南方各州中名列前茅,有“南方扬基国”(the southern Yankeeland)之称。闻名于世的“可口可乐”(cocacola)饮料就诞生于该市。在亚特兰大的周围农场盛产优质的花生、桃子,其产量居全国之冠。亚特兰大的旅游业很发达,旅游景点很多。每天有成群的游客蜂至该城,在那里人们可以目睹久负盛名的“桃林中心摩天大厦建筑群”

How Many Golds for China at Atlanta?

ＨｏｗＭａｎｙＧｏｌｄｓｆｏｒＣｈｉｎａａｔＡｔｌａｎｔａ？ＢｙｓｔａｆｆｒｅｐｏｒｔｅｒＸＴＡＥＲＡＳＣＵＲＴＡｌＮＳｒｉｓｅｏｎｔｈｅ２６ｔｈＯｌｙｍｐｉｃＧａｍｅｓｍＡｔｌａｎｔａＵＳＡ，ｓｐｏｒｔｓｌｏｖｅｒｓａｌｌａｎｄｍｏｒｅｅｘｃｉｔｅ...

Prospects for Chinese Swimmers at the Atlanta Olympics

ＰｒｏｓｐｅｃｔｓｆｏｒＣｈｉｎｅｓｅＳｗｉｍｍｅｒｓａｔｔｈｅＡｔｌａｎｔａＯｌｙｍｐｉｃｓＢｙＨＯＮＧＴＡＯＬｅＪｉｎｇｙｉ，ａｗｏｍａｎｓｗｉｍｍｅｒｆａｍｏｕｓｉｎｆｒｅｅｓｔｙｌｅ．ＡＴＴＨＥｌａｓｔＯｌｙｍｐｉｃＧａｒｍｅｓｔｈｅＣｈｉｎ...

Human-Environment Patterns of Metropolitan Spatial Restructuring:Atlanta,Georgia and Shanghai,PRC,1950-2000

This paper compares the spatial and environmental impacts of rapid growth through the five decades in Atlanta, Georgia and Shanghai, PRC. Both metropolitan areas represent the prime demographic and economic engines of their respective regions, and exhibit some of the worst environmental degradation problems, though from significantly different sources. Atlanta epitomizes spatial patterns of sprawl arising from an unfettered topographic and economic setting. Shanghai, in a political economy transitioning from decades of centralized constraint, seeks to spread out some of the world’s densest core settlement population to its inner suburbs. Remotely sensed photographic images are utilized to classify land use changes, while census figures and environmental data are integrated in a Geographic Information System to correlate shifts through time.

不同评分系统对基于新修订Atlanta标准的老年急性胰腺炎患者预后预测价值的比较

目的比较在新修订Atlanta标准下,不同评分系统对老年患者急性胰腺炎(AP)严重程度、器官衰竭及并发症的早期预测价值。方法收集我院急性胰腺炎患者的病历资料。患者入院后,完成计算机断层扫描严重程度指数(CTSI)评分、急性胰腺炎严重程度床边指数(BISAP)评分、胰腺3项(PANC-3)评分、无害性急性胰腺炎(HAPS)评分。比较4种评分预测SAP、胰腺局部并发症及多器官功能衰竭的受试者工作特征(ROC)的曲线下面积(AUC)及敏感度、特异性、约登指数。结果CTSI、BISAP、PANC-3、HAPS评分系统预测SAP的AUC分别为0.76、0.91、0.48、0.55,敏感度分别为75.87%、89.61%、61.18%、78.38%,特异性分别为80.29%、74.72%、67.48%、69.69%,约登指数分别为0.56、0.64、0.29、0.48。CTSI、BISAP、PANC-3、HAPS评分系统预测胰腺局部并发症的AUC分别为0.94、0.82、0.59、0.64,敏感度分别为74.59%、68.23%、71.11%、69.28%,特异性分别为93.88%、83.01%、78.59%、76.46%,约登指数分别为0.68、0.51、0.50、0.46。CTSI、BISAP、PANC-3、HAPS评分系统预测多器官衰竭的AUC分别为0.60、0.84、0.64、0.80,敏感度分别为54.18%、74.82%、58.59%、65.67%,特异性分别为76.11%、77.20%、72.68%、89.36%,约登指数分别为0.30、0.52、0.31、0.55。结论BISAP评分在预测SAP的准确度、多器官衰竭风险方面均高于CTSI、HAPS、PANC-3评分系统。

ATLANTA HAWKS 逆水行舟

体育界有种说法叫"瓶颈",大致是一支球队长期处于一个成绩不上不下的阶段,始终不能再进一步。连续两年折戟东区半决赛的亚特兰大老鹰正处于这样一个阶段,他们为此不惜在今年夏天炒掉了功勋教练迈克·伍德森,可惜休赛期一连串的操作后球队实力并没有提高,这支球队恐怕也将就此退出东区一流球队的行列。

Epidemiological trends in acute pancreatitis:A retrospective cohort in a tertiary center over a seven year period

BACKGROUND Acute pancreatitis(AP)remains a major cause of hospitalization and mortality with important health-related costs worldwide.Using an electronic database of a large tertiary center,we estimated the incidence,etiology,severity and costs of hospitalized AP cases in southern Romania.AIM To estimate the incidence,cost and tobacco usage of hospitalized AP cases in southern Romania and to update and upgrade the knowledge we have on the etiology,severity(in regard to Revised Atlanta Classification),outcome,morphology and local complications of AP.METHODS We performed an electronic health care records search on AP patients treated at Emergency University Hospital of Bucharest(Spitalul Universitar de UrgențăBucurești)between 2015 and 2022.The incidence,etiology,and severity were calculated;potential risk factors were evaluated,and the hospitalization costs of AP were documented and analyzed.The cohort of this study is part of the BUCharest-Acute Pancreatitis Index registry.RESULTS A total of 947 consecutive episodes of AP where the patients were hospitalized in the gastroenterology department were analyzed,with 79.45%as 1st episode and the rest recurrent.The majority of the patients were males(68.9%).Alcoholic(45.7%),idiopathic(16.4%)and biliary(15.2%)were the main causes.The incidence was estimated at 29.2 episodes/100000 people.The median length of stay was 7 d.The median daily cost was 747.96 RON(165 EUR).There was a high prevalence of active tobacco smokers(68.5%).The prevalence of severe disease was 11.1%.The admission rate to the intensive care unit was 4.6%,with a mortality rate of 38.6%.The overall mortality was 5.5%.CONCLUSION We estimated the incidence of AP at 29.2 episodes that required hospitalization per 100000 people.The majority of our cases were found in males(68.9%)and were related to alcohol abuse(45.7%).Out of the cases we were able to find data regarding tobacco usage,the majority were active smokers(68.5%).Most patients had a mild course(54.4%),with a mortality rate of 5.5%.Interstitial AP prevailed(45.3%).The median daily cost of hospitalization was 747.96 RON(165 EUR).

近两届奥运会气象服务保障综述

悉尼、亚特兰大奥运会的气象服务保障基本上代表了目前世界最高水平的奥运气象服务 ,为了借鉴前人的工作 ,更好地为 2 0 0 8年北京奥运会服务 ,对这两届奥运会的气象服务保障情况进行综述。

新亚特兰大分类下生化指标预测急性胰腺炎严重度的价值

目的基于急性胰腺炎(acute pancreatitis,AP)新亚特兰大分类,重新评价常用的生化指标对AP严重度的预测价值。方法回顾性分析2014年4月-2014年8月因AP入院患者的临床资料,参照新亚特兰大分类,将患者分为轻症AP(MAP)、中重症AP(MSAP)及重症AP(SAP)。通过单因素及多因素分析评价各指标对预测AP严重度的价值。结果 87例AP患者和26名健康对照者纳入本研究。54例(62.1%)为MAP,23例(26.4%)为MSAP,10例(11.5%)为SAP。单因素及多因素分析显示:入院48 h白蛋白、红细胞体积分布宽度-变异系数、C反应蛋白是预测AP严重度的独立因素。ROC曲线分析显示,只有C反应蛋白的曲线下面积>0.8,鉴别MAP与MSAP/SAP时C反应蛋白最佳界值为57.9 mg/L,敏感性和特异性分别为75.8%和94.4%。结论当采用亚特兰大修正标准进行AP分类时,住院48 h C反应蛋白仍是预测疾病严重程度非常有价值的指标。血清白蛋白、红细胞体积分布宽度-变异系数对预测疾病严重度也可能有价值。

医源性颈部过度旋转性损伤

目的：报道１３例颈部推拿治疗患者，因采用“拧头”手法操作，旋转暴力过大而致寰齿关节脱位及神经功能障碍属医源性损害。方法：通过对１３例患者系统神经检查、ＣＴ和ＭＲＩ的比较和相关研究进行分类，结果：根据寰齿关节变位情况不同区分为：１寰齿关节旋转性半脱位，（１）齿突尖移位型；（２）齿突基底部移位型；（３）全齿突移位型。２寰椎前脱位。根据临床特征又区分为：１神经根型；２神经根—脊髓型；３神经根—脊髓—延髓型的临床分型。结论：对于环齿关节因旋转暴力过大而引起医源性损害尚存在一定的规律性分型，提供了对该类医源性损害的依据，提出在颈椎病推拿中应避免“拧头”这一手法操作。

Predictive value of C-reactive protein/albumin ratio in acute pancreatitis

BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.

2012年亚特兰大急性胰腺炎严重程度分类的临床特征研究

目的比较1992年和2012年亚特兰大急性胰腺炎(AP)严重程度分类的临床特征有无差异。方法回顾性分析广西医科大学第一附属医院近3年的AP患者临床资料,分别按1992年和2012年AP分类标准将患者分为轻症组(MAP组)、重症组(SAP组)及轻度组(MAP1组)、中度组(MSAP组)、重度组(SAP1组)。比较两种分类方法的临床资料有无差异。结果纳入的162例AP患者中,男115例,女47例,平均发病年龄(48.62±15.37)岁,女性发病年龄高于男性(P=0.006),病因以胆源性、特发性及饱餐后为主,胆源性AP以女性为主(P<0.001)。不同的性别、年龄段及病因的住院日、住院费用差异均无统计学意义(P均>0.05)。MAP组及SAP组的性别、年龄、病因分布差异均无统计学意义(P均>0.05)。MSAP组的女性比例、发病年龄及胆源性比例均低于MAP1组及SAP1组。各组的住院日及住院费用随AP严重程度升高而升高,且SAP1组>SAP组(P均<0.001)。结论 2012年AP严重程度分类标准下,不同AP严重程度的临床特征有一定的差异,较1992年分类标准更有临床指导意义。

城市再开发中健康影响评估的应用--以美国亚特兰大市环线复兴项目为例

城市建成环境是影响人体健康的重要外部综合要素的集合,土地利用、道路与交通、城市形态等均会对个人健康产生直接或间接的影响。城市再开发是当下城市规划面临的重要课题之一,在建成环境的重构过程中将产生健康影响。因此,对城市再开发项目进行健康影响预测和评估,有助于促进居民健康的科学决策及提高项目的综合效益。文章分析了健康影响评估在城市规划和建设中的作用,探讨在应用过程中评估要素的选取和分析方法,并以美国亚特兰大市环线复兴项目的健康影响评估为例,探讨健康影响评估的实践应用,得出对我国城市规划的启示。

罗尔斯公平观视角下的美国城市更新策略研究——以亚特兰大环线再开发为例

近年来,美国一些以城市更新为导向的大型景观项目因其巨大的规模和尺度、多元的利益相关方以及所产生的积极社会效应而受到广泛关注,如纽约高线公园、亚特兰大环线。这些景观项目除关注空间设计品质外,相较传统更新实践更加重视利益分配、社会参与以及景观服务可达性等社会公平议题。基于罗尔斯公平理论的视角,系统分析了以亚特兰大环线项目为代表的美国城市更新策略,重点探讨了程序正义、重叠共识、结果正义的实现方法和形式,以期对中国当下的城市更新提供参考与借鉴。

景观园林规划设计领域的首席人物杰弗里·吉利柯

本文从专业教育背景、专业实践的发展与追求、作品解读和代表性作品简介四个方面介绍杰弗里·吉利柯，最后通过对其思考言论的了解，进一步加深对其作品和专业生涯的理解。

2012年版急性胰腺炎亚特兰大国际共识分类和定义的CT应用

目的:探讨2012年版急性胰腺炎分类和定义的CT应用。方法:按照2012年版急性胰腺炎分类和定义标准回顾性分析本院临床诊断为急性胰腺炎的80例CT及临床资料。结果:80例急性胰腺炎分为间质水肿性急性胰腺炎57例,坏死性急性胰腺炎23例;严重程度分为轻症急性胰腺炎57例,中度重症急性胰腺炎18例,重症急性胰腺炎5例。炎症累及胰周间隙、小网膜囊、肾旁前间隙59例,累及腹腔及肠系膜周围21例。并发症及炎性反应中急性胰周液体积聚23例,假性囊肿3例,坏死性积聚5例,包裹性坏死2例。肝脏损害15例,十二指肠壁、结肠壁肿胀增厚5例,腹腔积液11例,盆腔积液5例,胸腔积液18例,双下肺炎7例,心包积液2例,间质性肺水肿和泡性肺水肿各1例。结论:CT增强检查对急性胰腺炎的分类、严重程度分级、病变累及范围、并发症和全身性炎性反应的评估都有着重要的价值。

Magnetic resonance imaging of pancreatitis: An update

Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as nonionizing nature and higher safety profile of intravascular contrast media,making it particularly valuable in radiosensitive populations such as pregnant patients,and patients with recurrent pancreatitis requiring multiple follow-up examinations.Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis.This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis,pancreatitis complications and other important differential diagnoses that mimic pancreatitis.