Prevalence and prognosis of acute pancreatitis in critically ill patients with COVID-19

Background:Coronavirus disease 2019(COVID-19)is a global pandemic issue.In addition to the well-known respiratory and fever symptoms,gastrointestinal symptoms have also been reported.This study aimed to evaluate the prevalence and prognosis of patients with COVID-19 infection complicated with acute pancreatitis in intensive care unit(ICU).Methods:This was a retrospective observational cohort study,and patients aged 18 years or older,ad-mitted into the ICU in a single tertiary center from January 1,2020,to April 30,2022 were enrolled.Patients were identified by electronic medical records and reviewed manually.The primary outcome was the prevalence of acute pancreatitis among ICU patients with COVID-19.The secondary outcomes were the length of hospital stay,need for mechanical ventilation(MV),need for continuous renal replacement therapy(CRRT),and in-hospital mortality.Results:A total of 4133 patients,admitted into the ICU,were screened.Among these patients,389 were infected by COVID-19,and 86 were diagnosed with acute pancreatitis.COVID-19 positive patients were more likely to present with acute pancreatitis than COVID-19 negative patients(odds ratio=5.42,95%confidence interval:2.35-6.58,P<0.01).However,the length of hospital stay,need for MV,need for CRRT,and in-hospital mortality were not significantly different between acute pancreatitis patients with and without COVID-19 infection.Conclusions:Severe COVID-19 infections may cause acute pancreas damage in critically ill patients.How-ever,the prognosis may not differ between acute pancreatitis patients with and without COVID-19 infec-tion.

Congenital stapes suprastructure fixation presenting with fluctuating auditory symptoms:A case report

BACKGROUND Stapes ankylosis is a rare cause of conductive hearing loss,and stapes suprastructure fixation is extremely rare with fewer than 30 reported cases.Patients usually visit the clinic with non-progressive conductive hearing loss that typically began in the early years of life.CASE SUMMARY Herein,we report a case of a 37-year-old female with an isolated stapedial suprastructure fixation.The patient presented with unusual fluctuating auditory symptoms of tinnitus,ear fullness and mixed hearing loss.Pre-operative temporal bone computed tomography findings and operative findings revealed an isolated stapedial suprastructure fixation with monopod stapes caused by elongated pyramidal eminence.The hearing threshold recovered completely,and fluctuating auditory symptoms disappeared after the surgery.CONCLUSION This is the first report of stapedial suprastructure fixation with fluctuating auditory symptoms.Successful results are expected with surgical treatment.

Posterior sub-Tenon triamcinolone acetonide injection for annular choroidal detachment resistant to systemic immunosuppressive treatment

Dear Editor,I report two cases of annular choroidal detachment,which was resistant to systemic immunosuppressive treatment and presented a diagnostic dilemma but responded to posterior sub-Tenon triamcinolone acetonide(PSTA)injections.Annular choroidal detachment is known to occur in uveal effusion syndrome(UES)[1].

Comparison of RECIST version 1.0 and 1.1 in assessment of tumor response by computed tomography in advanced gastric cancer

Objective： Response Evaluation Criteria in Solid Tumors （RECIST） guideline version 1.0 （RECIST 1.0） was proposed as a new guideline for evaluating tumor response and has been widely accepted as a standardized measure. With a number of issues being raised on RECIST 1.0, however, a revised RECIST guideline version 1.1 （RECIST 1.1） was proposed by the RECIST Working Group in 2009. This study was conducted to compare CT tumor response based on RECIST 1.1 vs. RECIST 1.0 in patients with advanced gastric cancer （AGC）. Methods： We reviewed 61 AGC patients with measurable diseases by RECIST 1.0 who were enrolled in other clinical trials between 2008 and 2010. These patients were retrospectively re-analyzed to determine the concordance between the two response criteria using the κ statistic. Results： The number and sum of tumor diameters of the target lesions by RECIST 1.1 were significantly lower than those by RECIST 1.0 （P〈0.0001）. However, there was excellent agreement in tumor response between RECIST 1.1 and RECIST 1.0 0（κ=0.844）. The overall response rates （ORRs） according to RECIST 1.0 and RECIST 1.1 were 32.7% （20/61） and 34.5% （20/58）, respectively. One patient with partial response （PR） based on RECIST 1.0 was reclassified as stable disease （SD） by RECIST 1.1. Of two patients with SD by RECIST 1.0, one was downgraded to progressive disease and the other was upgraded to PR by RECIST 1.1. Conclusions： RECIST 1.1 provided almost perfect agreement with RECIST 1.0 in the CT assessment of tumor response of AGC.

Balloon dilation itself may not be a major determinant of post-endoscopic retrograde cholangiopancreatography pancreatitis

Endoscopic retrograde cholangiopancreatography(ERCP)is the essential first modality for common bile duct(CBD)stone therapy.The conventional endoscopic treatment for CBD stones is stone removal after endoscopic sphincterotomy(EST).Stone removal after papillary stretching using balloon dilation instead of the conventional method has been widely adopted.There are many reports regarding endoscopic papillary balloon dilation(EPBD)utilizing a small balloon(<10 mm)instead of EST for the removal of small CBD stones.In contrast,two cases of mortality due to postERCP pancreatitis(PEP)were reported after an EPBD clinical trial in the Western world,and the psychological barrier caused by these incidences hinders the use of this technique in Western countries.Endoscopic papillar large balloon dilation(EPLBD),which is used to treat large CBD stones,was not widely adopted when firstintroduced due to concerns about perforation and severe pancreatitis from the use of a large balloon(12-20mm).However,as experience with this procedure accumulates,the occurrence of PEP with EPLBD is confirmed to be much lower than with EPBD.This report reviews whether EPBD and EPLBD,two procedures that use balloon dilation but differ in terms of indications and concept,contribute to the occurrence of PEP.

Evidence from a familial case suggests maternal inheritance of primary biliary cholangitis

Primary biliary cholangitis(PBC) is an idiopathic autoimmune liver disease characterized by chronic cholestasis and destruction of the intrahepatic bile ducts. Similar to other autoimmune diseases, the pathogenesis of PBC is considered to be a complex etiologic phenomenon involving the interaction of genetic and environmental factors. Although a number of common variants associated with PBC have been reported from genome-wide association studies, a precise genetic mechanism underlying PBC has yet to be identified. Here, we describe a family with four sisters who were diagnosed with PBC. After the diagnosis of the index patient who was in an advanced stage of PBC, one sister presented with acute hepatitis, and two sisters were subsequently diagnosed with PBC. Notably, one half-sister with a different mother exhibited no evidence of PBC following clinical investigation. Our report suggests the possibility of a maternal inheritance of PBC susceptibility. Moreover, judging from the highpenetrance of the disease observed in this family, we inferred that a pathogenic genetic variant might be the cause of PBC development. We describe a family that exhibited diverse clinical presentations of PBC that included asymptomatic stages with mildly increased liver enzyme levels and symptomatic stages with acute hepatitis or advanced liver fibrosis. Additional studies are needed to investigate the role of genetic factors in the pathogenesis of this rare autoimmune disease.

Cryptogenic multifocal ulcerous stenosing enteritis: Radiologic features and clinical behavior

AIM To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior.METHODS Twenty pathologically and clinically confirmed CMUSE patients(males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series(SBS; n = 25), computed tomography(CT) enterography(n = 21), magnetic resonance(MR) enterography(n = 2), and abdominopelvic CT(n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during followup period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTS The main symptoms were abdominal pain(n = 12) and anemia(n = 10). All patients showed small bowel strictures(n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum(n = 47) or jejunum(n = 5). Strictures showed short-length(mean: 10.44 mm) and circumferential bowel wall thickening(mean: 5.56 mm) with layered enhancement(n = 48) that were also noted on initial SBS(n = 36) with shallow ulcers(n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on followup SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence(median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures.CONCLUSION Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.

Trends in the eradication rates of Helicobacter pylori infection for eleven years

AIM:To evaluate the trends in the eradication rate of Helicobacter pylori(H.pylori) over the past 11 years in a single center.METHODS:This retrospective study covered the period from January 2000 to December 2010.We evaluated 5746 patients diagnosed with gastric ulcers(GU),duodenal ulcers(DU),GU + DU,or nonpeptic ulcers associated with an H.pylori infection.We treated them annually with the 2 wk standard first-line triple regimen,proton pump inhibitor(PPI) + amoxicilin + clarithromycin(PAC;PPI,clarithromycin 500 mg,and amoxicillin 1 g,all twice a day).The follow-up test was performed at least 4 wk after the completion of the 2 wk standard H.pylori eradication using the PAC regimen.We also assessed the eradication rates of 1 wk second-line therapy with a quadruple standard regimen(PPI b.i.d.,tripotassium dicitrate bismuthate 300 mg q.i.d.,metronidazole 500 mg t.i.d.,and tetracycline 500 mg q.i.d.) after the failure of the first-line therapy.Statistical analysis was performed with 95%CI for the differences in the annual eradication rates.RESULTS:A total of 5746 patients [2333 males(58.8%),1636 females(41.2%);mean age of males vs females 51.31 ± 13.1 years vs 52.76 ± 13.6 years,P < 0.05,total mean age 51.9 ± 13.3 years(mean ± SD)] were investigated.Among these patients,1674 patients were excluded:35 patients refused treatment;18 patients ceased H.pylori eradication due to side effects;1211 patients had inappropriate indications for H.pylori eradication,having undergone stomach cancer operation or chemotherapy;and 410 patients did not undergo the follow-up.We also excluded 103 patients who wanted to stop eradication treatment after only 1 wk due to poor compliance or the side effects mentioned above.Finally,we evaluated the annual eradication success rates in a total of 3969 patients who received 2 wk first-line PAC therapy.The endoscopic and clinical findings in patients who received the 2 wk PAC were as follows:gastric ulcer in 855(21.5%);duodenal ulcer in 878(22.1%);gastric and duodenal ulcer in 124(3.1%),erosive,atrophic gastritis and functional dyspepsia in 2055(51.8%);and other findings(e.g.,MALToma,patients who wanted to receive the therapy even though they had no abnormal endoscopic finding) in 57(0.5%).The overall eradication rate of the 2 wk standard firstline triple regimen was 86.5%.The annual eradication rates from 2000 to 2010 were 86.7%,85.4%,86.5%,83.3%,89.9%,90.5%,88.4%,84.5%,89.1%,85.8%,and 88.3%,sequentially(P = 0.06).No definite evidence of a significant change in the eradication rate was seen during the past eleven years.The eradication rates of second-line therapy were 88.9%,82.4%,85%,83.9%,77.3%,85.7%,84.4%,87.3%,83.3%,88.9%,and 84%(P = 0.77).The overall eradication rate of 1 wk quadruple second-line therapy was 84.7%.There was no significant difference in the eradication rate according to the H.pylori associated diseases.CONCLUSION:This study showed that there was no trend change in the H.pylori eradication rate over the most recent 11 years in our institution.

Unilateral foveomacular retinitis resembling solar retinopathy among young soldiers in Korean army and associated multimodal imaging findings

AIM: To describe the clinical features and multimodal images of unilateral foveomacular retinitis in young Korean soldiers. METHODS: Ten patients having foveomacular retinitis were included. Fluorescein angiography, fundus autofluorescence(FAF), infrared reflectance(IR), and spectral-domain optical coherence tomography(SD-OCT) were analyzed.RESULTS: All patients were young males experienced insidious visual decline without exposure to bright light. Initial and final vision ranged from hand movement to 20/20(median 20/200) and 20/2000 to 20/20(median 20/500), respectively. Vision decreased in 6 patients while improved in two. Typical macular abnormality was yellow granular spots. SD-OCT showed ellipsoid zone(EZ) or interdigitation zone(IZ) disruption of fovea. The degree of EZ/IZ damage correlated with vision. Lesions were clearly visualized through IR and matched with SD-OCT findings.CONCLUSION: This is the first case series of foveomacular retinitis diagnosed with multimodal imaging. Foveomacular retinitis should be suspected in sudden unilateral visual decline especially in young soldiers. SD-OCT is the most important diagnostic modality.

Surgical outcomes of Korean ulcerative colitis patients with and without colitis-associated cancer

AIM: To determine the clinicopathologic characteristics of surgically treated ulcerative colitis(UC) patients, and to compare the characteristics of UC patients with colitis-associated cancer(CAC) to those without CAC. METHODS: Clinical data on UC patients who underwent abdominal surgery from 1980 to 2013 were collected from 11 medical institutions. Data were analyzed to compare the clinical features of patients with CAC and those of patients without CAC.RESULTS: Among 415 UC patients, 383(92.2%) underwent total proctocolectomy, and of these, 342(89%) were subjected to ileal pouch-anal anastomosis. CAC was found in 47 patients(11.3%). Adenocarcinoma was found in 45 patients, and the others had either neuroendocrine carcinoma or lymphoma. Comparing the UC patients with and without CAC, the UC patients with CAC were characteristically older at the time of diagnosis, had longer disease duration, underwent frequent laparoscopic surgery, and were infrequently given preoperative steroid therapy(P < 0.001-0.035). During the 37 mo mean follow-up period, the 3-yearoverall survival rate was 82.2%.CONCLUSION: Most Korean UC patients experience early disease exacerbation or complications. Approximately 10% of UC patients had CAC, and UC patients with CAC had a later diagnosis, a longer disease duration, and less steroid treatment than UC patients without CAC.

Preparation of Graphene Nanocomposite with Targeting Function and Its Photothermal/Photodynamic Combined Therapy

The study developed a mild method to prepare partially reduced graphene oxide(pRGO).Through the non-covalent interaction of pRGO with nucleic acid aptamers AS1411 and indocytinine green(ICG),photothermal and photosensitive nanocomposites pRGO-AS1411-ICG(pRAI)were constructed.The complex structure and morphological characteristics of pRGO and pRAI were used by fourier transform infrared spectroscopy(FTIR),raman spectroscopy(Raman),X-ray photoelectron spectroscopy(XPS),ultraviolet-visible spectroscopy(Uv-vis),and transmission electron microscope(TEM).And the effect of EDS phototherapeutic back heat therapy on tumor cells was carried out in cell experiments.The results showed that pRAI with targeting of AS1411 can effectively kill tumor cells through the dual effects of photothermal therapy(PTT)and photodynamic therapy(PDT).

Double tailgut cysts (presacral and precoccygeal hamartomas) with CA 19-9 elevation

Tailgut cyst, also called retrorectal hamartoma, is a rare congenital lesion and is usually located anterior to the sacrum and posterior to the rectum. We report a case of double tailgut cyst (presacral and precoccygeal hamartoma). A 62-year- old female visited the hospital complaining of anal pain and pressure in the perianal area for one month. Digital rectal examination revealed a round mass with hard consistency in the lateral and posterior part of rectum 5 cm from the anal verge. Pelvic magnetic resonance imaging showed two cystic and solid presacral masses (lateral and posterior part of rectum) compressing the rectum. The patient underwent surgical resection for pathologic diagnosis. At operation, two masses were located in the left presacral space without invasion to adjacent organs and soft tissue. Pathologic examination revealed double tailgut cysts without malignant transformation. A differential diagnosis of perirectal cystic hamartoma includes epidermal cysts, cystic teratomas, dermoid cysts, anal gland cysts, sarcoma and rectal duplications. Regional inflammatory process frequently complicates this lesion and perirectal fistula can develop. Tailgut cyst also has a malignancy potential, with development of adenocarcinomas. To establish a definite diagnosis and prevent complication, complete surgical resection is recommended.

Angiomyofibroblastoma of the vulva: A case report with literature review

Angiomyofibroblastoma (AMF) is a rare kind of soft tissue tumor that occurs predominantly in the vulva. Due to their location, clinicians often confuse AMF with Bartholin’s cyst or perineal hernia. Radiological evaluation is performed to rule out perineal hernia and invasive neoplasm. Like other benign mesenchymal tumors of vulva, AMF shows indolent behavior and rarely recurs after complete surgical excision.

Probiotics prophylaxis in pyelonephritis infants with normal urinary tracts

Background:Pyelonephritis in infants is considered as a major factor for the formation of renal scar.To prevent recurrent pyelonephritis and renal damage,prophylaxis is extremely important.The aim of this study was to compare the effectiveness of probiotic and antibiotic prophylaxis or no-prophylaxis in infants with pyelonephritis and normal urinary tract.Methods:Altogether 191 infants,who were diagnosed with acute pyelonephritis,proven to have normal urinary tracts and followed up for 6 months on prophylaxis,were retrospectively evaluated.According to the types of prophylaxis,the infants were divided into three groups[probiotics(Lactobacillus species),antibiotics(trimethoprim/sulfamethoxazole,TMP/SMX),and noprophylaxis].The incidence of recurrent urinary tract infection(UTI)during 6 months after the development of pyelonephritis,main causative uropathogens,and its antimicrobial sensitivities were compared.Results:The incidence of recurrent UTI in the probiotic group was 8.2%,which was significantly lower than 20.6%in the no-prophylaxis group(P=0.035)and was not significantly different from 10.0%of the antibiotic group(P=0.532).The significant difference between the probiotic and no-prophylaxis groups was seen only in male infants(P=0.032).The main causative organism of recurrent UTI was Escherichia coli(E.coli),which was not different among the three groups(P=0.305).The resistance rate of E.coli to TMP/SMX was 100%in the antibiotic group,which was significantly higher than 25.0%in the probiotic group and 41.7%in the no-prophylaxis group(P=0.008).Conclusion:Probiotic prophylaxis was more effective in infants with pyelonephritis and normal urinary tract than in those with no-prophylaxis.It could be used as a natural alternative to antibiotic prophylaxis.

韩国人群中细胞色素CYP17A1 CYP3A4和CYP3A43基因的多态性与前列腺癌致癌风险和侵袭力的关系

In this study, we evaluated genetic variants of the androgen metabolism genes CYP17A1, CYP3A4, and CYP3A43 to determine whether they play a role in the development of prostate cancer （PCa） in Korean men. The study population included 240 pathologically diagnosed cases of PCa and 223 age-matched controls. Among the 789 singie-nucleotide polymorphism （SNP） database variants detected, 129 were reported in two Asian groups （Han Chinese and Japanese） in the HapMap database. Only 21 polymorphisms of CYP17A1, CYP3A4, and CYP3A43 were selected based on linkage disequilibrium in Asians （d = 1）, locations （SNPs in exons were preferred）, and amino acid changes and were assessed. In addition, we performed haplotype analysis for the 21 SNPs in CYP17A1, CYP3A4, and CYP3A43 genes. To determine the association between genotype and haplotype distributions of patients and controls, logistic analyses were carried out, controlling for age. Twelve sequence variants and five major haplotypes were identified in CYP17A1. Five sequence variants and two major haplotypes were identified in CYP3A4. Four sequence variants and four major haplotypes were observed in CYP3A43. CYP17A1 haplotype-2 （Ht-2） （odds ratio [OR], 1.51; 95% confidence interval [Cl], 1.04-2,18） was associated with PCa susceptibility. CYP3A4 Ht-2 （OR. 1.87; 95% CI. 1.02-3.43） was associated with PCa metastatic potential according to tumor stage, rs17115149 （OR： 1.96; 95% Ch 1.04-3.68） and CYP17A1 Ht-4 （OR： 2.01; 95% Ch 1.07-4.11） showed a significant association with histologic aggressiveness according to Gleason score. Genetic variants of CYP17A1 and CYP3A4 may play a role in the development of PCa in Korean men.