Acute pancreatitis (AP) is a common clinical emergency of the abdomen with increasing incidence and lack of effective treatment. Traditional Chinese medicine, as a treasure of the Chinese people, has been used in the treatment of AP for decades with favorable therapeutic effects. Currently, clinical trials and experimental studies have shown that traditional Chinese medicine has the effects of inhibiting pancreatic enzyme activity, anti-inflammation, promoting gastrointestinal dynamics, as well as delaying the progress of AP, improving clinical symptoms, reducing related complications, and reducing the mortality rate. Therefore, traditional Chinese medicine has considerable clinic value in treating AP. Based on the related research progress and clinical practice of our team, the authors summarized the targets and mechanism of traditional Chinese medicine in treating AP.
Objective The method of metabonomics based on nuclear magnetic resonance (NMR) imaging was used to explore the difference in metabolites of serum and bile, and to analyze the metabolic variation related to the pathogenesis of gallbladder stones between normal people/liver transplantation donors and patients with gallbladder stones. Methods Prospectively collected the serum samples (17 cases) and bile samples (19 cases) in 19 patients with gallbladder stones who underwent surgery in West China Hospital form March 2016 to December 2016, as well as the serum samples of 10 healthy persons and the bile samples of 15 liver transplantation donors at the same time period. The differences of metabolites in the blood and bile in these 3 groups were compared by using 1H-NMR metabonomics technology and chemometric methods. Results The concentrations of valine, alanine, lysine, glutamine, glutamate, pyruvate, creatinine, choline, alpha-glucose, beta-glucose, tyrosine, histidine, and hypoxanthine in serum of patients with gallbladder stones decreased significantly, comparing with those of healthy people without gallbladder stones (P<0.05), while 1, 2-propanediol, acetoacetate, and lactate increased significantly in the serum of patients with gallbladder stones (P<0.05). The concentrations of taurine conjugated bile acids, glycine conjugated bile acids, choline, and phosphatidylcholine decreased significantly in the bile of patients with gallbladder stones when compared with those of liver transplantation donors (P<0.05), while cholesterol increased significantly in the bile of patients with gallbladder stones (P<0.05). Conclusions There are significant differences of the serum and bile metabolites between patients with gallbladder stones and healthy men without gallbladder stones/liver transplantation donors. 1H-NMR metabonomics is helpful to investigate the pathogenesis of gallbladder stones.
Objective To explore the reliability and effectiveness of prediction of the pedicle length of the proximally-based anterolateral thigh (pALT) flap which was used to repair the defects following the resection of various malignant tumors using computed tomographic angiography (CTA). Methods The clinical data of 12 patients who met the selection criteria by using pALT flap to repair wounds left after malignant tumor resection between June 2015 and December 2020 were retrospectively analyzed. There were 5 males and 7 females; the age ranged from 16 to 80 years, with an average age of 54.4 years. After tumor resection, the soft tissue defect ranged from 15 cm×5 cm to 30 cm×12 cm; defect sites included 4 cases of lower abdomen, 3 cases of groin, 2 cases of thigh, and 3 cases of buttocks. Preoperative CTA was used to obtain the location information of the descending branch of the lateral femoral circumflex artery and its perforators by maximum density projection, and the length of the pedicle of pALT flap was estimated. Fasciocutaneous flap (5 cases) or myocutaneous flap (7 cases) were cut during operation to repair the defect, and the size of flap ranged from 20 cm×7 cm to 30 cm×12 cm. The donor site of thigh was directly sutured (11 cases) or repaired with skin graft (1 case). Bland-Altman analysis was used to detect the consistency between the pALT flap vascular pedicle length estimated by CTA and the pALT flap vascular pedicle length actually obtained during operation. ResultsOne case had distal blood supply disturbance of the flap and was repaired with skin graft after debridement; the remaining 11 flaps survived. All donor and recipient incisions healed by first intention. All 12 cases were followed up 1-12 months, with an average of 4.3 months. One patient died of pelvic tumor recurrence at 6 months after operation, and no tumor recurrence was found in the other patients. Preoperative CTA estimated that the length of pALT flap vascular pedicle was 9.3-24.7 cm, with an average of 14.7 cm; the actual length of pALT flap vascular pedicle was 9.5-25.0 cm, with an average of 14.8 cm. Bland-Altman analysis showed that there was no significant difference between the pALT flap vascular pedicle length estimated by CTA before operation and the pALT flap vascular pedicle length actually obtained during operation, and the average difference was 0.1 (95% consistency limit: –0.89, 0.74), indicating that they had good consistency. ConclusionCTA can be accurately used to localize the perforator and predict the possible pedicle length of the pALT flap. When performing a pALT flap surgery, preoperative CTA is helpful for surgeons to make a preliminary assessment of the difficult of the operation. The time for exploration of perforators and dissection of the vascular pedicle, and complications can be reduced, and the safety of the operation can be improved.
Objective To compare the performance of five machine learning models with the traditional logistic regression model in predicting the risk of prolonged intensive care unit (ICU) stay after cardiac valve replacement, and to construct an interpretable predictive model to provide decision support for the early clinical identification of high-risk patients. Methods A retrospective analysis was conducted on the clinical data of patients who underwent cardiac valve replacement at the First Affiliated Hospital of Anhui Medical University from August 2021 to April 2025. Five machine learning models, including support vector machine (SVM), random forest (RF), naive Bayes, decision tree (DT), and extreme gradient boosting (XGBoost), were constructed to predict the risk of prolonged ICU stay (≥3 d), with the traditional logistic regression model included as a control. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, F1-score, and Brier score. The SHapley Additive exPlanations (SHAP) method was applied for the model interpretability analysis. Results A total of 621 patients who underwent cardiac valve replacement were included, comprising 319 (51.4%) males with a median age of 60 (interquartile range 54-68) years; 182 (29.3%) patients experienced a prolonged ICU stay. Among all models, the RF model exhibited the best overall performance, with an AUC of 0.864, accuracy of 0.770, sensitivity of 0.797, specificity of 0.756, F1-score of 0.703, and a Brier score of 0.149. The final optimized model incorporated 13 important variables: operative time, intraoperative lactate, left ventricular ejection fraction, hemoglobin, left atrial diameter, use of anticoagulants, blood urea nitrogen, cryoprecipitate transfusion, history of cerebrovascular disease, New York Heart Association (NYHA) cardiac function class≥Ⅲ, use of calcium channel blockers, history of prior cardiac surgery, and hepatic dysfunction. Conclusion The RF model possesses excellent predictive performance and interpretability in predicting prolonged ICU stay after cardiac valve replacement, demonstrating superior overall capability. It can serve as a valuable reference for the early clinical identification of high-risk patients and the optimization of intensive care medical resource allocation.
ObjectiveTo investigate the value of plasma microRNA-216 (miR-216) in patients with acute pancreatitis as a clinical biomarker to early identify severe acute pancreatitis (SAP).MethodsPatients with acute pancreatitis who admitted to the hospital within 48 hours after the onset of disease between September and November 2014 were enrolled in this study. Plasam and clinical data of all the patients were collected. MiR-216 in the plasma was detected using quantitative real time-polymerase chain reaction.ResultsA total of 25 patients were enrolled. The Ct value of plasma miR-216 in SAP patients (32.40±1.43) was significantly upregulated than mild acute pancreatitis (MAP) (35.85±1.91, P<0.05) and moderately severe acute pancreatitis (MSAP) patients (35.90±2.44,P<0.05), respectively. The area under receiver operating characteristic curve for plasmamiR-216 in predicting SAP was 0.792 (P<0.05), which did not differ much from other conventional parameters such as C-reactive protein, urinary nitrogen, and cytokines (P>0.05).ConclusionPlasma miR-216 is significantly upregulated in SAP patients compared with MAP and MSAP, but it shows no inferior efficiency than the investigated conventional predictors in predicting SAP.
Pain is one of the main presenting symptoms in patients with acute pancreatitis (AP) and is also an important clinical factor affecting fluid resuscitation, enteral nutrition, early mobilization, organ support, and post-discharge recovery. The 2026 European interdisciplinary guidelines on pain management in AP were developed using a high-quality guideline development framework and generated 41 consensus-based recommendations across nine topics: general principles of acute pain management, pain pathophysiology, pain assessment, pharmacological treatment, epidural analgesia, complementary therapies, the impact of pain control on clinical outcomes, management of special populations, and discharge and follow-up. The key recommendations include that opioid use should not be delayed in patients with severe pain because of theoretical safety concerns; non-steroidal anti-inflammatory drugs generally do not increase adverse events or worsen AP severity; patient-controlled intravenous analgesia should not be used as a routine strategy; epidural analgesia may have potential benefits in severe AP; acupuncture and Chaiqin Chengqi decoction may be considered as limited adjunctive treatment options; and routine imaging follow-up is not supported for patients with pain after discharge, with selective investigations recommended based on clinical indications. This guideline interpretation discusses the key recommendations, evidence base, and implementation considerations in the context of clinical practice in China, aiming to provide a reference for standardizing AP pain management and optimizing patient outcomes.