Objective To have more insight into roles of growth differentiation factor-15 (GDF15) in digestive tumor. Method The basic and clinical studies on the GDF15 in the digestive tumors published were searched in the databases for summarizing the latest advances on this issue. Results The GDF15, a novel member of transforming growth factor-β superfamily, played the diverse roles in the progress of the various diseases. The increasing number of evidence indicated that the GDF15 was associated with the diagnosis and prognostication of the digestive tumors, eg: colorectal cancer, hepatocellular carcinoma, pancreatic adenocarcinoma, and might serve as a potential biomarker and therapeutic target for the multiple digestive tumors. Conclusions Current basic and clinical studies provide some evidences that GDF15 plays a role in digestive tumors. Further studies are needed to elucidate its roles and molecular mechanisms in different stages of diseases.
Objective To evaluate the effectiveness and safety of early veno-venous hemofiltration in patients with severe acute pancreatitis (SAP). Methods We searched Cochrane Central Register of Controlled Trials (Issue 4, 2005), MEDLINE (1990 to 2006) and CBMdisc (1990 to 2006). We also handsearched the references of relevant articles. We included randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) comparing early veno-venous hemofiltration versus conventional therapy only, which reported either mortality rate, cure rate, or both. Two reviewers assessed the quality of each trial and extracted data independently. Trials were graded methodologically. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Ten RCTs and 6 CCTs involving 891 patients were included, all of which were China-based. The Jadad scores of all included RCTs were less than 3. Five trials were incorrectly described as having used random allocation. The baseline data of each trial were comparable. Meta-analyses showed that hemofiltration significantly increased the overall cure rate (OR 3.01, 95%CI 1.28 to 7.09) and decreased the overall mortality rate (OR 0.43, 95%CI 0.27 to 0.70). Moreover, APACHE-II score, conversion to operation rate and incidence of complications of SAP were reduced significantly., The duration of abdominal pain or distension and hospitalization stay were shortened compared with non-hemofiltration. However, continuous veno-venous hemofiltration (CVVH) did not improve overall prognosis, with greater possibility of adverse events. Repeated or intermittent short veno-venous hemfiltration (RSVVH/ISVVH) either with or without peritoneal dialysis, could improve the overall prognosis without any adverse events reported. Conclusions Based on these findings, early RSVVH/ISVVH was effective and safe for SAP, but the efficacy of CVVH could not be proven. Current studies were only available from China and were poor in methodological quality. Further, high-quality, large-scale, randomized controlled trials are required to identify reliably the effectiveness and safety of early veno-venous hemofiltration for SAP.
Integrated traditional Chinese and Western medicine has been used to treat acute pancreatitis (AP) for more than 50 years. It has become a dominant and specialized disease treated by integrated traditional Chinese and Western medicine. After many years of clinical practice, a relatively mature and complete treatment system has been formed. Therefore, it was proposed by the Chinese Society of Integrated Traditional Chinese and Western Medicine, the Chinese Medical Association, and the Chinese Association of Traditional Chinese Medicine to update and formulate the “Guidelines for the Diagnosis and Treatment of Acute Pancreatitis with Integrated Traditional Chinese and Western Medicine” (2021) group standards in 2022, and “Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis” finally published. The guideline condenses 25 kinds of important clinical issues, which guide to explain the diagnosis and treatment of AP in detail, focusing on the integration of traditional Chinese medicine and Western medicine in the management of AP, such as staging and syndrome differentiation, early fluid therapy, pain management, and organ function support in early stage. The advantages and the timing of early intervention of traditional Chinese medicine in AP are emphasized. This guideline also proposes suggestions on nutritional support, management of causes, treatment of late local complications and infections, as well as prevention of recurrence and follow-up strategies for long-term complications. This paper provides an interpretation of this guideline.
Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
【摘要】 目的 探讨血浆胰蛋白酶原激活肽(trypsinogen activation peptide,TAP)水平与重症急性胰腺炎(severe acute pancreatitis,SAP)胰腺坏死的关系。方法 2008年6月1日—2008年12月31日,采用ELISA法测定本院的35例SAP患者血浆TAP水平,并与胰腺增强CT扫描结果作对比,分析血浆TAP水平与胰腺坏死的关系,以及SAP无胰腺坏死组与SAP胰腺坏死组血浆TAP水平的差异。结果 入院时血浆TAP水平预测胰腺坏死的最佳截值点是10.43 nmol/mL,其敏感性、特异性、阳性预测值、阴性预测值分别为75%、73.9%、60%、15%,阳性比为2.87,阴性比为0.338。入院第1天血浆TAP水平预测胰腺坏死的最佳截值点是6.91 μmol/L,其敏感性、特异性、阳性预测值、阴性预测值分别为90.9%、65.2%、55.6%、6.3%,阳性似然比为2.61,阴性似然比为0.001。SAP胰腺坏死组入院时、入院第一天血浆TAP水平高于SAP无胰腺坏死组(Plt;0.05)。结论 血浆TAP水平变化与SAP病情变化密切相关,病程早期检测血浆TAP水平有助于SAP患者胰腺坏死的预测