Hypertriglyceridemia Induced Pancreatitis: plasmapheresis or conservative management?

Introduction Hypertriglyceridemia-induced acute pancreatitis (HIAP) may result in severe morbidity and mortality. The most effective management strategy is unknown. While plasmapheresis is often performed, it is possible that a conservative approach which includes fasting, intravenous fluids and high-dose insulin, may be successful. Objectives To compare the 28 day mortality and morbidity parameters among patients admitted to the intensive care unit (ICU) due to HIAP when treated conservatively, as compared to patients who were treated with plasmapheresis. Materials and Methods A retrospective study was performed, including all patients at least 18 years of age who were admitted to the ICU between the years 2010 to 2020 with diagnosis of HIAP. Patients underwent plasmapheresis or were managed conservatively. Collected data included patient demographics, chronic illness and medications, hospital and ICU admission times, 28-day mortality, need for ventilation, number of ventilation days, need for inotropic support, daily triglyceride levels, APACHE II score, lactate on admission, need for dialysis, antibiotic treatment, surgical or percutaneous intervention. Results The study included 29 patients. Twenty two patients were treated conservatively and 7 patients with plasmapheresis. There were no significant statistical differences between the groups regarding demographic parameters, chronic disease and medications. Furthermore, on ICU admission and during the subsequent 4 days APACHE score, serum lactate and triglyceride levels were similar between the groups. There was no significant difference in mortality. However, plasmapheresis was associated with greater morbidity (longer admission times, need for ventilation and number of ventilation days, need for inotropic support and dialysis, and invasive surgical intervention). Finally, when compared to conservative management, the rate of serum triglyceride decrease was not improved following plasmapheresis. Conclusion Efficacy of conservative treatment in lowering the serum triglyceride level in HIAP is similar to plasmapheresis. Due to the small patient cohort further prospective studies are needed to confirm these findings. </jats:sec

Online Learning

In the models that we have studied so far, we have assumed that the demand model and its parameters are all known. In practice, demand models need to be estimated before dynamic pricing, assortment optimization, and revenue management can be effectively done. In some instances, there is enough data over a long period of time to calibrate different demand models, do model selection, and update parameter estimates. At the other extreme, we may be pricing for products for which we have little or no information. In this case, demand learning needs to be done on the fly. This is particularly true for online retailing of new products. In this chapter, we address the problem of online demand learning. We study the expected loss in revenue of a learning-and-earning policy relative to an optimal clairvoyant policy that knows the expected demand function. We consider both the case of ample and constrained capacity and measure how the regret grows as the length of the sales horizon increases. We present only the strongest available results for both the case of ample and the case of constrained capacity. In Sect. 10.2, we consider the case with ample capacity, whereas in Sect. 10.3, we consider the case with constrained capacity. © Springer Science+Business Media, LLC, part of Springer Nature 2019