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An Y, Tu Z, Wang A, Gou W, Yu H, Wang X, Xu F, Li Y, Wang C, Li J, Zhang M, Xiao M, Di Y, Hou W, Cui Y. Qingyi decoction and its active ingredients ameliorate acute pancreatitis by regulating acinar cells and macrophages via NF-κB/NLRP3/Caspase-1 pathways. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2025; 139:156424. [PMID: 40020626 DOI: 10.1016/j.phymed.2025.156424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 01/08/2025] [Accepted: 01/23/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND AND PURPOSE Macrophage infiltration and activation is a critical step during acute pancreatitis (AP). NLRP3 inflammasomes in macrophages plays a critical role in mediating pancreatic inflammatory responses. Qing-Yi Decoction(QYD)has been used for many years in clinical practice of Nankai Hospital combined with traditional Chinese and western medicine treatment of acute pancreatitis. Although QYD has a well-established clinical efficacy, little is known about its bioactive ingredients, how they interact with different therapeutic targets and the pathways to produce anti-inflammatory effects. Here, we elucidate the therapeutic effects of QYD against acute pancreatitis and reveal its mechanism of action. METHODS The main components of QYD were identified using UHPLC-Q-Orbitrap MS. Network pharmacology was employed to predict potential therapeutic targets and their mechanisms of action. C57BL/6 mice were randomly divided into control group, model group, low, medium and high dose (6, 12, 24 g/kg) QYD groups, with 10 mice in each group. The therapeutic effect of QYD on cerulein-induced acute pancreatitis. (CER-AP) was evaluated by histopathological score, immunohistochemistry, serum amylase and cytokines detection by ELISA. The protein expressions of MyD88/NF-κB/NLRP3 signaling pathway were detected by Western blotting. Along with molecular docking of key bioactive compounds and targets, RAW264.7 cells stimulated with 1μg/ml LPS is used to screen components with more potent effects on target proteins. AR42 J cells were stimulated with 100 nM dexamethasone (dexa) combined with 10 nM cerulein (CN) as s a cell-culture model of acute pancreatitis. Inhibitory effects of the main chemical composition Wogonoside on NLRP3 inflammasomes were analyzed by qRT-PCR and Western blots. RESULTS Using UHPLC-Q-Orbitrap MS, 217 compounds were identified from QYD, including Wogonoside, Catechins, Rhein, etc. A visualization network of QYD-compounds-key targets-pathways-AP show that QYD may modulate PI3K-Akt signaling pathway, NOD-like receptor signaling pathway, MAPK signaling pathway, Ras signaling pathway and Apoptosis signaling pathway by targeting TNF, IL1β, AKT1, TP53 and STAT3 exerting a therapeutic effect on AP. QYD administration effectively mitigated CER-induced cytokine storm, pancreas edema and serum amylase. QYD (12 mg/kg) showed better effect. The protein expression levels of MyD88, NF-κB, NLRP3, Caspase-1 and GSDMD in pancreatic tissue were significantly decreased. Through molecular docking and LPS-RAW264.7 inflammation model, the selected Wogonoside significantly decreased IL-1β mRNA. The expression levels of NLRP3/Caspase-1/GSDMD pathway-related proteins were also decreased on AR42J-AP. CONCLUSION The results of network pharmacology indicate that QYD can inhibit AP through multiple pathways and targets. This finding was validated through in vivo tests, which demonstrated that QYD can reduce AP by inhibiting NLRP3 inflammasomes, additionally, it should be noted that 12mg/kg was a relatively superior dose. One of the main chemical compositions Wogonoside regulated NLRP3 inflammasome activation to protect against AP. This study is the first to verify the intrinsic molecular mechanism of QYD in treating AP by combining network pharmacology and animal experiments. The findings can provide evidence for subsequent clinical research and drug development.
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Affiliation(s)
- Yu An
- Tianjin Medical University, Tianjin, China
| | - Zhengwei Tu
- Tianjin Nankai Hospital, Tianjin, China; Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Ao Wang
- Tianjin Medical University, Tianjin, China
| | - Wenfeng Gou
- Peking Union Medical College & Institute of Radiological Medicine, Chinese Academy of Medical Sciences, Tianjin 300192, China
| | - Huijuan Yu
- Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; State Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | | | - Feifei Xu
- Peking Union Medical College & Institute of Radiological Medicine, Chinese Academy of Medical Sciences, Tianjin 300192, China
| | - Yanli Li
- Peking Union Medical College & Institute of Radiological Medicine, Chinese Academy of Medical Sciences, Tianjin 300192, China
| | - Cong Wang
- Tianjin Medical University, Tianjin, China
| | - Jinan Li
- Tianjin Medical University, Tianjin, China
| | - Mengyue Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; State Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | | | - Ying Di
- Tianjin Medical University, Tianjin, China
| | - Wenbin Hou
- Peking Union Medical College & Institute of Radiological Medicine, Chinese Academy of Medical Sciences, Tianjin 300192, China.
| | - Yunfeng Cui
- Tianjin Medical University, Tianjin, China; Tianjin Nankai Hospital, Tianjin, China; Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
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Kowal MR, Bhatnagar V, Pine J, Pathak S, Smith A, Shapey I. Systematic review of peritoneal lavage and dialysis for patients with severe acute pancreatitis. HPB (Oxford) 2025; 27:425-433. [PMID: 39939210 DOI: 10.1016/j.hpb.2025.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/22/2025] [Accepted: 01/28/2025] [Indexed: 02/14/2025]
Abstract
AIMS Severe acute pancreatitis (SAP) remains a lethal condition with a rising incidence worldwide. Recent randomised trials suggest that peritoneal lavage and/or dialysis (PLD), when administered early in SAP, may be beneficial to improve patient outcomes. This study aimed to review this data systematically. METHODS Studies featuring PLD for the treatment of SAP were searched systematically (2012 Atlanta classification to 2023). A traditional approach to reporting data was augmented by a narrative synthesis. RESULTS 210 articles were reviewed, of which six studies featuring 499 patients were included. The technical approach, duration and type of lavage varied in each study and no safety concerns were reported. In patients undergoing PLD, improvements in inflammatory markers and length of stay were seen in all studies. Where reported, fewer invasive procedures for peri-pancreatic fluid collections were required after PLD. Lower mortality was seen in cohorts receiving laparoscopic lavage alone and combined lavage and dialysis when compared with standard treatment. All studies were rated at moderate or high risk of bias. CONCLUSIONS PLD demonstrates potential as an early therapy to improve outcomes for patients with SAP. Further research is required to define intervention delivery, explore acceptability and investigate efficacy through a powered randomised controlled trial.
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Affiliation(s)
- Mikolaj R Kowal
- The Department of Hepatobiliary Surgery, St. James's University Hospital, Beckett Street, Leeds, UK; Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - Varuni Bhatnagar
- Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - James Pine
- The Department of Hepatobiliary Surgery, St. James's University Hospital, Beckett Street, Leeds, UK; Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Samir Pathak
- The Department of Hepatobiliary Surgery, St. James's University Hospital, Beckett Street, Leeds, UK; Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Andrew Smith
- The Department of Hepatobiliary Surgery, St. James's University Hospital, Beckett Street, Leeds, UK; Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Iestyn Shapey
- The Department of Hepatobiliary Surgery, St. James's University Hospital, Beckett Street, Leeds, UK; Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Wan Y, Hu Q, Shi J, Liu L, Zhang X, Huang J, Wang H. J-shaped association between blood urea nitrogen-to-creatinine ratio and mortality in critically ill patients with acute pancreatitis: a retrospective cohort study using the MIMIC-IV database. Eur J Med Res 2025; 30:185. [PMID: 40108699 PMCID: PMC11921597 DOI: 10.1186/s40001-025-02430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 03/04/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Both blood urea nitrogen (BUN) and creatinine (Cr) are indicators of kidney function, and the BUN/Cr ratio has been identified as an independent prognostic marker for adverse outcomes in critically ill patients with various conditions. However, the relationship between the BUN/Cr ratio and long-term mortality in critically ill patients with acute pancreatitis (AP) remains unclear. Hence, the primary objective of this study was to determine the prognostic value of the BUN/Cr ratio in patients with AP. METHODS We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary exposure variable was the BUN/Cr ratio at intensive care unit (ICU) admission, and the primary outcome was 365-day all-cause mortality. Kaplan-Meier analyses and multivariate Cox proportional hazards models were used to assess this relationship, while restricted cubic spline (RCS) was used to explore potential non-linear associations. In addition, subgroup analyses were conducted to assess consistency between groups. RESULTS A total of 850 critically ill patients with AP were included, with a mean age of 59.61 years, 58.59% male, and an overall 365-day mortality rate of 20.94%. Patients in the highest BUN/Cr quartile had significantly higher mortality rates compared to those in lower quartiles. Multivariate Cox regression analysis demonstrated that, even after adjusting for potential confounders, an elevated BUN/Cr ratio remained an independent predictor of increased 28-day and 365-day mortality. RCS analysis confirmed a J-shaped relationship between the BUN/Cr ratio and 28-day and 365-day mortality, with a sharp increase in the risk of death above the 16.80 threshold. Subgroup analysis indicated that this association was consistent across various patient characteristics. CONCLUSION This study identified a non-linear relationship between the BUN/Cr ratio and 365-day mortality in critically ill patients with AP, suggesting that the BUN/Cr ratio may serve as an easily accessible, cost-effective, and accurate prognostic marker for this population.
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Affiliation(s)
- Yu Wan
- Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated Hospital, Xining, China
- Graduate School, Qinghai University, Xining, China
- Department of Breast Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qiong Hu
- Department of Cadre Medical, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Shi
- Graduate School, Qinghai University, Xining, China
| | - Limei Liu
- Graduate School, Qinghai University, Xining, China
| | - Xiangsong Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated Hospital, Xining, China
- Graduate School, Qinghai University, Xining, China
| | - Jianjun Huang
- Department of Breast Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| | - Haijiu Wang
- Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated Hospital, Xining, China.
- Graduate School, Qinghai University, Xining, China.
- Qinghai Research Key Laboratory for Echinococcosis, Qinghai University Affiliated Hospital, Xining, China.
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Swetha K, Indumathi MC, Kishan R, Siddappa S, Chen CH, Marathe GK. Selenium Mitigates Caerulein and LPS-induced Severe Acute Pancreatitis by Inhibiting MAPK, NF-κB, and STAT3 Signaling via the Nrf2/HO-1 Pathway. Biol Trace Elem Res 2025:10.1007/s12011-025-04531-2. [PMID: 39907886 DOI: 10.1007/s12011-025-04531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 01/20/2025] [Indexed: 02/06/2025]
Abstract
Severe acute pancreatitis (SAP) leads to systemic inflammation, resulting in multiorgan damage. Acute lung injury and acute respiratory distress syndrome develop in one-third of SAP patients, with a high mortality rate of 60% due to secondary complications. Patients with pancreatitis often have selenium deficiency, and selenium supplements may provide beneficial effects. This study examined the protective role of selenium in a model of SAP induced by caerulein + lipopolysaccharide (cae + LPS). Mice were administered selenium (1 mg/kg) before being challenged with caerulein (6 injections of 50 μg/kg) and LPS (10 mg/kg). At 3 h after the last caerulein injection, blood was collected for estimating pancreatic enzymes and cytokine levels, and the mice were euthanized. We performed morphological and histological studies, measured levels of protease and oxidative stress markers and conducted western blot, ELISA, and RT-qPCR analyses. We examined lung tissue histologically and estimated myeloperoxidase levels. Selenium pretreatment significantly reduced pancreatic enzyme levels such as amylase, lipase, and proteases (specifically MMPs) and reversed tissue injury in the pancreas and lungs caused by cae + LPS. In addition, selenium-treated mice showed decreased levels of inflammatory markers and chemokines. Examination of the downstream inflammatory pathways confirmed the protective effect of selenium, which mediates its anti-inflammatory and antioxidant action by inhibiting the major inflammatory signaling pathways (MAPKs, NF-κB, and STAT3) and activating the phosphorylation of Nrf2 via Nrf2/HO-1 pathways. These findings suggest that selenium may be a potential therapeutic option for treating SAP-associated secondary complications.
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Affiliation(s)
- Kamatam Swetha
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri Mysore, 570006, India
| | | | - Raju Kishan
- Department of Studies in Molecular Biology, University of Mysore, Manasagangotri Mysore, 570006, India
| | - Shiva Siddappa
- Division of Biochemistry, School of Life Sciences, JSS Academy of Higher Education and Research, Mysore, 570015, India
| | - Chu-Huang Chen
- Vascular and Medicinal Research, The Texas Heart Institute, Houston, TX, 77030, USA
| | - Gopal K Marathe
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri Mysore, 570006, India.
- Department of Studies in Molecular Biology, University of Mysore, Manasagangotri Mysore, 570006, India.
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Liau MYQ, Liau JYJ, Selvakumar SV, Chan KS, Shelat VG. Heart rate variability in acute pancreatitis: a narrative review. Transl Gastroenterol Hepatol 2024; 9:68. [PMID: 39503030 PMCID: PMC11535813 DOI: 10.21037/tgh-24-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/21/2024] [Indexed: 10/31/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Acute pancreatitis (AP) is a complex inflammatory disorder with potential systemic repercussions including sepsis, multiple organ failure and mortality. As such, the development of a prognostic tool to assess the complications and severity of AP is critical as urgent medical intervention is warranted in cases of severe AP to prevent complications and reduce mortality. Despite the plethora of scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) score available for prognostication of AP, they often require manual invasive blood testing and lack the ability to monitor the dynamic progression of the disease. To this end, heart rate variability (HRV), a measure of the autonomic nervous system's modulation on cardiac activity, has emerged as a promising tool. Having been previously posited as a tool to monitor the progression of cardiovascular and neurological conditions, the use of HRV as a risk stratification tool for AP is highly plausible. Therefore, this study aims to synthesize the existing literature regarding the usage of HRV as a tool for the prognostication and monitoring of AP. METHODS A comprehensive literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and Embase from inception to December 2023. Articles with mentions of AP and HRV were reviewed, and the complications of AP and its effects on HRV parameters were analyzed. KEY CONTENT AND FINDINGS Early studies on the use of HRV in AP have revealed the association of decreased HRV parameters with the development of subsequent complications, reflecting the suppression of sympathetic activity as a predominant driving force. In addition, HRV has also been shown to outperform other established scoring systems in predicting outcomes of the complications of AP, but more studies are needed to validate its accuracy. CONCLUSIONS Preliminary studies have shown that certain parameters of HRV may be used to predict the severity of AP and prognosticate outcomes. Although HRV monitoring demonstrates potential to be superior to existing scoring systems in AP, more research is needed to validate its use as a prognostic tool. Nevertheless, the prospective utility of HRV monitoring in predicting the onset and outcomes of AP and its complications remains optimistic.
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Affiliation(s)
- Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jovan Yi Jun Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Surya Varma Selvakumar
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishalkumar Girishchandra Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Surgical Science Training Centre, Tan Tock Seng Hospital, Singapore, Singapore
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Huang CX, Xu XY, Gu DM, Xue HP. Application of psychological intervention in intensive care unit nursing for patients with severe acute pancreatitis. World J Psychiatry 2024; 14:913-919. [PMID: 38984336 PMCID: PMC11230085 DOI: 10.5498/wjp.v14.i6.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Severe acute pancreatitis (SAP) is a familiar critical disease in the intensive care unit (ICU) patients. Nursing staff are important spiritual pillars during the treatment of patients, and in addition to routine nursing, more attention needs be paid to the patient's psychological changes. AIM To investigate the effects of psychological intervention in ICU patients with SAP. METHODS One hundred ICU patients with SAP were hospitalized in the authors' hospital between 2020 and 2023 were selected, and divided into observation and control groups per the hospitalization order. The control and observation groups received routine nursing and psychological interventions, respectively. Two groups are being compared, using the Self-rating Anxiety Scale (SAS), Self-Determination Scale (SDS), Acute Physiology and Chronic Health Evaluation (APACHE) II, and 36-item Short Form Health Survey (SF-36) scores; nursing satisfaction of patients; ICU care duration; length of stay; hospitalization expenses; and the incidence of complications. RESULTS After nursing, the SDS, SAS, and APACHE II scores in the experimental group were significantly lower than in the control group (P < 0.05). The SF-36 scores in the observation group were significantly higher than those in the control group (P < 0.05). The nursing satisfaction of patients in the experimental group was 94.5%, considerably higher than that of 75.6% in the control group (P < 0.05). The ICU care duration, length of stay, and hospitalization expenses in the observation group were significantly lower than those in the control group, and the incidence of complications was lower (P < 0.05). CONCLUSION For patients with SAP, the implementation of standardized psychological intervention measures can effectively alleviate adverse psychological conditions.
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Affiliation(s)
- Chun-Xia Huang
- Department of Outpatient, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Xiao-Yan Xu
- Emergency Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Dong-Mei Gu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Hui-Ping Xue
- Emergency Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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Yang H, Cao R, Zhou F, Wang B, Xu Q, Li R, Zhang C, Xu H. The role of Interleukin-22 in severe acute pancreatitis. Mol Med 2024; 30:60. [PMID: 38750415 PMCID: PMC11097471 DOI: 10.1186/s10020-024-00826-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Severe acute pancreatitis (SAP) begins with premature activation of enzymes, promoted by the immune system, triggering a potential systemic inflammatory response that leads to organ failure with increased mortality and a bleak prognosis. Interleukin-22 (IL-22) is a cytokine that may have a significant role in SAP. IL-22, a member of the IL-10 cytokine family, has garnered growing interest owing to its potential tissue-protective properties. Recently, emerging research has revealed its specific effects on pancreatic diseases, particularly SAP. This paper provides a review of the latest knowledge on the role of IL-22 and its viability as a therapeutic target in SAP.
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Affiliation(s)
- Hongli Yang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, P.R. China
| | - Ruofan Cao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, P.R. China
| | - Feifei Zhou
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, P.R. China
| | - Ben Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, P.R. China
| | - Qianqian Xu
- Department of Gastroenterology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Ji'nan, Shandong, 250021, P.R. China
| | - Rui Li
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, P.R. China
| | - ChunHua Zhang
- Shandong First Medical University, Ji'nan, Shandong, 250117, P.R. China
| | - Hongwei Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, P.R. China.
- Medical Science and Technology Innovation Center, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, P.R. China.
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Bai Y, Gong G, Aierken R, Liu X, Cheng W, Guan J, Jiang Z. A retrospective study investigating the clinical significance of body mass index in acute pancreatitis. PeerJ 2024; 12:e16854. [PMID: 38304193 PMCID: PMC10832621 DOI: 10.7717/peerj.16854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Background Acute pancreatitis is an unpredictable and potentially fatal condition for which no definitive cure is currently available. Our research focused on exploring the connection between body mass index, a frequently overlooked risk factor, and both the onset and progression of acute pancreatitis. Material/Methods A total of 247 patients with acute pancreatitis admitted to Jiangsu Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were retrospectively reviewed. After screening, 117 patients with complete height and body weight data were selected for detailed assessment. Additionally, 85 individuals who underwent physical examinations at our hospital during this period were compiled to create a control group. The study received ethical approval from the ethics committee of Jiangsu Province Hospital of Chinese Medicine (Ref: No.2022NL-114-02) and was conducted in accordance with the China Good Clinical Practice in Research guidelines. Results A significant difference in body mass index (BMI) was observed between the healthy group and acute pancreatitis (AP) patients (p < 0.05), with a more pronounced disparity noted in cases of hyperlipidemic acute pancreatitis (p < 0.01). A potential risk for AP was identified at a BMI greater than 23.56 kg/m2 (AUC = 0.6086, p < 0.05). Being in the obese stage I (95%CI, [1.11-1.84]) or having a BMI below 25.4 kg/m2 (95%CI, [1.82-6.48]) are identified as risk factors for adverse AP progression. Moreover, BMI effectively predicts the onset of acute edematous pancreatitis and acute necrotizing pancreatitis (AUC = 0.7893, p < 0.001, cut-off value = 25.88 kg/m2). A higher BMI correlates with increased recurrence rates within a short timeframe (r = 0.7532, p < 0.01). Conclusions Elevated BMI is a risk factor for both the occurrence and progression of AP, and underweight status may similarly contribute to poor disease outcomes. BMI is crucial for risk prediction and stratification in AP and warrants ongoing monitoring and consideration.
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Affiliation(s)
- Yuanzhen Bai
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guanwen Gong
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Reziya Aierken
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xingyu Liu
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Cheng
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Junjie Guan
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei Jiang
- Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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Xia H, Guo J, Shen J, Jiang S, Han S, Li L. Ketogenic Diet Exacerbates L-Arginine-Induced Acute Pancreatitis and Reveals the Therapeutic Potential of Butyrate. Nutrients 2023; 15:4427. [PMID: 37892502 PMCID: PMC10609823 DOI: 10.3390/nu15204427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The ketogenic diet (KD) has emerged as a popular weight-loss regimen in recent years. However, it has been confirmed to elicit a mild inflammatory response in the intestinal epithelium and exacerbate various digestive disorders. The severity of acute pancreatitis (AP) is closely associated with the permeability of the intestinal epithelium and gut microbiota, yet the impact of KD on acute pancreatitis remains unclear. In this study, we induced acute pancreatitis using L-arginine in mice fed with KD. The consumption of KD resulted in an elevation of lipopolysaccharide-binding protein (LBP), accompanied by upregulated cytokines (IL-1a, IL-5, IL-12, MIP-1a, and Rantes) and dysfunction of the intestinal barrier both in control and AP groups. The bloom of Lachnospirales and Erysipelotrichales was observed as a specific profile of gut microbiota in KD-fed mice with AP, along with downregulation of carbohydrate metabolism and depletion of short-chain fatty acids (SCFAs). Antibiotic decontamination reduced the cytokine storm and tissue necrosis but did not significantly improve the integrity of the intestinal barrier in KD-fed mice with AP. The overgrowth of Mycoplasmatales in feces and Enterobacterales in colonic tissue appears to explain the limitation of antibiotic treatment to aggravate acute pancreatitis. Butyrate supplementation attenuated the depletion of SCFAs, promoted the intestinal barrier, and reduced the necrotic area in AP mice. The bloom of Bacteroidales and the correlated increase in tryptophan metabolism explain the therapeutic potential of butyrate supplements for acute pancreatitis. In conclusion, our findings suggest that the ketogenic diet exacerbates acute pancreatitis through its impact on the gut microbiota and subsequent disruption of the intestinal barrier, while butyrate supplementation reverses this effect.
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Affiliation(s)
| | | | | | | | | | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (H.X.); (J.G.); (S.J.); (S.H.)
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Zhao W. Immune-Related Genes can Serve as Potential Biomarkers for Predicting Severe Acute Pancreatitis. Horm Metab Res 2023; 55:711-721. [PMID: 37391177 DOI: 10.1055/a-2105-6152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
We aimed to investigate immune-related candidate genes for predicting the severity of acute pancreatitis (AP). RNA sequencing profile GSE194331 was downloaded, and differentially expressed genes (DEGs) were investigated. Meanwhile, the infiltration of immune cells in AP were assessed using CIBERSORT. Genes related with the infiltration of immune cells were investigated using weighted gene co-expression network analysis (WGCNA). Furthermore, immune subtypes, micro-environment, and DEGs between immune subtypes were explored. Immune-related genes, protein-protein interaction (PPI) network, and functional enrichment analysis were further performed. Overall, 2533 DEGs between AP and healthy controls were obtained. After trend cluster analysis, 411 upregulated and 604 downregulated genes were identified. Genes involved in two modules were significantly positively related to neutrophils and negatively associated with T cells CD4 memory resting, with correlation coefficient more than 0.7. Then, 39 common immune-related genes were obtained, and 56 GO BP were enriched these genes, including inflammatory response, immune response, and innate immune response; 10 KEGG pathways were enriched, including cytokine-cytokine receptor interaction, Th1 and Th2 cell differentiation, and IL-17 signaling pathway. Genes, including S100A12, MMP9, IL18, S100A8, HCK, S100A9, RETN, OSM, FGR, CAMP, were selected as genes with top 10 degree in PPI, and the expression levels of these genes increased gradually in subjects of healthy, mild, moderately severe, and severe AP. Our findings indicate a central role of immune-related genes in predicting the severity of AP, and the hub genes involved in PPI represent logical candidates for further study.
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Affiliation(s)
- Weijuan Zhao
- Emergency, Affiliated Wuxi Fifth Hospital of Jiangnan University (Infectious Diseases Hospital of Wuxi), Wuxi, China
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11
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Frolov PA, Korotkevich AG, Pavlenko VV, Pachgin IV, Krasnov KA. Prevention of acute post-manipulation pancreatitis. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2023:114-121. [DOI: 10.31146/1682-8658-ecg-213-5-114-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most informative and often in-demand methods for the detection and treatment of pathology of the biliary tract, its diagnostic value is 79-98%. A significant disadvantage of the method are side effects and various complications (acute pancreatitis, bleeding, retroduodenal perforation, cholangitis, acute cholecystitis, etc.). Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and severe complication of intraluminal endoscopic operations on the large duodenal papilla, its etiology is multifactorial, and the pathophysiology has not yet been fully studied. According to many randomized, controlled studies, the incidence of PEP ranges from 2.7 to 37%. Despite all the possibilities of modern medicine and the introduction of new methods, mortality with the development of PEP remains at a very high level: it reaches 7-15%, and with the development of destructive forms - 40-70%. The problems of prevention of PEP are still the subject of discussions and numerous studies by leading clinics around the world. In this paper, we conducted a review of the literature over the past decade using the sources of major medical libraries Medline, eLibrary, PubMed. The article discusses current modern pathogenetic mechanisms and the main risk factors for the development of PEP, related to both the characteristics of the patient and the procedure being performed, technical options for performing ERCP. The article also presents currently used and recommended by most authors methods of drug prevention of PEP and various technical solutions related to this complication. Thus, the not entirely satisfactory results of the proposed methods of prevention of PEP force the authors to search for safer and more effective solutions to this urgent problem at the present time.
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Affiliation(s)
- P. A. Frolov
- Kuzbass Clinical Hospital of Emergency Medical Care named after M. A. Podgorbunsky
| | - A. G. Korotkevich
- Novokuznetsk State Institute of Advanced Training of Doctors; Novokuznetsk City Clinical Hospital No. 29 named after A. A. Lutsik
| | - V. V. Pavlenko
- Kuzbass Clinical Hospital of Emergency Medical Care named after M. A. Podgorbunsky; Kemerovo State Medical University
| | - I. V. Pachgin
- Kuzbass Clinical Hospital of Emergency Medical Care named after M. A. Podgorbunsky
| | - K. A. Krasnov
- Kuzbass Clinical Hospital of Emergency Medical Care named after M. A. Podgorbunsky; Kemerovo State Medical University
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12
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Garcia Borobia F, Flores Clotet R, Bejarano Gonzalez N, Gonzalez Martinez S, Garcia Monforte N, Romaguera Monzonis A, Gonzalez Abos C, Gonzalez Abos S, Lucas Guerrero V, Perez Perarnau A, Mota Villaplana F. Predictive Value of Antithrombin III and d -Dimer in the Development of Moderate-To-Severe Acute Pancreatitis : A Prospective, Observational Study (AT-PROPANC). Pancreas 2023; 52:e241-e248. [PMID: 37801622 DOI: 10.1097/mpa.0000000000002245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To analyze if antithrombin III (AT-III) and d -dimer levels at admission and at 24 hours can predict acute pancreatitis (AP) progression to moderately severe AP (MSAP) to severe AP (SAP) and to determine their predictive value on the development of necrosis, infected necrosis, organ failure, and mortality. METHODS Prospective observational study conducted in patients with mild AP in 2 tertiary hospitals (2015-2017). RESULTS Three hundred forty-six patients with mild AP were included. Forty-four patients (12.7%) evolved to MSAP/SAP. Necrosis was detected in 36 patients (10.4%); in 10 (2.9%), infection was confirmed. Organ failure was recorded in 9 patients (2.6%), all of whom died. Those who progressed to MSAP/SAP showed lower AT-III levels; d -dimer and C-reactive protein (CRP) levels increased. The best individual marker for MSAP/SAP at 24 hours is CRP (area under the curve [AUC], 0.839). Antithrombin III (AUC, 0.641), d -dimer (AUC, 0.783), and creatinine added no benefit compared with CRP alone. Similar results were observed for patients who progressed to necrosis, infected necrosis, and organ failure/death. CONCLUSION Low AT-III and high d -dimer plasma levels at 24 hours after admission were significantly associated with MSAP/SAP, although their predictive ability was low. C-reactive protein was the best marker tested. CLINICAL STUDY IDENTIFIER ClinicalTrials.gov NCT02373293.
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Affiliation(s)
- Francisco Garcia Borobia
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | - Roser Flores Clotet
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | - Natalia Bejarano Gonzalez
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | | | - Neus Garcia Monforte
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | - Andreu Romaguera Monzonis
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | | | - Sandra Gonzalez Abos
- Department of General Surgery, Consorci Sanitari Integral, L'Hospitalet de Llobregat
| | - Victoria Lucas Guerrero
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
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Traboulsi C, Gligorijevic N. A Rare Case of Acute Necrotizing Pancreatitis Infected With Prevotella Species. Cureus 2023; 15:e36145. [PMID: 37065282 PMCID: PMC10101509 DOI: 10.7759/cureus.36145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Acute pancreatitis is one of the leading causes of gastrointestinal-related hospitalizations in the United States. One of the complications of acute pancreatitis is infected pancreatic necrosis. We present a rare case of acute necrotizing pancreatitis infected with Prevotella species in a young patient. We demonstrate the importance of early suspicion of complicated acute pancreatitis and the need for early intervention to prevent hospital re-admission and improve the morbidity and mortality associated with infected pancreatic necrosis.
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14
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Evaluation of acute pancreatitis based on BISAP scoring system: A cohort study of 50 cases. ACTA MEDICA MARTINIANA 2022. [DOI: 10.2478/acm-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background/Aim
Acute pancreatitis is encountered in both medical and surgical specialty. Assessment of severity and grading is done using radiological investigations mostly like ultrasonography or CECT. We present a study to assess the severity of Acute Pancreatitis based on Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system.
Material & Methods
The study was conducted on 50 patients presenting with acute pancreatitis who were included as per inclusion criteria and a detailed history, clinical examination and blood investigation performed. Data like serum amylase, serum lipase, serum calcium, blood urea nitrogen (BUN), pleural effusion and systemic inflammatory response syndrome (SIRS) was collected from the patients. Based on data collected in 24 hours of hospitalization, BISAP score was calculated.
Results
Results showed that no significant temperature rise, pancreatic necrosis, SIRS or impaired mental status in patients with BISAP severity of <=3. However, patients having BISAP score >3, factors like BUN, age, pleural effusion, and organ failure show significant correlation. Also on comparative analysis of patients showed that the hospital stay, respiratory rate, pulse and laboratory markers (blood urea, serum creatinine, serum amylase, serum lipase) were significantly higher in patients with BISAP score ≥3.
Conclusion
BISAP score is an easy, quick and bedside method to assess the severity of acute pancreatitis and predict its mortality. It is easy bedside procedure that can be done in every setup.
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15
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Zheng ZX, Bi JT, Cai X, Liu YQ. The clinical significance of body mass index in the early evaluation of acute biliary pancreatitis. Heliyon 2022; 8:e12003. [PMID: 36471835 PMCID: PMC9718974 DOI: 10.1016/j.heliyon.2022.e12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/29/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Obesity has increased across the globe in recent years and is considered an established risk factor for many diseases. The main objective was to investigate the early assessment value of Body Mass Index (BMI) in the prediction of severity in acute biliary pancreatitis (ABP) and by using BMI to evaluate the severity of ABP. Methods The retrospective analysis was designed to assess the relationship between Body Mass Index and the severity of acute pancreatitis in Beijing Jishuitan Hospital from January 2019 to December 2021. The SPSS 24.0 software was used for statistical analysis, Logistic Regression, and ROC curve for the factors affecting the severity of acute biliary pancreatitis. Results A total of 259 ABP patients were analyzed in our study. The BMI was significantly correlated with the Ranson scoring and MCTSI scoring (p = 0.000, 0.000). The difference in BMI in different severity of ABP patients was statistically significant (p = 0.000). The Logistic Regression analyses confirmed that BMI was an independent risk factor for the severity of ABP (p = 0.035). Combined detection of BMI, WBC, serum calcium, and SAMY in prognosis of the severity of acute pancreatitis positive rate is higher than single positive rate. Conclusion The BMI gradually increased with the severity of acute pancreatitis and was an independent risk factor for the condition. Combined detection of BMI and medical tests can effectively improve acute pancreatitis patients' clinical diagnostic accuracy and early treatment, and help to reduce complications.
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Affiliation(s)
- Zhi Xue Zheng
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Jing Tao Bi
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xuan Cai
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ya Qi Liu
- Department of General Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
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16
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Liu D, Wen L, Wang Z, Hai Y, Yang D, Zhang Y, Bai M, Song B, Wang Y. The Mechanism of Lung and Intestinal Injury in Acute Pancreatitis: A Review. Front Med (Lausanne) 2022; 9:904078. [PMID: 35872761 PMCID: PMC9301017 DOI: 10.3389/fmed.2022.904078] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/10/2022] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP), as a common cause of clinical acute abdomen, often leads to multi-organ damage. In the process of severe AP, the lungs and intestines are the most easily affected organs aside the pancreas. These organ damages occur in succession. Notably, lung and intestinal injuries are closely linked. Damage to ML, which transports immune cells, intestinal fluid, chyle, and toxic components (including toxins, trypsin, and activated cytokines to the systemic circulation in AP) may be connected to AP. This process can lead to the pathological changes of hyperosmotic edema of the lung, an increase in alveolar fluid level, destruction of the intestinal mucosal structure, and impairment of intestinal mucosal permeability. The underlying mechanisms of the correlation between lung and intestinal injuries are inflammatory response, oxidative stress, and endocrine hormone secretion disorders. The main signaling pathways of lung and intestinal injuries are TNF-α, HMGB1-mediated inflammation amplification effect of NF-κB signal pathway, Nrf2/ARE oxidative stress response signaling pathway, and IL-6-mediated JAK2/STAT3 signaling pathway. These pathways exert anti-inflammatory response and anti-oxidative stress, inhibit cell proliferation, and promote apoptosis. The interaction is consistent with the traditional Chinese medicine theory of the lung being connected with the large intestine (fei yu da chang xiang biao li in Chinese). This review sought to explore intersecting mechanisms of lung and intestinal injuries in AP to develop new treatment strategies.
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Affiliation(s)
- Dongling Liu
- School of Pharmacy, Gansu University of Chinese Medicine, Lanzhou, China
| | - Linlin Wen
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
- County People’s Hospital, Pingliang, China
| | - Zhandong Wang
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yang Hai
- Gansu University of Chinese Medicine/Scientific Research and Experimental Center, Lanzhou, China
| | - Dan Yang
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yanying Zhang
- Gansu University of Chinese Medicine/Scientific Research and Experimental Center, Lanzhou, China
- Gansu Provincial Engineering Laboratory for Research and Promotion of Quality Standardization of Authentic Medicinal Materials in Gansu Province/Provincial Key Laboratory of Pharmaceutical Chemistry and Quality Research in Colleges and Universities in Gansu Province/Gansu Provincial Laboratory Animal Industry Technology Center, Lanzhou, China
| | - Min Bai
- Gansu Provincial Engineering Laboratory for Research and Promotion of Quality Standardization of Authentic Medicinal Materials in Gansu Province/Provincial Key Laboratory of Pharmaceutical Chemistry and Quality Research in Colleges and Universities in Gansu Province/Gansu Provincial Laboratory Animal Industry Technology Center, Lanzhou, China
| | - Bing Song
- Gansu University of Chinese Medicine/Scientific Research and Experimental Center, Lanzhou, China
- Gansu Provincial Engineering Laboratory for Research and Promotion of Quality Standardization of Authentic Medicinal Materials in Gansu Province/Provincial Key Laboratory of Pharmaceutical Chemistry and Quality Research in Colleges and Universities in Gansu Province/Gansu Provincial Laboratory Animal Industry Technology Center, Lanzhou, China
| | - Yongfeng Wang
- Gansu Provincial Engineering Laboratory for Research and Promotion of Quality Standardization of Authentic Medicinal Materials in Gansu Province/Provincial Key Laboratory of Pharmaceutical Chemistry and Quality Research in Colleges and Universities in Gansu Province/Gansu Provincial Laboratory Animal Industry Technology Center, Lanzhou, China
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17
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Koo AY, Gao L. Post-return of spontaneous circulation (ROSC) Accelerated Idioventricular Rhythm in the Setting of Severe Pancreatitis and Hyperkalemia. Cureus 2022; 14:e23573. [PMID: 35495000 PMCID: PMC9045550 DOI: 10.7759/cureus.23573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/05/2022] Open
Abstract
A 73-year-old female with a history of coronary artery disease, hypertension, and diabetes presented to the emergency department in cardiac arrest. After cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC), a post-ROSC electrocardiogram demonstrated Accelerated Idioventricular Rhythm (AIVR). The patient was found to have hyperkalemia due to anuric acute renal failure and antecedent severe pancreatitis. After medical management and dialysis, the patient recovered with good neurological recovery. AIVR traditionally has been seen or documented as occurring after ischemia and subsequent coronary artery reperfusion. However, etiologies that promote ventricular automaticity must be considered as well. Electrolyte disturbances, drug toxicities such as digoxin, volatile anesthetics, cardiomyopathies, and ischemia can lead to AIVR. Treatment involves considering and correcting any underlying etiology with avoidance of antiarrhythmics, which may precipitate hemodynamic instability and asystole.
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18
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Acharya R, Dahal P, Parajuli S. Harmless Acute Pancreatitis Negative among Cases of Acute Pancreatitis in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1297-1301. [PMID: 35199790 PMCID: PMC9200029 DOI: 10.31729/jnma.6627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute Pancreatitis is a common disease, diagnosed in about 3% of cases presenting with abdominal pain. Severe disease with multiple systemic complications develops in 10-20% of the cases which require intensive care in specialized centres. Harmless acute pancreatitis score is a simple and economical score predicting the non-severe course of disease within 30 minutes of admission. The aim of our study was to find the prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis in a tertiary care centre. METHODS A descriptive cross-sectional study was conducted after obtaining the ethical approval (Reference no. 344/2076/77). The study was carried out from September 2019 to February 2020 taking 50 patients with the first attack of acute pancreatitis. Convenient sampling was done. Harmless acute pancreatitis score prediction of severe disease and final outcome as severe or non-severe was noted with predefined severity criteria. Data were entered in Microsoft Excel and Statistical Package for the Social Sciences and results represented in tables and charts. Point estimate at 95% was done and frequency and percentage were calculated. RESULTS Out of 50 patients with first attack of acute pancreatitis, using the harmless acute pancreatitis score, the prevalence of harmless acute pancreatitis was 22 (56%) (44.45-67.5 at 90% Confidence Interval). CONCLUSIONS The harmless acute pancreatitis score is an easy, less expensive, quick and promising early scoring system for prediction of non-severe courses of acute pancreatitis. The prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis was found to be similar to other studies.
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Affiliation(s)
- Ravi Acharya
- Department of General Surgery, Rapti Academy of Health Sciences, Dang, Nepal,Correspondence: Dr. Ravi Acharya, Department of General Surgery, Rapti Academy of Health Sciences (RAHS), Dang, Nepal. , Phone: +977-9851167637
| | - Peeyush Dahal
- Burn And Plastic Unit, Bir Hospital, Kathmandu, Nepal
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19
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Fujiwara J, Matsumoto S, Sekine M, Mashima H. C-reactive protein predicts the development of walled-off necrosis in patients with severe acute pancreatitis. JGH Open 2021; 5:907-914. [PMID: 34386599 PMCID: PMC8341195 DOI: 10.1002/jgh3.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/01/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Walled-off necrosis (WON) is reported to occur in 1-9% of patients with acute pancreatitis. However, the factors associated with the onset of this condition have not been elucidated. This study aimed to investigate the potential predictive factors for WON in patients diagnosed with severe acute pancreatitis at our hospital. METHODS This study included 26 patients with severe acute pancreatitis identified among the 211 patients with acute pancreatitis admitted to our hospital between January 2014 and December 2018. Patients with and without WON (WON and non-WON groups, respectively) were compared to identify potential factors involved in the onset of this condition. RESULTS The 26 patients had a median age of 67 years, and 65% were male. WON occurred in 15 patients (57.7%). In a univariate analysis, the WON and non-WON groups differed significantly in terms of maximum C-reactive protein (CRP) levels (median) (322.7 mg/L vs 163.8 mg/L [P = 0.001]). In a multivariate analysis, a significant association was identified between the maximum CRP level and the onset of WON (odds ratio: 1.20, 95% confidence interval: 1.05-1.37). The CRP level peaked within 3 days in 88%. CONCLUSION The maximum CRP level was identified as a predictive factor for the onset of WON, and a high proportion of patients with WON exhibited elevated CRP levels within 3 days after diagnosis. This work suggests the clinical importance of continuous monitoring at an early stage after diagnosis to identify the maximum CRP level.
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Affiliation(s)
- Junichi Fujiwara
- Department of Gastroenterology, Saitama Medical CenterJichi Medical UniversitySaitama‐shiSaitamaJapan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical CenterJichi Medical UniversitySaitama‐shiSaitamaJapan
| | - Masanari Sekine
- Department of Gastroenterology, Saitama Medical CenterJichi Medical UniversitySaitama‐shiSaitamaJapan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical CenterJichi Medical UniversitySaitama‐shiSaitamaJapan
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20
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Zhang Q, Zhou J, Zhou J, Fang RH, Gao W, Zhang L. Lure-and-kill macrophage nanoparticles alleviate the severity of experimental acute pancreatitis. Nat Commun 2021; 12:4136. [PMID: 34230486 PMCID: PMC8260623 DOI: 10.1038/s41467-021-24447-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023] Open
Abstract
Acute pancreatitis is a disease associated with suffering and high lethality. Although the disease mechanism is unclear, phospholipase A2 (PLA2) produced by pancreatic acinar cells is a known pathogenic trigger. Here, we show macrophage membrane-coated nanoparticles with a built-in 'lure and kill' mechanism (denoted 'MΦ-NP(L&K)') for the treatment of acute pancreatitis. MΦ-NP(L&K) are made with polymeric cores wrapped with natural macrophage membrane doped with melittin and MJ-33. The membrane incorporated melittin and MJ-33 function as a PLA2 attractant and a PLA2 inhibitor, respectively. These molecules, together with membrane lipids, work synergistically to lure and kill PLA2 enzymes. These nanoparticles can neutralize PLA2 activity in the sera of mice and human patients with acute pancreatitis in a dose-dependent manner and suppress PLA2-induced inflammatory response accordingly. In mouse models of both mild and severe acute pancreatitis, MΦ-NP(L&K) confer effective protection against disease-associated inflammation, tissue damage and lethality. Overall, this biomimetic nanotherapeutic strategy offers an anti-PLA2 treatment option that might be applicable to a wide range of PLA2-mediated inflammatory disorders.
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Affiliation(s)
- Qiangzhe Zhang
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Julia Zhou
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jiarong Zhou
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Ronnie H Fang
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Weiwei Gao
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Liangfang Zhang
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
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21
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Franca R, Zudeh G, Lucafò M, Rabusin M, Decorti G, Stocco G. Genome wide association studies for treatment-related adverse effects of pediatric acute lymphoblastic leukemia. WIREs Mech Dis 2021; 13:e1509. [PMID: 33016644 DOI: 10.1002/wsbm.1509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/01/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric hematological malignancy; notwithstanding the success of ALL therapy, severe adverse drugs effects represent a serious issue in pediatric oncology, because they could be both an additional life threatening condition for ALL patients per se and a reason to therapy delay or discontinuation with important fallouts on final outcome. Cancer treatment-related toxicities have generated a significant need of finding predictive pharmacogenomic markers for the a priori identification of at risk patients. In the era of precision medicine, high throughput genomic screening such as genome wide association studies (GWAS) might provide useful markers to tailor therapy intensity on patients' genetic profile. Furthermore, these findings could be useful in basic research for better understanding the mechanistic and regulatory pathways of the biological functions associated with ALL treatment toxicities. The purpose of this review is to give an overview of high throughput genomic screening of the last 10 years that had investigated the landscape of ALL treatment-associated toxicities. This article is categorized under: Cancer > Genetics/Genomics/Epigenetics.
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Affiliation(s)
- Raffaella Franca
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Zudeh
- University of Trieste, PhD Course in Reproductive and Developmental Sciences, Trieste, Italy
| | - Marianna Lucafò
- Institute for Maternal and Child Health I.R.C.C.S Burlo Garofolo, Trieste, Italy
| | - Marco Rabusin
- Institute for Maternal and Child Health I.R.C.C.S Burlo Garofolo, Trieste, Italy
| | - Giuliana Decorti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health I.R.C.C.S Burlo Garofolo, Trieste, Italy
| | - Gabriele Stocco
- Department of Life Sciences, University of Trieste, Trieste, Italy
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22
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Zhang K, Zhang X. MiR-146b-3p protects against AR42J cell injury in cerulein-induced acute pancreatitis model through targeting Anxa2. Open Life Sci 2021; 16:255-265. [PMID: 33817317 PMCID: PMC7968541 DOI: 10.1515/biol-2021-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Acute pancreatitis (AP) is a common inflammatory disorder. MicroRNAs play crucial roles in the pathogenesis of AP. In this article, we explored the detailed role and molecular mechanisms of miR-146b-3p in AP progression. Methods The rat AR42J cells were treated with cerulein to establish the AP model in vitro. The miR-146b-3p and Annexin A2 (Anxa2) mRNA levels were assessed by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Cell viability and apoptosis were tested using the Cell Counting Kit-8 (CCK-8) and flow cytometry assays, respectively. Caspase-3 activity and the production of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay and qRT-PCR. Targeted interaction between miR-146b-3p and Anxa2 was verified by the dual-luciferase reporter and RNA immunoprecipitation assays. Western blot analysis was performed to detect the expression of Anxa2 protein. Results Our data revealed that miR-146b-3p was significantly downregulated in AP samples. The enforced expression of miR-146b-3p alleviated cerulein-induced injury in AR42J cells, as evidenced by the promotion in cell viability and the repression in cell apoptosis, as well as the reduction in IL-1β, IL-6, and TNF-α production. Anxa2 was directly targeted and inhibited by miR-146b-3p. Moreover, the alleviative effect of miR-146b-3p overexpression on cerulein-induced AR42J cell injury was mediated by Anxa2. Conclusions The current work had led to the identification of miR-146b-3p overexpression that protected against cerulein-induced injury in AR42J cells at least in part by targeting Anxa2, revealing a promising target for AP diagnosis and treatment.
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Affiliation(s)
- Kunpeng Zhang
- Department of Hepatobiliary Surgery, Xingtai People's Hospital, Xingtai, Hebei, 054001, China.,Department of Neurology, Xingtai People's Hospital, 16 Hongxing Street, Qiaodong District, Xingtai, Hebei, 054001, China
| | - Xiaoyu Zhang
- Department of Neurology, Xingtai People's Hospital, 16 Hongxing Street, Qiaodong District, Xingtai, Hebei, 054001, China
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Ng WH, Tipih T, Makoah NA, Vermeulen JG, Goedhals D, Sempa JB, Burt FJ, Taylor A, Mahalingam S. Comorbidities in SARS-CoV-2 Patients: a Systematic Review and Meta-Analysis. mBio 2021; 12:e03647-20. [PMID: 33563817 PMCID: PMC7885108 DOI: 10.1128/mbio.03647-20] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 12/13/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe at unprecedented speed and is showing no signs of slowing down. The outbreak of coronavirus disease 2019 (COVID-19) has led to significant health burden in infected patients especially in those with underlying comorbidities. The aim of this study was to evaluate the correlation between comorbidities and their role in the exacerbation of disease in COVID-19 patients leading to fatal outcomes. A systematic review was conducted using data from MEDLINE, Scopus, Web of Science, and EMBASE databases published from 1 December 2019 to 15 September 2020. Fifty-three articles were included in the systematic review. Of those 53 articles, 8 articles were eligible for meta-analysis. Hypertension, obesity, and diabetes mellitus were identified to be the most prevalent comorbidities in COVID-19 patients. Our meta-analysis showed that cancer, chronic kidney diseases, diabetes mellitus, and hypertension were independently associated with mortality in COVID-19 patients. Chronic kidney disease was statistically the most prominent comorbidity leading to death. However, despite having high prevalence, obesity was not associated with mortality in COVID-19 patients.IMPORTANCE COVID-19 has plagued the world since it was first identified in December 2019. Previous systematic reviews and meta-analysis were limited by various factors such as the usage of non-peer reviewed data and were also limited by the lack of clinical data on a global scale. Comorbidities are frequently cited as risk factors for severe COVID-19 outcomes. However, the degree to which specific comorbidities impact the disease is debatable. Our study selection involves a global reach and covers all comorbidities that were reported to be involved in the exacerbation of COVID-19 leading to fatal outcomes, which allows us to identify the specific comorbidities that have higher risk in patients. The study highlights COVID-19 high-risk groups. However, further research should focus on the status of comorbidities and prognosis in COVID-19 patients.
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Affiliation(s)
- Wern Hann Ng
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, Southport, QLD, Australia
| | - Thomas Tipih
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Nigel A Makoah
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Jan-G Vermeulen
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Dominique Goedhals
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Division of Virology, National Health Laboratory Service, Bloemfontein, South Africa
| | - Joseph B Sempa
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Felicity J Burt
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Division of Virology, National Health Laboratory Service, Bloemfontein, South Africa
| | - Adam Taylor
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, Southport, QLD, Australia
| | - Suresh Mahalingam
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, Southport, QLD, Australia
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Yang B, Davis JM, Gomez TH, Younes M, Zhao X, Shen Q, Wang R, Ko TC, Cao Y. Characteristic pancreatic and splenic immune cell infiltration patterns in mouse acute pancreatitis. Cell Biosci 2021; 11:28. [PMID: 33531047 PMCID: PMC7852096 DOI: 10.1186/s13578-021-00544-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A systemic evaluation of immune cell infiltration patterns in experimental acute pancreatitis (AP) is lacking. Using multi-dimensional flow cytometry, this study profiled infiltrating immune cell types in multiple AP mouse models. METHODS Three AP models were generated in C57BL/6 mice via cerulein (CAE) injection, alcohol and palmitoleic acid (EtOH + POA) injection, and alcohol diet feeding and cerulein (EtOH + CAE) injection. Primary pancreatic cells and splenocytes were prepared, and multi-dimensional flow cytometry was performed and analyzed by manual gating and computerized PhenoGraph, followed by visualization with t-distributed stochastic neighbor embedding (t-SNE). RESULTS CAE treatment induced a time-dependent increase of major innate immune cells and a decrease of follicular B cells, and TCD4+ cells and the subtypes in the pancreas, whereas elicited a reversed pattern in the spleen. EtOH + POA treatment resulted in weaker effects than CAE treatment. EtOH feeding enhanced CAE-induced amylase secretion, but unexpectedly attenuated CAE-induced immune cell regulation. In comparison with manual gating analysis, computerized analysis demonstrated a remarkable time efficiency and reproducibility on the innate immune cells and B cells. CONCLUSIONS The reverse pattern of increased innate and decreased adaptive immune cells was consistent in the pancreas in CAE and EtOH + POA treatments. Alcohol feeding opposed the CAE effect on immune cell regulation. Together, the immune profiling approach utilized in this study provides a better understanding of overall immune responses in AP, which may facilitate the identification of intervention windows and new therapeutic strategies. Computerized analysis is superior to manual gating by dramatically reducing analysis time.
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Affiliation(s)
- Baibing Yang
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Joy M Davis
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Thomas H Gomez
- Center of Laboratory Animal Medicine and Care, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Mamoun Younes
- Department of Pathology & Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Department of Pathology, George Washington University School of Medicine and Health Sciences, George Washington University Hospital, Washington, DC, 20037, USA
| | - Xiurong Zhao
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Qiang Shen
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA
| | - Run Wang
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Tien C Ko
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
| | - Yanna Cao
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
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Manandhar S, Sinha P, Ejiwale G, Bhatia M. Hydrogen Sulfide and its Interaction with Other Players in Inflammation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1315:129-159. [PMID: 34302691 DOI: 10.1007/978-981-16-0991-6_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hydrogen sulfide (H2S) plays a vital role in human physiology and in the pathophysiology of several diseases. In addition, a substantial role of H2S in inflammation has emerged. This chapter will discuss the involvement of H2S in various inflammatory diseases. Furthermore, the contribution of reactive oxygen species (ROS), adhesion molecules, and leukocyte recruitment in H2S-mediated inflammation will be discussed. The interrelationship of H2S with other gasotransmitters in inflammation will also be examined. There is mixed literature on the contribution of H2S to inflammation due to studies reporting both pro- and anti-inflammatory actions. These apparent discrepancies in the literature could be resolved with further studies.
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Affiliation(s)
- Sumeet Manandhar
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Priyanka Sinha
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Grace Ejiwale
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Madhav Bhatia
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
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26
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Li C, Ren Q, Wang Z, Wang G. Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database. BMJ Open 2020; 10:e041893. [PMID: 33361165 PMCID: PMC7759962 DOI: 10.1136/bmjopen-2020-041893] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/13/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To develop and validate a prediction model for predicting in-hospital mortality in patients with acute pancreatitis (AP). DESIGN A retrospective observational cohort study based on a large multicentre critical care database. SETTING All subject data were collected from the eICU Collaborative Research Database (eICU-CRD), which covers 200 859 intensive care unit admissions of 139 367 patients in 208 US hospitals between 2014 and 2015. PARTICIPANTS A total of 746 patients with AP were drawn from eICU-CRD. Due to loss to follow-up (four patients) or incomplete data (364 patients), 378 patients were enrolled in the primary cohort to establish a nomogram model and to conduct internal validation. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of the prediction model was in-hospital mortality. All risk factors found significant in the univariate analysis were considered for multivariate analysis to adjust for confounding factors. Then a nomogram model was established. The performance of the nomogram model was evaluated by the concordance index (C-index) and the calibration plot. The nomogram model was internally validated using the bootstrap resampling method. The predictive accuracy of the nomogram model was compared with that of Acute Physiology, Age, and Chronic Health Evaluation (APACHE) IV. Decision curve analysis (DCA) was performed to evaluate and compare the potential net benefit using of different predictive models. RESULTS The overall in-hospital mortality rate is 4.447%. Age, BUN (blood urea nitrogen) and lactate (ABL) were the independent risk factors determined by multivariate analysis. The C-index of nomogram model ABL (0.896 (95% CI 0.825 to 0.967)) was similar to that of APACHE IV (p=0.086), showing a comparable discriminating power. Calibration plot demonstrated good agreement between the predicted and the actual in-hospital mortality. DCA showed that the nomogram model ABL was clinically useful. CONCLUSIONS Nomogram model ABL, which used readily available data, exhibited high predictive value for predicting in-hospital mortality in AP.
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Affiliation(s)
- Caifeng Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qian Ren
- Advertising Center, Tianjin Daily, Tianjin, China
| | - Zhiqiang Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Guolin Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
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Continuous Hemofiltration Reduces Mortality in Severe Acute Pancreatitis: A Meta-Analysis. Emerg Med Int 2020; 2020:6474308. [PMID: 32670639 PMCID: PMC7341416 DOI: 10.1155/2020/6474308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/20/2020] [Accepted: 04/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Severe acute pancreatitis (SAP) is a deadly condition, with a mortality rate ranging from 15% to 30%. Recently, blood purification therapy has been adopted in administrating SAP patients. The present study aimed at evaluating the effect of continuous hemofiltration therapy for SAP. Methods A systematic search of Cochrane Library, PubMed, and Embase was carried out until October 1st, 2019. Prospective studies comparing outcomes for SAP patients between continuous hemofiltration and standard therapy were enrolled. Results Continuous hemofiltration therapy was associated with lower level of PACHE II score (MD = −1.49; 95% CI: −2.69 to −0.29, P=0.02), CRP (MD = −1.56 mg/L; 95% CI: −2.64 to −0.47, P=0.005), Cr (MD = −3.57 umol/L; 95% CI: −5.50 to −1.65, P=0.003), and Bun (MD = −3.63 mmol/L; 95% CI: −6.07 to −1.20, P=0.003) at 72 h after onset of treatment. Continuous hemofiltration therapy was associated with shorter length of abdominal pain relief time (MD = −1.82 hours; 95% CI: −2.93 to −0.71, P=0.001), lower surgery rate (OR = 0.15; 95% CI: 0.03 to 0.78, P=0.02), and mortality rate (OR = 0.54; 95% CI: 0.37 to 0.77, P=0.0007). Conclusions continuous hemofiltration therapy could effectively alleviate SAP as early as 72 hours after onset of treatment, lowering the level of Bun, Cr, CRP, and APACHE II scores. Continuous hemofiltration therapy could confer SAP patients with lower mortality rates.
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28
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Lv Y, Jing G, Zhu G, Luo H, Li B, Xie Y, Li C, Wang X. Effects and mechanism of the etanercept on pancreatic encephalopathy. Mol Med Rep 2020; 21:2615-2623. [PMID: 32323789 DOI: 10.3892/mmr.2020.11062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 02/25/2020] [Indexed: 11/05/2022] Open
Abstract
Pancreatic encephalopathy (PE) is a common fatal complication of acute pancreatitis (AP). Proinflammatory cytokines such as tumor necrosis factor (TNF)‑α and interleukin (IL)‑6 are generated during AP, and act synergistically to promote PE and multisystem failure. Caerulein‑induced AP provides a convenient model to explore the role of proinflammatory cytokines in PE. The aim of the present study was to examine the effect of the TNF‑α inhibitor etanercept in PE models and elucidate the regulatory mechanisms. To model PE in vitro, rat hippocampal H19‑7/IGF‑IR neuronal cells were treated with 10 nmol/ml caerulein alone or in combination with etanercept (1, 10 or 100 µmol/ml). To model PE in vivo, rats were injected with 50 µg/kg caerulein alone or combined with 10 mg/kg etanercept. At 6 h after administration, it was noted that etanercept downregulated expression of TNF‑α, IL‑1β and IL‑6 by negatively regulating NF‑κB (a master regulator of cytokine expression) signaling, and prevented the accumulation of reactive oxygen species. Conversely, etanercept promoted the expression of the neurotrophic and anti‑inflammatory hypoxia‑inducible factor 1 α (HIF‑1α). In rat hippocampus, etanercept also reduced the levels of TNF‑α, IL‑1β and IL‑6, upregulated HIF‑1α expression and inhibited the inflammatory response to reduce edema and neural necrosis. Together, these data suggested that etanercept could attenuate caerulein‑induced PE, at least in part via suppression of NF‑κB signaling and alleviation of oxidative stress.
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Affiliation(s)
- Yifan Lv
- Department of Neurosurgery, Medical College, Jinan University, Guangzhou, Guangdong 510220, P.R. China
| | - Guojie Jing
- Department of Neurosurgery, Huizhou First People's Hospital, Huizhou, Guangdong 516000, P.R. China
| | - Gang Zhu
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, Guangdong 516000, P.R. China
| | - Honghai Luo
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, Guangdong 516000, P.R. China
| | - Baisheng Li
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, Guangdong 516000, P.R. China
| | - Yituan Xie
- Department of Neurosurgery, Huizhou First People's Hospital, Huizhou, Guangdong 516000, P.R. China
| | - Caiming Li
- Department of Neurosurgery, Huizhou First People's Hospital, Huizhou, Guangdong 516000, P.R. China
| | - Xiangyu Wang
- The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510220, P.R. China
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Husu HL, Kuronen JA, Leppäniemi AK, Mentula PJ. Open necrosectomy in acute pancreatitis-obsolete or still useful? World J Emerg Surg 2020; 15:21. [PMID: 32183878 PMCID: PMC7079510 DOI: 10.1186/s13017-020-00300-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multiple organ failure and early surgery are associated with high morbimortality after open necrosectomy. Data are mostly derived from historical cohorts with early necrosectomy bereft of step-up treatment algorithm implementation. Thus, mostly circumstantial evidence suggests a better clinical course following mini-invasive surgical and endoscopic necrosectomy. We studied the results of open necrosectomy in a contemporary cohort of patients with complicated pancreatic necrosis treated at a tertiary center. METHODS A retrospective cohort study from a university teaching hospital. Results of 109 consecutive patients treated with open necrosectomy during a 12-year period are reported. RESULTS The overall 90-day mortality rate was 22.9%. The 90-day mortality rate was 10.6% if necrosectomy could be delayed until 4 weeks from symptom onset and the necrosis had become walled off on preoperative imaging. The risk factors for 90-day mortality were age over 60 years (OR 19.4), pre-existing co-morbidities (OR 16.9), necrosectomy within 4 weeks (OR 6.5), multiple organ failure (OR 12.2), white blood cell count over 23 × 109 (OR 21.4), and deterioration or prolonged organ failure as an indication for necrosectomy (OR 10.4). None or one of these risk factors was present in 52 patients (47.7% of all patients), and these patients had no mortality. CONCLUSION Late open necrosectomy for walled-off necrosis has a low mortality risk. Open necrosectomy can be done without mortality in the absence of multiple risk factors for surgery.
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Affiliation(s)
- Henrik Leonard Husu
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 800, FI-00029 HUS, Helsinki, Finland.
| | - Jouni Antero Kuronen
- Medical Imaging Center, Helsinki University Hospital, P.O. Box 750, FI-00029 HUS, Helsinki, Finland
| | - Ari Kalevi Leppäniemi
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 800, FI-00029 HUS, Helsinki, Finland
| | - Panu Juhani Mentula
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 800, FI-00029 HUS, Helsinki, Finland
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Li L, Liu M, Zhang T, Jia Y, Zhang Y, Yuan H, Zhang G, He C. Indomethacin down-regulating HMGB1 and TNF-α to prevent pancreatitis after endoscopic retrograde cholangiopancreatography. Scand J Gastroenterol 2019; 54:793-799. [PMID: 31177924 DOI: 10.1080/00365521.2019.1623306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background and aims: Several articles demonstrated that non-steroidal anti-inflammation drugs (NSAIDs) were effective in reducing the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). However, studies revealed inconsistent results. The mechanism of NSAIDs in preventing PEP is still little known. Therefore, the aim of our study was to evaluate the efficacy of NSAIDs for PEP prophylaxis and further to explore the mechanism of NSAIDs for prevention of PEP. Methods: Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to receive 100 mg rectal indomethacin or glycerin suppository 15-20 min before ERCP. The primary outcome was the rate of PEP. And the levels of serum HMGB1 and TNF-α were also measured before ERCP and 3 and 24 h after ERCP. Univariate analysis and multivariate analysis were carried out to estimate the independent risk factors for PEP. Results: Totally, 100 patients were enrolled, 50 received indomethacin and 50 with placebo (glycerin suppository). PEP developed in six patients in indomethacin group and 16 in the control group, the difference was significant (p = .016). The levels of HMGB1 and TNF-α were significantly decreased in indomethacin group at 3 (p < .0001) and 24 h (p < .0001) after ERCP, compared to the control group. Multivariate analysis revealed that duration of ERCP (OR, 0.221; 95% CI, 0.072-0.680; p = .008) and usage of NSAIDs (OR, 0.278; 95% CI, 0.090-0.861; p = .026) were independent predictors of PEP. Conclusions: Rectal indomethacin could significantly reduce the risk of PEP by down-regulating the levels of HMGB1 and TNF-α.
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Affiliation(s)
- Lin Li
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Miaomiao Liu
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Tingting Zhang
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Yuliang Jia
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Yan Zhang
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Heming Yuan
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Guozheng Zhang
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Chiyi He
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
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Zhang Y, Zhang J, Sheng H, Li H, Wang R. Acute phase reactant serum amyloid A in inflammation and other diseases. Adv Clin Chem 2019; 90:25-80. [PMID: 31122611 DOI: 10.1016/bs.acc.2019.01.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute-phase reactant serum amyloid A (A-SAA) plays an important role in acute and chronic inflammation and is used in clinical laboratories as an indicator of inflammation. Although both A-SAA and C-reactive protein (CRP) are acute-phase proteins, the detection of A-SAA is more conclusive than the detection of CRP in patients with viral infections, severe acute pancreatitis, and rejection reactions to kidney transplants. A-SAA has greater clinical diagnostic value in patients who are immunosuppressed, patients with cystic fibrosis who are treated with corticoids, and preterm infants with late-onset sepsis. Nevertheless, for the assessment of the inflammation status and identification of viral infection in other pathologies, such as bacterial infections, the combinatorial use of A-SAA and other acute-phase proteins (APPs), such as CRP and procalcitonin (PCT), can provide more information and sensitivity than the use of any of these proteins alone, and the information generated is important in guiding antibiotic therapy. In addition, A-SAA-associated diseases and the diagnostic value of A-SAA are discussed. However, the relationship between different A-SAA isotypes and their human diseases are mostly derived from research laboratories with limited clinical samples. Thus, further clinical evaluations are necessary to confirm the clinical significance of each A-SAA isotype. Furthermore, the currently available A-SAA assays are based on polyclonal antibodies, which lack isotype specificity and are associated with many inflammatory diseases. Therefore, these assays are usually used in combination with other biomarkers in the clinic.
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Affiliation(s)
- Yan Zhang
- Shanghai R&D Center, DiaSys Diagnostic Systems (Shanghai) Co., Ltd., Shanghai, China
| | - Jie Zhang
- Shanghai R&D Center, DiaSys Diagnostic Systems (Shanghai) Co., Ltd., Shanghai, China
| | - Huiming Sheng
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haichuan Li
- C.N. Maternity & Infant Health Hospital, Shanghai, China
| | - Rongfang Wang
- Shanghai R&D Center, DiaSys Diagnostic Systems (Shanghai) Co., Ltd., Shanghai, China.
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Fabrès V, Dossin O, Reif C, Campos M, Freiche V, Maurey C, Pilot‐Storck F, Desquilbet L, Benchekroun G. Development and validation of a novel clinical scoring system for short-term prediction of death in dogs with acute pancreatitis. J Vet Intern Med 2019; 33:499-507. [PMID: 30770578 PMCID: PMC6430934 DOI: 10.1111/jvim.15421] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is associated with a high death rate in dogs, but accurate predictors of early death are still lacking. OBJECTIVES To develop a scoring system for prediction of short-term case fatality in dogs with AP. ANIMALS One hundred sixty-nine dogs with AP including 138 dogs in the training cohort and 31 dogs in the validation cohort. METHODS Multicenter, retrospective cohort study. Survival analysis was used to assess the associations with short-term death (within 30 days after admission). Independent predictors of death were identified by a stepwise selection method and used for the score calculation. RESULTS Death rate within 30 days after admission was 33% in the training cohort. Four independent risk factors for short-term death were identified in the training cohort: presence of systemic inflammatory response syndrome, coagulation disorders, increased creatinine and ionized hypocalcemia. Canine Acute Pancreatitis Severity (CAPS) score was developed to predict short-term death, integrating these 4 factors in a weighted way. A simplified version of CAPS score (sCAPS) including respiratory rate instead of SIRS was also assessed. The area under the receiver-operating characteristic curve (AUC) of CAPS and sCAPS scores was 0.92 in the training cohort with an optimal cutoff of 11 (sensitivity, 89%; specificity, 90%) and 6 (sensitivity, 96%; specificity, 77%), respectively. CAPS and sCAPS score were validated in the validation cohort with respective AUC of 0.91 and 0.96. CONCLUSIONS AND CLINICAL IMPORTANCE We propose 2 scoring systems that allow early and accurate prediction of short-term death in dogs with AP.
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Affiliation(s)
- Virginie Fabrès
- Department of Internal MedicineEcole Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Olivier Dossin
- Department of Clinical SciencesUniversité de Toulouse ENVTToulouseFrance
- IRSDUniversité de Toulouse INSERM, INRA, ENVT, UPSToulouseFrance
| | - Clémence Reif
- Department of Internal MedicineEcole Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Miguel Campos
- Department of Internal MedicineEcole Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Science, Vetsuisse FacultyUniversity of BernBernSwitzerland
- U955 – IMRB, Team 10 ‐ Biology of the neuromuscular system, InsermUPEC, Ecole nationale vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Valerie Freiche
- Department of Internal MedicineEcole Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Christelle Maurey
- Department of Internal MedicineEcole Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Fanny Pilot‐Storck
- U955 – IMRB, Team 10 ‐ Biology of the neuromuscular system, InsermUPEC, Ecole nationale vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Loïc Desquilbet
- U955 – IMRB, Team 10 ‐ Biology of the neuromuscular system, InsermUPEC, Ecole nationale vétérinaire d'AlfortMaisons‐AlfortFrance
- Department of Biostatistic and EpidemiologyEcole nationale vétérinaire d'AlfortMaisons‐AlfortFrance
| | - Ghita Benchekroun
- Department of Internal MedicineEcole Nationale Vétérinaire d'AlfortMaisons‐AlfortFrance
- U955 – IMRB, Team 10 ‐ Biology of the neuromuscular system, InsermUPEC, Ecole nationale vétérinaire d'AlfortMaisons‐AlfortFrance
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Miao B, Li FW, Zhang SW, Wang H, Qi WJ, Wang C. Efficacy and safety of Tongfu powder in acute pancreatitis patients with gastrointestinal dysfunction: a clinical trial. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3665-3673. [PMID: 30464398 PMCID: PMC6217005 DOI: 10.2147/dddt.s163645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective To evaluate the efficacy and safety of Tongfu powder for external application on Shénquè (the umbilicus, hereafter, Tongfu powder) versus mosapride in acute pancreatitis (AP) patients with gastrointestinal dysfunction. Methods A total of 102 AP patients were diagnosed using the latest Atlanta Criterion and recruited at the Department of Infectious Disease, Beijing Friendship Hospital (Beijing, People’s Republic of China) from August 2014 to December 2016. Patients were randomized into the Tongfu powder group and mosapride group using the random table. Information on scores (eg, the gastrointestinal function score) on days 1 and 7 of hospitalization, biochemical indicators (eg, interleukin [IL]-2 and IL-6), indicators for curative effects (eg, first defecation time, bowel sound recovery time, hospitalization costs, and duration) were collected and compared between the 2 groups. Results The gastrointestinal function score decreased significantly after treatment, and the changes were significantly different between the Tongfu powder group and the mosapride group (P<0.05). Significantly shorter time to first defecation and bowel sound recovery was observed in the Tongfu powder group versus the mosapride group (P<0.05). The improvements of IL-2, IL-4, intestinal fatty acid binding protein, motilin, and vasoactive intestinal peptide in the Tongfu powder group were higher than those in the mosapride group (P<0.05). There were no significant differences in hospital cost and length of hospital stay between the 2 groups. Conclusion This study suggested that Tongfu powder for external application may improve gastrointestinal function for AP patients compared with mosapride.
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Affiliation(s)
- Bin Miao
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Feng-Wu Li
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Shu-Wen Zhang
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Hong Wang
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Wen-Jie Qi
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Chao Wang
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China,
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Cao X, Wang HM, Du H, Chen EX, Yang XF, Wang SL, Ding Y, She ZF. Early predictors of hyperlipidemic acute pancreatitis. Exp Ther Med 2018; 16:4232-4238. [PMID: 30344698 DOI: 10.3892/etm.2018.6713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to investigate early risk factors for hyperlipidemic acute pancreatitis (HLAP) in order to open up novel routes for its prevention and treatment. Demographics, laboratory data obtained within 48 h, enhanced computed tomography (CT) imaging data and the modified CT severity index (MCTSI) for 111 patients with HLAP who were assessed at Ordos Central Hospital (Ordos, China) between January 2015 and October 2017 were retrospectively analyzed. Of these, 17 patients progressed to infectious pancreatic necrosis (IPN) and 14 patients progressed to organ failure (OF), the occurrence of which were the study outcomes. The patients were divided into pairs groups: IPN and non-IPN, as well as OF and non-OF, and differences between the groups were determined regarding various clinicopathological parameters. Furthermore, univariate and multivariate regression analyses were performed to identify parameters associated with the risk of progression to IPN or OP. On univariate analysis, the following parameters were deemed as being significantly associated with the risk of IPN: Serum calcium ions, C-reactive protein (CRP), extent of necrosis, procalcitonin (PTC) and the MCTSI. Furthermore, calcium ions, red cell distribution width (RDW), extent of necrosis and the MCTSI were significantly associated with the risk of OF on univariate analysis. Multivariate logistic regression analysis for these parameters then indicated that CRP (P=0.014), RDW (P=0.025) and the extent of necrosis (P=0.022) were significant and independent predictors of progression; thus, these are early risk factors for patients with HLAP. Receiver operating characteristic curves were generated to evaluate the predictive value of these factors, and the area under the curve for the three parameters was 0.863 [95% confidence interval (CI), 0.646-0.886], 0.727 (95% CI, 0.651-0.803) and 0.833 (95% CI, 0.739-0.936), respectively. Therefore, CRP, RDW and the extent of necrosis are early predictive indexes for the risk of progression in HLAP.
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Affiliation(s)
- Xi Cao
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Huai-Ming Wang
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Hai Du
- CT-MRI Room, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Er-Xia Chen
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Xiu-Feng Yang
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Shi-Long Wang
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Ya Ding
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Zhan-Fei She
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
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Kalubowilage M, Covarrubias-Zambrano O, Malalasekera AP, Wendel SO, Wang H, Yapa AS, Chlebanowski L, Toledo Y, Ortega R, Janik KE, Shrestha TB, Culbertson CT, Kasi A, Williamson S, Troyer DL, Bossmann SH. Early detection of pancreatic cancers in liquid biopsies by ultrasensitive fluorescence nanobiosensors. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:1823-1832. [PMID: 29782949 DOI: 10.1016/j.nano.2018.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 01/15/2023]
Abstract
Numerous proteases, such as matrix metalloproteinases (MMPs), cathepsins (CTS), and urokinase plasminogen activator (UpA), are dysfunctional (that is, over- or under-expressed) in solid tumors, when compared to healthy human subjects. This offers the opportunity to detect early tumors by liquid biopsies. This approach is of particular advantage for the early detection of pancreatic cancer, which is a "silent killer". We have developed fluorescence nanobiosensors for ultrasensitive (sub-femtomolar) arginase and protease detection, consisting of water-dispersible Fe/Fe3O4 core/shell nanoparticles and two tethered fluorescent dyes: TCPP (Tetrakis(4-carboxyphenyl)porphyrin) and cyanine 5.5. Upon posttranslational modification or enzymatic cleavage, the fluorescence of TCPP increases, which enables the detection of proteases at sub-femtomolar activities utilizing conventional plate readers. We have identified an enzymatic signature for the detection of pancreatic adenocarcinomas in serum, consisting of arginase, matrix metalloproteinase-1, -3, and - 9, cathepsin-B and -E, urokinase plasminogen activator, and neutrophil elastase, which is a potential game-changer.
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Affiliation(s)
| | | | | | - Sebastian O Wendel
- Department of Chemistry, Kansas State University, Manhattan, KS, USA; Department of Anatomy & Physiology, Kansas State University, Manhattan, KS, USA
| | - Hongwang Wang
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Asanka S Yapa
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | | | - Yubisela Toledo
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Raquel Ortega
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Katharine E Janik
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Tej B Shrestha
- Department of Anatomy & Physiology, Kansas State University, Manhattan, KS, USA
| | | | - Anup Kasi
- University of Kansas Medical School, Kansas City, KS, USA
| | | | - Deryl L Troyer
- Department of Anatomy & Physiology, Kansas State University, Manhattan, KS, USA
| | - Stefan H Bossmann
- Department of Chemistry, Kansas State University, Manhattan, KS, USA.
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Li Y, Ye Y, Yang M, Ruan H, Yu Y. Application of semi-automated ultrasonography on nutritional support for severe acute pancreatitis. Comput Med Imaging Graph 2018; 67:40-44. [PMID: 29753963 DOI: 10.1016/j.compmedimag.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/13/2018] [Accepted: 04/23/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the application value of semi-automated ultrasound on the guidance of nasogastrojejunal tube replacement for patients with acute severe pancreatitis (ASP), as well as the value of the nutritional support for standardized treatment in clinical practice. METHODS The retrospective research was performed in our hospital, and 34 patients suffering from ASP were enrolled into this study. All these identified participants ever received CT scans in order to make definitive diagnoses. Following, these patients received semi-automated ultrasound examinations within 1 days after their onset, in order to provide enteral nutrititon treatment via nasogastrojejunal tube, or freehand nasogastrojejunal tube replacement. In terms of statistical analysis, the application value of semi-automated ultrasound guidance on nasogastrojejunal tube replacement was evaluated, and was compared with tube replacement of no guidance. After cathetering, the additional enteral nutrition was provided, and its therapeutic effect on SAP was analyzed in further. RESULTS A total of 34 patients with pancreatitis were identified in this research, 29 cases with necrosis of pancreas parenchyma. After further examinations, 32 cases were SAP, 2 cases were mild acute pancreatitis. When the firm diagnosis was made, additional enteral nutrition (EN) was given, all the patient conditions appeared good, and they all were satisfied with this kind of nutritional support. According to our clinical experience, when there was 200-250 ml liquid in the stomach, the successful rate of intubation appeared higher. Additionally, the comparison between ultrasound-guided and freehand nasogastrojejunal tube replacement was made. According to the statistical results, in terms of the utilization ratio of nutritional support, it was better in ultrasound-guided group, when compared with it in freehand group, within 1 day, after 3 days and after 7 days (7/20 versus 2/14; P < 0.05; 14/20 versus 6/14; P < 0.05; 20/20 versus 12/14; P < 0.05). Besides, the complications caused by cathetering between two groups was not statistically different (P > 0.05). CONCLUSIONS It can be indicated that semi-automated ultrasound guidance is a reliable method for nasogastrojejunal tube replacement, and should be substituted for no guidance of cathetering. In terms of therapeutic effect of EN, additional nutritional support contributed to significantly improve the prognosis of SAP patients, and should be widely recommended in clinical practice. Surely, this conclusion should be evaluated in further, by means of randomized controlled trials and economic evaluation.
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Affiliation(s)
- Ying Li
- Department of Critical Care Medicine, Second People's Hospital of Shenzhen, Shenzhen, 518035, PR China.
| | - Yu Ye
- Department of Neurosurgery, Longgang Central Hospital of Shenzhen, Shenzhen, 518116, PR China.
| | - Mei Yang
- Department of Critical Care Medicine, Second People's Hospital of Shenzhen, Shenzhen, 518035, PR China.
| | - Haiying Ruan
- Department of Critical Care Medicine, Second People's Hospital of Shenzhen, Shenzhen, 518035, PR China.
| | - Yuan Yu
- Department of Critical Care Medicine, Second People's Hospital of Shenzhen, Shenzhen, 518035, PR China.
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Gong D, Zhang P, Ji D, Chen Z, Li W, Li J, Li L, Liu Z. Improvement of Immune Dysfunction in Patients with Severe Acute Pancreatitis by High-Volume Hemofiltration: A Preliminary Report. Int J Artif Organs 2018. [DOI: 10.1177/039139881003300104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective The aim of this study was to investigate the effect of high-volume hemofiltration (HVHF) on ameliorating immune dysfunction in patients with severe acute pancreatitis (SAP). Methods Twelve patients diagnosed with SAP admitted to the intensive care unit of general surgery, Jinling Hospital, from January 2004 to December 2006 were included in this study. They were assigned to the standard medical therapy group (SMT group, n=4) or HVHF group (n=8) immediately after enrollment, in a 1:2 ratio. The SMT group were given standard treatment for SAP, while the HVHF group were given standard as well as 72-hour HVHF treatment initiated within 2 hours after enrollment. Patients in the 2 groups were comparable for the baseline clinical parameters. All patients were monitored over a 72-hour observation period for continuous clinical status, blood cell counts including monocytes, CD4+ and CD8+ T cells, and HLA-DR expression on monocytes. Blood samples were collected from those patients at 0, 6, 12, 24, 48, and 72 hour after enrollment for measurement of plasma Th1-type cytokines (interleukin-1 [IL-1], IL-2, interferon-γ [IFN-γ], and tumor necrosis factor-α [TNF-α]) and Th2-type cytokines (IL-4, IL-5, IL-6, IL-10, and IL-13) using ELISA. Results Within 72 hours, all measured cytokines except IL-4 were maintained at high levels, accompanied with a low level of peripheral monocytes, CD4+ and CD8+ T cell counts, and HLA-DR expression. Seventy-two hours later, plasma cytokines IFN-γ, IL-1, IL-2, IL-5, IL-10, and IL-13 (p<0.05), but not TNF-α and IL-6, in patients in the HVHF group were significantly reduced, while there was no change for these parameters in the SMT group. Plasma levels of IFN-γ, TNF-α, IL-1, IL-2, IL-5, and IL-13 in the HVHF group were significantly lower than those in the SMT group. Peripheral CD4+ and CD8+ T cells, monocyte count, and HLA-DR expression were increased significantly (p<0.05) only in the HVHF group, not in the SMT group. HLA-DR expression in the HVHF group was significant higher than that in the SMT group (p<0.05). Conclusions HVHF significantly reduced plasma inflammatory cytokine concentrations including those of IFN-γ, TNF-α, IL-1, IL-2, IL-5, and IL-13, while it increased monocyte HLA-DR expression in patients with SAP. The association of plasma cytokine reduction and cellular immune function recovery and clinical outcome needs further investigation.
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Affiliation(s)
- Dehua Gong
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing - PR China
| | - Peng Zhang
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an - PR China
| | - Daxi Ji
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing - PR China
| | - Zhaohong Chen
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing - PR China
| | - Weiqin Li
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing - PR China
| | - Jieshou Li
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing - PR China
| | - Leishi Li
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing - PR China
| | - Zhihong Liu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing - PR China
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Elevated Serum miR-7, miR-9, miR-122, and miR-141 Are Noninvasive Biomarkers of Acute Pancreatitis. DISEASE MARKERS 2017; 2017:7293459. [PMID: 29332987 PMCID: PMC5733206 DOI: 10.1155/2017/7293459] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 12/20/2022]
Abstract
Background It has been reported that several microRNAs (miRNAs), such as miR-141, miR-9, and miR-122, are involved in the regulation of pancreatitis-related proteins or that their levels change in acute pancreatitis (AP) animal models. However, the serum levels, as well as the clinical diagnostic and prognostic values, of these miRNAs in AP patients remain unclear. Furthermore, as a pancreas- (islet) enriched miRNA, miR-7 was reported to be downregulated in AP patients, which requires further verification. Methods The levels of miR-7, miR-9, miR-122, and miR-141 were examined and compared using qRT-PCR among 80 severe AP patients, 80 mild AP patients, and 74 healthy controls. Results The serum levels of these four miRNAs were increased markedly in the AP patients compared with the controls, and these levels decreased significantly after effective therapy. Particularly, the level of miR-7 was higher in severe AP patients than in mild AP patients. ROC curve analysis demonstrated that four miRNAs could be used as potential biomarkers for AP. Moreover, these miRNAs showed strong positive correlations with CRP, which may be associated with inflammation. Conclusions The serum miR-7, miR-9, miR-122, and miR-141 levels were increased in AP patients. These 4 miRNAs may represent diagnostic and prognostic biomarkers for AP.
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Wang G, Liu H, Xu L, Wen P, Wen J, Zhou SF, Xiao X. Effect of Laparoscopic Peritoneal Lavage and Drainage and Continuous Venovenous Diahemofiltration on Severe Acute Pancreatitis. J Laparoendosc Adv Surg Tech A 2017; 27:1145-1150. [PMID: 28586262 DOI: 10.1089/lap.2016.0637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Guiliang Wang
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Hai Liu
- Department of Scientific Research, Gannan Medical University, Gan Zhou, People's Republic of China
| | - Linfang Xu
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Ping Wen
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Jianbo Wen
- Department of Hepatobiliary Surgery, Gannan Medical University Pingxiang Hospital, Pingxiang, People's Republic of China
| | - Shu-feng Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, Florida
| | - Xianzhong Xiao
- Laboratory of Shock, Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
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Marchetti V, Gori E, Lippi I, Luchetti E, Manca ML, Pierini A. Elevated serum creatinine and hyponatraemia as prognostic factors in canine acute pancreatitis. Aust Vet J 2017; 95:444-447. [DOI: 10.1111/avj.12638] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/05/2016] [Accepted: 01/09/2017] [Indexed: 12/13/2022]
Affiliation(s)
- V Marchetti
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - E Gori
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - I Lippi
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - E Luchetti
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - ML Manca
- Department of Clinical and Experimental Medicine; University of Pisa; Italy
| | - A Pierini
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
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Yan Y, Lu B, Li P, Wang J. NOD receptor and TLR9 modulation in severe acute pancreatitis‑induced intestinal injury. Mol Med Rep 2017; 16:8471-8476. [PMID: 28990073 DOI: 10.3892/mmr.2017.7661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 05/09/2017] [Indexed: 11/05/2022] Open
Abstract
Severe acute pancreatitis (SAP) has a rapid onset and may cause multiple organ dysfunction syndrome (MODS), which has high mortality. Nucleotide binding oligomerization domain (NOD) receptor and Toll‑like receptor 9 (TLR9), a pattern recognition receptor in innate immunity, are involved in inflammation, immunity and pathogen recognition. The role and mechanism of the NOD receptor and TLR9 in early MODS of SAP‑induced intestinal injury, however, remain unclear. Wistar rats were divided into control, SAP, TLR9 inhibitor and NOD receptor activation groups. Reverse transcription‑quantitative polymerase chain reaction was used to analyze the expression of TLR9, NOD1 and NOD2 in the experimental treatment groups. Serum amylase, creatinine and alanine aminotransferase indices were measured, ELISA was used to determine the expression of tumor necrosis factor‑α (TNF‑α) and interleukin‑1β (IL‑1β) and western blot analysis was used to assess nuclear factor (NF)‑κB expression levels in intestinal tissues. Reactive oxygen species (ROS) levels and superoxide dismutase (SOD) activity were quantified by spectrometry. SAP and NOD receptor activation groups exhibited significantly elevated TLR9, NOD1, NOD2, TNF‑α, IL‑1β and nuclear factor (NF)‑κB levels compared with the control group. Furthermore, ROS production was increased, SOD activity was decreased and higher serum indices were exhibited, compared with the control group. The NOD receptor group presented more significant differences compared with the SAP group. The TLR9 inhibitor group exhibited opposite effects, with markedly decreased TLR9, NOD1, NOD2, TNF‑α, IL‑1β and NF‑κB levels. The TLR9 inhibitor group also presented reduced ROS production, increased SOD activity and lower serum indexes compared to the SAP group. The present study therefore indicated that NOD receptor and TLR9 may modulate the inflammatory response and further impact upon intestinal injury of SAP, via the regulation of NF‑κB expression and the oxidation/antioxidation balance, suggesting therapeutically targeting NOD receptor and TLR9 might be a useful approach for the treatment of severe acute pancreatitis.
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Affiliation(s)
- Yupeng Yan
- Intensive Care Unit, China Meitan General Hospital, Beijing 100028, P.R. China
| | - Bin Lu
- Department of Anesthesiology, Beijing Hospital of Traditional Chinese Medicine, Beijing 100010, P.R. China
| | - Pengyang Li
- Department of Orthopedics, Dongzhimen Hospital, Beijing 100010, P.R. China
| | - Ji Wang
- Intensive Care Unit, China Meitan General Hospital, Beijing 100028, P.R. China
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李 雪, 杨 文, 周 谊. 集束化护理在重症急性胰腺患者胃肠功能恢复中的应用. Shijie Huaren Xiaohua Zazhi 2017; 25:2071-2079. [DOI: 10.11569/wcjd.v25.i23.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
重症急性胰腺炎(severe acute pancreatitis, SAP)是临床中常见的发病率高、并发症多、死亡率较高的疾病, 其死亡的主要原因是并发了不同程度的多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS), 全身炎症反应综合征(systemic inflammatory response syndrome, SIRS)是导致MODS的重要基础, 而胃肠功能障碍又是激发SIRS的源头. 因此, 胃肠功能障碍在该病的发生发展过程中起重要作用, 早期胃肠功能恢复有助于疾病的恢复和并发症的预防. 集束化护理的运用, 可以使每一位患者在有限的时间内, 得到最有效的治疗, 这是集束化护理最突出的特点. 文章就集束化护理在SAP患者的胃肠功能恢复中的应用进行简要综述, 为临床工作提供循证参考.
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Abstract
Introduction: Acute pancreatitis is inflammatory process of the pancreas associated with local and systemic complications. At present, there are lots of scores (such as Ransons, APACHE II, bedside index for severity in acute pancreatitis) that help us in predicting severity at the time of admission but these are time consuming or require complex calculation and are costly. Material and Methods: PANC3 Scoring System is one of the better systems because the three criteria used (hematocrit, body mass index, and pleural effusion) are simple, easy to assess, readily available, and economic. In this prospective study, 100 cases were evaluated to see the prospects of PANC3 scoring in predicting the severity of acute pancreatitis as decided by modified Marshals score. Results: The results showed that PANC3 score had a 96.43% specificity, 75% sensitivity, 80% positive predictive value, and 95.29% negative predictive value. Conclusion: Hence, the PANC3 score is a cost-effective, promising score that helps in predicting the severity of acute pancreatitis leading to prompt treatment and early referral to higher center.
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Affiliation(s)
- Avreen Singh Shah
- Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Arun Kumar Gupta
- Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Kulwant Singh Ded
- Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
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Yoon SB, Lee IS, Choi MH, Lee K, Ham H, Oh HJ, Park SH, Lim CH, Choi MG. Impact of Fatty Liver on Acute Pancreatitis Severity. Gastroenterol Res Pract 2017; 2017:4532320. [PMID: 28536603 PMCID: PMC5426076 DOI: 10.1155/2017/4532320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/22/2017] [Indexed: 12/16/2022] Open
Abstract
Aim. Acute pancreatitis is typically a mild disease, but some patients develop severe courses. Fatty liver changes are seen in patients with acute pancreatitis, but its clinical significance has not been well-studied. We aimed to investigate the relationship between fatty liver and the severity of acute pancreatitis. Methods. Unenhanced CT images of patients with acute pancreatitis were retrospectively reviewed by a radiologist, and mean hepatic and splenic attenuation was measured in Hounsfield units (HU). Fatty liver was defined as mean hepatic/splenic HU < 1. Results. Among 200 patients, fatty liver was found in 67 (33.5%) and nonfatty liver in 133 (66.5%). Compared with patients without fatty liver, the severity of pancreatitis and levels of serum C-reactive protein were higher in fatty liver patients. The prevalence of local complications, persistent organ failure, and mortality were also higher in patients with fatty liver. Even after adjusting for age, sex, body mass index, and cause of pancreatitis, fatty liver was significantly associated with moderately severe or severe acute pancreatitis. Conclusions. Fatty liver may play a prognostic role in acute pancreatitis. Fatty liver could be incorporated into future predictive scoring models.
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Affiliation(s)
- Seung Bae Yoon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungjin Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyoju Ham
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Jin Oh
- Center for Cancer Prevention and Detection, National Cancer Center, Goyang-si, Republic of Korea
| | - Se Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Rathnakar SK, Vishnu VH, Muniyappa S, Prasath A. Accuracy and Predictability of PANC-3 Scoring System over APACHE II in Acute Pancreatitis: A Prospective Study. J Clin Diagn Res 2017; 11:PC10-PC13. [PMID: 28384928 PMCID: PMC5376859 DOI: 10.7860/jcdr/2017/23168.9375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/21/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Acute Pancreatitis (AP) is one of the common conditions encountered in the emergency room. The course of the disease ranges from mild form to severe acute form. Most of these episodes are mild and spontaneously subsiding within 3 to 5 days. In contrast, Severe Acute Pancreatitis (SAP) occurring in around 15-20% of all cases, mortality can range between 10 to 85% across various centres and countries. In such a situation we need an indicator which can predict the outcome of an attack, as severe or mild, as early as possible and such an indicator should be sensitive and specific enough to trust upon. PANC-3 scoring is such a scoring system in predicting the outcome of an attack of AP. AIM To assess the accuracy and predictability of PANC-3 scoring system over APACHE II in predicting severity in an attack of AP. MATERIALS AND METHODS This prospective study was conducted on 82 patients admitted with the diagnosis of pancreatitis. Investigations to evaluate PANC-3 and APACHE II were done on all the patients and the PANC-3 and APACHE II score was calculated. RESULTS PANC-3 score has a sensitivity of 82.6% and specificity of 77.9%, the test had a Positive Predictive Value (PPV) of 0.59 and Negative Predictive Value (NPV) of 0.92. Sensitivity of APACHE II in predicting SAP was 91.3% and specificity was 96.6% with PPV of 0.91, NPV was 0.96. CONCLUSION Our study shows that PANC-3 can be used to predict the severity of pancreatitis as efficiently as APACHE II. The interpretation of PANC-3 does not need expertise and can be applied at the time of admission which is an advantage when compared to classical scoring systems.
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Affiliation(s)
- Surag Kajoor Rathnakar
- Junior Resident, Department of General Surgery, ESIC Medical College, Bangaluru, Karnataka, India
| | | | - Shridhar Muniyappa
- Professor, Department of General Surgery, ESIC Medical College, Bangaluru, Karnataka, India
| | - Arun Prasath
- Junior Resident, Department of General Surgery, ESIC Medical College, Bangaluru, Karnataka, India
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Yang N, Hao J, Zhang D. Antithrombin III and D-dimer levels as indicators of disease severity in patients with hyperlipidaemic or biliary acute pancreatitis. J Int Med Res 2017; 45:147-158. [PMID: 28222624 PMCID: PMC5536593 DOI: 10.1177/0300060516677929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To assess changes in anticoagulation and fibrinolytic systems between biliary and hyperlipidaemic acute pancreatitis (AP). Methods Patients with biliary or hyperlipidaemic AP were enrolled. Demographic and clinical data were collected, and antithrombin III (ATIII), protein C, protein S, and D-dimer levels were investigated. Results A total of 45 patients with biliary AP and 50 patients with hyperlipidaemic AP were included (68 with mild AP and 27 with moderately-severe AP). ATIII and protein C levels in the mild AP group were significantly higher, but prothrombin time and D-dimer were significantly lower, versus the moderately-severe AP group. ATIII and D-dimer were found to be risk factors for moderately-severe AP. ATIII could predict AP severity, particularly in patients with biliary AP. D-dimer was a sensitive and specific predictor for disease severity in patients with AP, particularly in patients with hyperlipidaemic AP. Conclusion ATIII and protein C levels decreased as severity of AP increased, particularly in cases of biliary AP. D-dimer levels increased with severity of AP, particularly in hyperlipidaemic AP. ATIII and D-dimer may be useful biomarkers for assessing AP severity in patients with biliary and hyperlipidaemic AP, respectively.
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Affiliation(s)
- Ning Yang
- 1 Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianyu Hao
- 2 Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Donglei Zhang
- 2 Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Gill JR. Pancreatitis: A Forensic Perspective. Acad Forensic Pathol 2016; 6:237-248. [PMID: 31239895 DOI: 10.23907/2016.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/01/2016] [Accepted: 05/06/2016] [Indexed: 12/19/2022]
Abstract
Among the numerous etiologies of acute and chronic pancreatitis, several underlying causes (e.g., chronic alcohol abuse, trauma, medical therapy) may result in a death that is reportable to the medical examiner/coroner. As such, forensic pathologists are likely to encounter pancreatitis at autopsy and therefore must be familiar with its etiologies, mechanisms of death, autopsy findings, and medicolegal investigation. This review will focus on the aspects of pancreatitis that may be useful to forensic pathologists in their daily practice. This includes determining if acute or chronic pancreatitis caused or contributed to death as well as determining the etiologically specific proximate cause of death. Current theories of how these various processes result in inflammation of the pancreas are reviewed.
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Affiliation(s)
- James R Gill
- Connecticut Office of the Chief Medical Examiner
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Oz Atalay F, Aytac Vuruskan B, Vuruskan H. Significance of amyloid A immunoexpression in the prognosis of renal cell carcinoma. APMIS 2016; 124:257-62. [PMID: 26750935 DOI: 10.1111/apm.12499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/22/2015] [Indexed: 12/20/2022]
Abstract
The study investigated immunoexpression of amyloid A (AA) in clear cell renal cell carcinoma (CCRCC) and evaluated its clinicopathologic correlation, particularly in disease progression. Expression of AA protein was evaluated in patients with CCRCC by immunohistochemistry. 146 cancerous tissue samples from 86 male and 60 female patients were studied. The relationship between AA protein expression and TNM stage, nuclear grade, renal capsule invasion, perirenal invasion, and survival of the patients were assessed. Thirty four percent of CCRCC cases were AA positive. The positive AA immunoexpression was related to higher Fuhrman nuclear grade, presence of perirenal invasion of the tumor, and poor survival of patients with CCRCC. There was not any statistically significant difference between patients' gender, status of capsule invasion, and stages of the tumor in terms of AA immunoexpression. Tumor stage (Hazard ratio (HR) = 7.76 (95% CI: 2.43-24.8) for stage 3 and HR = 29.9 (95% CI: 6.97-128.32) for stage 4) and AA immunoexpression (HR = 2.16 (95% CI: 1.01-4.64) were found to be associated with survival of the patients with CCRCC in Cox regression analysis. Immunoexpression of AA was increased in high grade CCRCCs. Immunoexpression of AA was associated with poor survival in patients with CCRCC. Thus, AA staining might be used as a useful immunohistological marker for the prediction of poor prognosis in renal cell cancer.
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Affiliation(s)
- Fatma Oz Atalay
- Department of Surgical Pathology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Berna Aytac Vuruskan
- Department of Surgical Pathology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Hakan Vuruskan
- Department of Urology, Uludag University Faculty of Medicine, Bursa, Turkey
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Noel P, Patel K, Durgampudi C, Trivedi RN, de Oliveira C, Crowell MD, Pannala R, Lee K, Brand R, Chennat J, Slivka A, Papachristou GI, Khalid A, Whitcomb DC, DeLany JP, Cline RA, Acharya C, Jaligama D, Murad FM, Yadav D, Navina S, Singh VP. Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections. Gut 2016; 65:100-11. [PMID: 25500204 PMCID: PMC4869971 DOI: 10.1136/gutjnl-2014-308043] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Peripancreatic fat necrosis occurs frequently in necrotising pancreatitis. Distinguishing markers from mediators of severe acute pancreatitis (SAP) is important since targeting mediators may improve outcomes. We evaluated potential agents in human pancreatic necrotic collections (NCs), pseudocysts (PCs) and pancreatic cystic neoplasms and used pancreatic acini, peripheral blood mononuclear cells (PBMC) and an acute pancreatitis (AP) model to determine SAP mediators. METHODS We measured acinar and PBMC injury induced by agents increased in NCs and PCs. Outcomes of caerulein pancreatitis were studied in lean rats coadministered interleukin (IL)-1β and keratinocyte chemoattractant/growth-regulated oncogene, triolein alone or with the lipase inhibitor orlistat. RESULTS NCs had higher fatty acids, IL-8 and IL-1β versus other fluids. Lipolysis of unsaturated triglyceride and resulting unsaturated fatty acids (UFA) oleic and linoleic acids induced necro-apoptosis at less than half the concentration in NCs but other agents did not do so at more than two times these concentrations. Cytokine coadministration resulted in higher pancreatic and lung inflammation than caerulein alone, but only triolein coadministration caused peripancreatic fat stranding, higher cytokines, UFAs, multisystem organ failure (MSOF) and mortality in 97% animals, which were prevented by orlistat. CONCLUSIONS UFAs, IL-1β and IL-8 are elevated in NCs. However, UFAs generated via peripancreatic fat lipolysis causes worse inflammation and MSOF, converting mild AP to SAP.
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Affiliation(s)
- Pawan Noel
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Krutika Patel
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Chandra Durgampudi
- Departments of Medicine, University of Pittsburgh Medical Center, Pasavant, Pennsylvania, USA
| | - Ram N Trivedi
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Rahul Pannala
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kenneth Lee
- Departments of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Randall Brand
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Chennat
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam Slivka
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Asif Khalid
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David C Whitcomb
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James P DeLany
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel A Cline
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chathur Acharya
- Departments of Medicine, University of Pittsburgh Medical Center, Pasavant, Pennsylvania, USA
| | - Deepthi Jaligama
- Departments of Medicine, University of Pittsburgh Medical Center, Pasavant, Pennsylvania, USA
| | - Faris M Murad
- Departments of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Dhiraj Yadav
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Navina
- Departments of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vijay P Singh
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
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Popa CC, Badiu DC, Rusu OC, Grigorean VT, Neagu SI, Strugaru CR. Mortality prognostic factors in acute pancreatitis. J Med Life 2016; 9:413-418. [PMID: 27928447 PMCID: PMC5141403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of the study was to present the biological prognostic factors of mortality in patients with acute pancreatitis. Methods: Several usual laboratory values were monitored: glucose, urea, partial pressure of oxygen, WBC count, hemoglobin, total bilirubin, and cholesterol. A statistical analysis was performed by using ROC curves and AUC interpretation. Results: The overall mortality rate was 21.1% and was different depending on the severity of the disease. Only 2.22% of the patients with a mild disease died, as opposed to 45.63% of the patients with a severe form. All the analyses studied were significantly elevated in the deceased patients. A close correlation between blood glucose, urea, partial pressure of oxygen, WBC, hemoglobin, total bilirubin, and cholesterol and mortality was objectified by measuring the AUC, which was of 97.1%, 95.5%, 93.4%, 92.7%, 87.4%, 82.2%, and 79.0%. Conclusions: The usual, easy to use, fast, and cheap tests were useful in predicting mortality in patients with acute pancreatitis. Our study confirmed that the combination of several factors led to an accurate mortality prediction.
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Affiliation(s)
- CC Popa
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Department of Surgery, 2nd General Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - DC Badiu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Department of Surgery, General Surgery Clinic, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
| | - OC Rusu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Department of Surgery, 2nd General Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - VT Grigorean
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Department of Surgery, General Surgery Clinic, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
| | - SI Neagu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Department of Surgery, General Surgery Clinic, “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, Romania
| | - CR Strugaru
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Department of Medical Genetics, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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