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Silva-Vaz P, Abrantes AM, Castelo-Branco M, Gouveia A, Botelho MF, Tralhão JG. Murine Models of Acute Pancreatitis: A Critical Appraisal of Clinical Relevance. Int J Mol Sci 2019; 20:E2794. [PMID: 31181644 PMCID: PMC6600324 DOI: 10.3390/ijms20112794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
Acute pancreatitis (AP) is a severe disease associated with high morbidity and mortality. Clinical studies can provide some data concerning the etiology, pathophysiology, and outcomes of this disease. However, the study of early events and new targeted therapies cannot be performed on humans due to ethical reasons. Experimental murine models can be used in the understanding of the pancreatic inflammation, because they are able to closely mimic the main features of human AP, namely their histologic glandular changes and distant organ failure. These models continue to be important research tools for the reproduction of the etiological, environmental, and genetic factors associated with the pathogenesis of this inflammatory pathology and the exploration of novel therapeutic options. This review provides an overview of several murine models of AP. Furthermore, special focus is made on the most frequently carried out models, the protocols used, and their advantages and limitations. Finally, examples are provided of the use of these models to improve knowledge of the mechanisms involved in the pathogenesis, identify new biomarkers of severity, and develop new targeted therapies.
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Affiliation(s)
- Pedro Silva-Vaz
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
- General Surgery Department, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal.
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal.
| | - Ana Margarida Abrantes
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Miguel Castelo-Branco
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal.
| | - António Gouveia
- General Surgery Department, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal.
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal.
| | - Maria Filomena Botelho
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-548 Coimbra, Portugal.
| | - José Guilherme Tralhão
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-548 Coimbra, Portugal.
- Surgery Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal.
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Lin Q, JI Y, Chen Y, Sun H, Yang D, Chen A, Chen T, Zhang XM. Radiomics model of contrast‐enhanced MRI for early prediction of acute pancreatitis severity. J Magn Reson Imaging 2019; 51:397-406. [PMID: 31132207 DOI: 10.1002/jmri.26798] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Qiao Lin
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
- Medical Imaging and Department of RadiologyGaoping District People's Hospital of Nanchong Nanchong Sichuan China
| | - Yi‐fan JI
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
| | - Yong Chen
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
| | - Huan Sun
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
| | - Dan‐dan Yang
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
| | - Ai‐li Chen
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
| | - Tian‐wu Chen
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
| | - Xiao Ming Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of RadiologyAffiliated Hospital of North Sichuan Medical College Nanchong Sichuan China
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Wang F, Wen Q, Zhang S, Fu Z, Liu F, Cui J, Liu J, Tian H. Sustained bile drainage decreases the organs injuries via inflammation-associated factors modulation in a severe acute pancreatitis rat model. Exp Ther Med 2019; 17:4628-4634. [PMID: 31086593 DOI: 10.3892/etm.2019.7478] [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: 07/11/2018] [Accepted: 03/07/2019] [Indexed: 11/06/2022] Open
Abstract
The timely and effective treatment for severe acute pancreatitis (SAP) is favorable to prognosis. Decompression of the bile duct might be a feasible way to decrease the progression of SAP. The present study investigated the effects of sustained bile external drainage on organs injury caused by SAP in Sprague-Dawley (SD) rats and the mechanisms involved. A total of 72 female SD rats weighting 190-230 g were randomly divided into four groups (n=18): Sham operation group (SOG), SOG + bile drainage group (BDG), SAP group, and SAP + BDG. Sodium taurocholate solution (4%; 1 mg/kg body weight) was used to set up SAP model via injection of retrograde puncture of biliopancreatic duct through the duodenum. A cannula was inserted into the bile duct and fixed externally to establish BDG model. At each time points (t=3, 6, 12; n=6), tissues from the liver, lung, and pancreas, and blood samples were collected. Serum amylase (AMY) was analyzed in all the samples. The levels of tumor necrosis factor-α (TNF-α), heme oxygenase-1 (HO-1), interleukin-10 (IL-10) and high mobility group box 1 (HMGB1) were detected by ELISA. Hematoxylin-eosin staining was performed to observe the histopathological changes, and nuclear transcription factor (NF)-κB-p65 levels in the pancreas were analyzed by western blotting. The data indicated that BDG alleviated the SAP progression and multiple organs injuries. Meanwhile, the histopathological changes of the pancreas, liver, and lungs were improved by BDG. BDG decreased the pathological scores of pancreas significantly (P<0.05). The levels of AMY, TNF-α, HMGB1, and NF-κB-p65 were significantly downregulated by BDG (P<0.05), while the level of HO-1 was upregulated and IL-10 was unchanged. In summary, BDG may attenuate the multiple organs injuries caused by SAP via downregulation of TNF-α, HMGB1, NF-κB-p65 and upregulation of HO-1.
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Affiliation(s)
- Fuhai Wang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Qingbin Wen
- Department of Surgery, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Sai Zhang
- Department of Surgery, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Zhen Fu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Feng Liu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Jing Cui
- Department of Pathology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Ju Liu
- Laboratory of Microvascular Medicine, Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Hu Tian
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
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104
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Chatila AT, Bilal M, Guturu P. Evaluation and management of acute pancreatitis. World J Clin Cases 2019; 7:1006-1020. [PMID: 31123673 PMCID: PMC6511926 DOI: 10.12998/wjcc.v7.i9.1006] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/19/2018] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
Acute pancreatitis (AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately 390000 hospitalizations. The burden of AP is only expected to increase over time. Despite recent advances in medicine, pancreatitis continues to be associated with a substantial morbidity and mortality. The most common cause of AP is gallstones, followed closely by alcohol use. The diagnosis of pancreatitis is established with any two of three following criteria: (1) Abdominal pain consistent with that of AP; (2) Serum amylase and/or lipase greater than three times the upper limit of normal; and (3) Characteristics findings seen in cross-sectional abdominal imaging. Multiple criteria and scoring systems have been established for assessing severity of AP. The cornerstones of management include aggressive intravenous hydration, appropriate nutrition and pain management. Endoscopic retrograde cholangiopancreatography and surgery are important aspects in management of acute gallstone pancreatitis. We provide a comprehensive review of evaluation and management of AP.
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Affiliation(s)
- Ahmed T Chatila
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Praveen Guturu
- Division of Gastroenterology and Hepatology, the University of Texas Medical Branch, Galveston, TX 77555, United States
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Rodriguez-Nicolas A, Jiménez P, Carmona FD, Martín J, Matas Cobos AM, Ruiz-Cabello F, Redondo-Cerezo E. Association between Genetic Polymorphisms of Inflammatory Response Genes and Acute Pancreatitis. Immunol Invest 2019; 48:585-596. [DOI: 10.1080/08820139.2019.1576729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Antonio Rodriguez-Nicolas
- Servicio de Análisis Clínicos e Inmunología, UGC de Laboratorio Clínico, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Programa de doctorado en Biomedicina, Universidad de Granada, Granada, Spain
| | - Pilar Jiménez
- Servicio de Análisis Clínicos e Inmunología, UGC de Laboratorio Clínico, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - F. David Carmona
- Departamento de Genética e Instituto de Biotecnología, Universidad de Granada, Granada, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina López Neyra, CSIC, Granada, Spain
| | - Ana M. Matas Cobos
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Francisco Ruiz-Cabello
- Servicio de Análisis Clínicos e Inmunología, UGC de Laboratorio Clínico, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Eduardo Redondo-Cerezo
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
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106
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Wan J, Yang X, He W, Zhu Y, Zhu Y, Zeng H, Liu P, Xia L, Lu N. Serum D-dimer levels at admission for prediction of outcomes in acute pancreatitis. BMC Gastroenterol 2019; 19:67. [PMID: 31046705 PMCID: PMC6498652 DOI: 10.1186/s12876-019-0989-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Systemic alterations in coagulation are associated with complications of acute pancreatitis (AP). D-dimer, a fibrin degradation product, was recently described as a marker of pancreatitis outcome. Early prediction is essential for reducing mortality in AP. The present study aims to assess the relationship between elevated serum D-dimer levels and the severity of AP. METHODS We performed an observational retrospective study with data from 3451 enrolled patients with AP. Serum D-dimer levels were measured upon admission, after 24 h and during the week after admission by immunoturbidimetry. Univariate and multivariate analyses were used to determine whether elevated D-dimer levels were independently associated with the severity of AP. RESULTS Of the 3451 AP patients, 2478 (71.8%) had serum D-dimer levels measured within 24 h of hospital admission; 1273 of these patients had D-dimer levels ≤2.5 mg/L, and 1205 had D-dimer levels > 2.5 mg/L (934 patients had mild AP (MAP); 1086, moderately severe AP (MSAP); and 458, severe AP (SAP)). Patients with D-dimer levels > 2.5 mg/L (n = 1205) had higher incidences of SAP (75.5% vs. 24.5%), acute peripancreatic fluid collection (APFC) (53.3% vs. 46.7%), acute necrotic collection (ANC) (72.4% vs. 27.6%), pancreatic necrosis (PN) (65.2% vs. 34.8%), infected pancreatic necrosis (IPN) (77.7% vs. 22.8%), organ failure (OF) (68.5% vs. 31.5%), persistent organ failure (POF) (75.5% vs. 24.5%), ICU requirement (70.2% vs. 29.8%), and mortality (79.2% vs. 20.8%) than did patients with D-dimer levels ≤2.5 mg/L (n = 1273). The multivariate analysis showed that patients with higher serum D-dimer levels had poorer prognoses that worsened over time. CONCLUSION The measurement of D-dimer levels at admission may be useful for risk stratification of AP.
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Affiliation(s)
- Jianhua Wan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Xiaoyu Yang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Wenhua He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Yong Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Hao Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Pi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Liang Xia
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China.
| | - Nonghua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, People's Republic of China
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Liu C, Zhou X, Ling L, Chen S, Zhou J. Prediction of mortality and organ failure based on coagulation and fibrinolysis markers in patients with acute pancreatitis: A retrospective study. Medicine (Baltimore) 2019; 98:e15648. [PMID: 31124944 PMCID: PMC6571240 DOI: 10.1097/md.0000000000015648] [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: 12/07/2018] [Revised: 04/07/2019] [Accepted: 04/19/2019] [Indexed: 02/05/2023] Open
Abstract
This study explored the predictive value of coagulation and fibrinolysis markers with acute pancreatitis (AP)-related mortality and organ failure.We retrospectively reviewed and analyzed coagulation and fibrinolysis markers and clinical outcomes of the patients with AP.A total of 273 patients with AP were enrolled, 7 patients died and 28 patients suffered from organ failure. Uni- and multivariate logistic regression identified the differences of all of the coagulation and fibrinolysis markers as risk factors for AP-related mortality. The differences of APTT value, TT value, D-dimmer level, FDP level, and AT III level were risk factors for organ failure. Furthermore, the OR of the differences of platelet, PT, APTT, TT, fibrinogen, D-dimmer, FDP, and AT III was substantially improved by grouping with intervals of 10 × 10/L, 2 seconds, 5 seconds, 3 seconds, 0.5 g/L, 3 mg/L FEU, 5 mg/L and 10%, respectively. The risk of mortality can increase up to 1.62, 5.17, and 5.60 fold for every 10 × 10/L, 2 seconds and 5 seconds of increase in platelet, PT and APTT, respectively. There is approximate 2-fold increase in risk of organ failure for every 2 seconds of TT increase. In receiver operating characteristic analysis, there is no difference in the predictive power of bedside index for severity in acute pancreatitis (BISAP) with them in mortality or organ failure.In patients with AP, the dynamic changes of coagulation and fibrinolysis markers are good predictors for AP-related mortality and organ failure, especially platelet, PT and APTT in mortality and TT in organ failure.
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Affiliation(s)
- Chaonan Liu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu
| | - Xinfeng Zhou
- Department of Laboratory Medicine, Stone Forest Tianqi Hospital of the Second Affiliated Hospital, Kunming Medical University, Stone Forest County, Kunming City, China
| | - Liqin Ling
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu
| | - Si Chen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu
| | - Jing Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu
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Rashid MU, Hussain I, Jehanzeb S, Ullah W, Ali S, Jain AG, Khetpal N, Ahmad S. Pancreatic necrosis: Complications and changing trend of treatment. World J Gastrointest Surg 2019; 11:198-217. [PMID: 31123558 PMCID: PMC6513789 DOI: 10.4240/wjgs.v11.i4.198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.
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Affiliation(s)
- Mamoon Ur Rashid
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Ishtiaq Hussain
- Department of Gastroenterology, Cleveland Clinic, Weston, FL 33326, United States
| | - Sundas Jehanzeb
- Department of Gastroenterology, Cleveland Clinic, Weston, FL 33326, United States
| | - Waqas Ullah
- Internal Medicine, Abington Hospital, Abington, PA 19001, United States
| | - Saeed Ali
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Akriti Gupta Jain
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Neelam Khetpal
- Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
| | - Sarfraz Ahmad
- Department of Gynecologic Oncology, Advent Health Cancer Institute, Orlando, FL 32804, United States
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Pu WL, Bai RY, Zhou K, Peng YF, Zhang MY, Hottiger MO, Li WH, Gao XM, Sun LK. Baicalein attenuates pancreatic inflammatory injury through regulating MAPK, STAT 3 and NF-κB activation. Int Immunopharmacol 2019; 72:204-210. [PMID: 30999210 DOI: 10.1016/j.intimp.2019.04.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis (AP) is a common acute abdominal disease with local or systemic inflammatory response, caused by abnormal activation of digestive enzymes. Baicalein has been shown to exert anti-inflammatory effects and to attenuate the pathological changes of AP. The aim of the research was to investigate the effects of baicalein on caerulein induced pancreatitis, and to elucidate the putative underlying mechanism. In this study, the therapeutic potential of baicalein and its mechanism were investigated in a caerulein-induced AP in vivo and in vitro model. The results indicate that baicalein treatment alleviates the caerulein-induced pathological damage in the pancreas. Baicalein decreased the expression level of pro-inflammatory cytokines and chemokines of the pancreas in caerulein treated mice and of isolated pancreatic acinar cells. Moreover, baicalein inhibited the expression of NF-κB p65 and the phosphorylation of p38 MAPK, ERK (extracellular signal-regulated kinase) as well as STAT 3, which indicates that baicalein exerts its anti-inflammatory effects via dampening the NF-κB, MAPK and STAT 3 signaling pathways. Together, this study provides experimental evidence for the clinical application of Scutellaria baicalensis Georgi or baicalein and indicates that baicalein may be a promising candidate for treatment of AP patients in the future.
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Affiliation(s)
- Wei-Ling Pu
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Chinese Medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Ru-Yu Bai
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Kun Zhou
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Chinese Medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yan-Fei Peng
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Meng-Ying Zhang
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Micheal O Hottiger
- Department of Molecular Mechanisms of Disease, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Wen-Hua Li
- College of Medicine, Xizang Minzu University (Tibetan National University), Xianyang 712082, Shaanxi, China
| | - Xiu-Mei Gao
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Tianjin Key Laboratory of Chinese Medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Li-Kang Sun
- Tianjin Key Laboratory of Chinese Medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
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Hou S, Tang X, Cui H, Liu C, Bai X, Shi L, Shi Y. Fatty liver disease is associated with the severity of acute pancreatitis:A systematic review and meta-analysis. Int J Surg 2019; 65:147-153. [PMID: 30986497 DOI: 10.1016/j.ijsu.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/21/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatty liver (FL) has been positively associated with the risk of acute pancreatitis (AP), but whether FL is associated with the severity of AP remains unknown. To this, a meta-analysis was conducted to assess the effect of FL on severity and outcomes of AP. METHOD We searched PubMed, EMBASE and the Cochrane library to identify all eligible studies (up to June 2017). We pooled the odds ratios (ORs) or weighted mean differences (WMD) from individual studies using a random-effects model to investigate associations between FL and the prognosis of AP. RESULT Four studies were included in the meta-analysis, including a total of 805 patients with fatty liver-related acute pancreatitis (FLAP) and 1026 patients with non fatty liver-related acute pancreatitis (NFLAP). The incidences of moderately severe AP (MSAP) (OR = 2.72, 95%CI: 1.82-4.05, P < 0.001) and severe AP (SAP) (OR = 3.57, 95%CI: 2.06-6.18, P < 0.001) were statistically significantly higher in FLAP group than those in NFLAP group. Taking obesity into consideration, a higher rate of MSAP and SAP were also found in patients with FL, no matter whether they were obese or not. Furthermore, mortality (OR = 4.16, 95%CI: 2.57-6.73, P < 0.001), systemic inflammatory response syndrome (SIRS) (OR = 2.82, 95%CI: 2.3-3.47, P < 0.001) and local complications were also statistically significantly higher in the FLAP group than in NFLAP group. CONCLUSION Fatty liver is associated with the severity of acute pancreatitis.
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Affiliation(s)
- Sen Hou
- Department of General Surgery, Xuchang Central Hospital, Henan, China
| | - Xinya Tang
- Department of General Surgery, Xuchang Central Hospital, Henan, China
| | - Huxiao Cui
- Department of General Surgery, Xuchang Central Hospital, Henan, China
| | - Chaoxu Liu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 201907, China
| | - Xiangyu Bai
- Institute of Pharmacy, Pharmaceutical College of Henan University, 85 Minglun Street, Kaifeng, Henan, 475001, China
| | - Liubin Shi
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 201907, China
| | - Yong Shi
- Department of General Surgery, Xuchang Central Hospital, Henan, China.
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Kosekli MA, Herek Ö, Ozmen Ö, Sahinduran S. Ameliorative effect of certolizumab on experimentally induced acute necrotic pancreatitis in rats. ACTA ACUST UNITED AC 2019; 65:204-210. [PMID: 30892445 DOI: 10.1590/1806-9282.65.2.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The effects of Certolizumab, a pegylated monoclonal antibody to tumor necrosis factor α, on experimentally induced acute pancreatitis (AP) were examined. METHODS Thirty-six Wistar Albino male rats were randomly divided into four groups. Group I was the control group and no medication administered to this group. Group II was the Certolizumab group, and 100 ml/kg serum physiologic administered into the biliopancreatic duct and a single dose of 10 μg Certolizumab was simultaneously administered intraperitoneally. Acute pancreatitis was induced with a retrograde injection of 3% Na taurocholate into the common biliopancreatic duct in the study (Group III) and treatment (Groups IV) groups. Rats were sacrificed 72 hours later. Serum amylase, lipase, lactate dehydrogenase activities, along with pancreatic histopathology, were examined. RESULTS Certolizumab treatment significantly decreased serum amylase, lipase, and LDH levels; histopathologically edema, hemorrhage, parenchymal necrosis, fat necrosis, and infiltration scores; immunohistochemically MDA, MPO, TNF-α and Caspase-3 activity. CONCLUSION The results support the idea that certolizumab might be beneficial for the severity of AP.
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Affiliation(s)
| | - Özkan Herek
- Department of Children Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Özlem Ozmen
- Department of Pathology, Faculty of Veterinary Medicine, Mehmet Akif Ersoy University, Burdur, Turkey
| | - Sima Sahinduran
- Department of Internal Medicine, Faculty of Veterinary Medicine, Mehmet Akif Ersoy University, Burdur, Turkey
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Xu WB, Hu QH, Wu CN, Fan ZK, Song ZF. Serum soluble fibrinogen-like protein 2 concentration predicts delirium after acute pancreatitis. Brain Behav 2019; 9:e01261. [PMID: 30884164 PMCID: PMC6456778 DOI: 10.1002/brb3.1261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Inflammation can cause delirium. Soluble fibrinogen-like protein 2 (sFGL2) is a modulator of the immune response and more recently found to be a biomarker for brain injury. This study was designed to discover the predictive capability of serum sFGL2 concentrations for delirium after acute pancreatitis (AP). MATERIALS AND METHODS In this prospective, observational study, serum sFGL2 concentrations were quantified in 184 healthy controls and in 184 AP patients. Disease severity was assessed by Acute Physiology and Chronic Health Care Evaluation II score, Ranson score, multiple organ dysfunction score, and sequential organ failure assessment score. Delirium was recorded during hospital stay. Predictors of delirium were identified using multivariate analysis. RESULTS Serum sFGL2 concentrations were substantially higher in AP patients than in controls. Serum sFGL2 concentrations were intimately correlated with the preceding severity parameters. Serum sFGL2 and the aforementioned severity parameters were independent predictors for delirium. Under receiver operating characteristic curve, the discriminatory ability of serum sFGL2 was equivalent to those of the above-mentioned severity parameters. Moreover, serum sFGL2 dramatically improved the predictive value of the aforementioned severity parameters. CONCLUSIONS Elevation of serum sFGL2 concentrations is strongly associated with the AP severity and has the potential to distinguish delirium after AP.
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Affiliation(s)
- Wen-Bin Xu
- Department of General Surgery, The Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Qian-Hua Hu
- Department of General Surgery, The Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Chan-Ni Wu
- Department of Gastroenterology, The Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Zhi-Kun Fan
- Department of General Surgery, The Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Zhang-Fa Song
- Department of Anorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Acute Pancreatitis Caused by Tamoxifen-Induced Severe Hypertriglyceridemia After 4 Years of Tamoxifen Use. ACG Case Rep J 2019; 6:1-3. [PMID: 31157284 PMCID: PMC6657993 DOI: 10.14309/crj.0000000000000025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/20/2018] [Indexed: 01/18/2023] Open
Abstract
We report a case of a 55-year-old woman with hypertension and diabetes mellitus, who took tamoxifen for the past 4 years. She presented with acute pancreatitis caused by markedly elevated serum triglycerides (3,883 mg/dL). Tamoxifen is known to cause a mild increase in serum triglycerides, but it rarely increases to such high levels to cause acute pancreatitis. The patient recovered well, and tamoxifen was switched to letrozole. It is crucial to monitor serum lipids up to 4 years and beyond for patients on tamoxifen, particularly in patients with known dyslipidemia or diabetes mellitus.
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Kothari S, Kalinowski M, Kobeszko M, Almouradi T. Computed tomography scan imaging in diagnosing acute uncomplicated pancreatitis: Usefulness vs cost. World J Gastroenterol 2019; 25:1080-1087. [PMID: 30862996 PMCID: PMC6406186 DOI: 10.3748/wjg.v25.i9.1080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Literature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis (AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography (CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis (AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of AUP.
AIM To assess the overutilization and associated cost of CT imaging among patients meeting diagnostic criteria for AUP.
METHODS In this Institutional Review Board-approved retrospective, single-center study, we identified all adult patients admitted with AP from January 1, 2012 through October 1, 2017. Patients were identified via International Classification of Diseases (ICD-9) code for AP (577.0) and ICD-10 codes for different etiological AP (K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria (presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal). Ranson criteria and BISAP scores on presentation were calculated and patients that met scores less than or equal to 2 for both were included to suggest AUP. The utilization and cost of imaging in these patients were recorded.
RESULTS Between January 2012 and October 2017, 1305 patients presented to the emergency department with AP, and 405 patients (31%) met our inclusion criteria for AUP (201 males, 204 females; mean age 49 years, range 18-98). Of those, 210 patients (51.85%) underwent CT imaging. One patient (0.47%) had evidence of pancreatic necrosis, one patient had cyst formation (0.47%), and the remaining 208 patients (99.05%) had either normal CT scan imaging or findings consistent with mild AP without necrosis. The average cost of CT scan imaging was $4510 with a total cost of $947056. Median length of hospitalization stay was 3 d among both groups. Combining Ranson’s Criteria and BISAP score identified AUP in our patient population with an accuracy of 99.5%.
CONCLUSION CT imaging is unnecessary when AUP is diagnosed clinically and biochemically. Reducing overuse of diagnostic CT scans will decrease healthcare expenditure and radiation exposure to patients.
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Affiliation(s)
- Shana Kothari
- Department of Internal Medicine, University of Illinois at Chicago - Advocate Christ Medical Center, Oak Lawn, IL 60453, United States
| | - Michael Kalinowski
- Department of Internal Medicine, University of Illinois at Chicago - Advocate Christ Medical Center, Oak Lawn, IL 60453, United States
| | - Matthew Kobeszko
- Department of Internal Medicine, University of Illinois at Chicago - Advocate Christ Medical Center, Oak Lawn, IL 60453, United States
| | - Tarek Almouradi
- Department of Gastroenterology, Advocate Christ Medical Center, Oak Lawn, IL 60453, United States
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Abstract
Acute pancreatitis (AP) has an annual incidence of 30-45 per 100,000 inhabitants. In Germany approximately one third of the cases are of biliary or alcoholic origin. The diagnosis is based on the typical epigastric pain with radiation and a threefold increase of lipase or amylase in serum. Imaging procedures only rarely need to be included for the primary diagnostics. An early risk assessment is important to be able to allocate patients with severe AP to surveillance in an intensive care unit (ICU). Elevation of blood urea nitrogen, hematocrit and blood glucose are early predictors of poor outcome.The removal of impacted gall-stones by endoscopic retrograde cholangiography (ERC) is the only causal treatment of biliary AP, which must be carried out when there are signs of cholangitis and in severe biliary AP. Pain management and early fluid substitution are the most important symptomatic approaches. In the early phase of AP 150-250 ml/h of crystalloid solution should be administered to compensate for the extravasal loss of fluid. In certain cases, the initial fluid requirement might be even higher. In the ICU setting echocardiography and advanced hemodynamic monitoring are available for guidance. Prophylactic antibiotic treatment is not recommended in mild AP and it is a matter of debate even in severe AP. Early enteral nutrition has been shown to improve the outcome. Even in cases of fluid collection and necrosis a primary surgery approach should be avoided in favor of a "step-up" procedure with radiologically guided drainage as well as endoscopic and if necessary video-assisted percutaneous retroperitoneal débridement. Surgery remains an option for complications and for infected necrosis which cannot be reached by any other means.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Universitätsklinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Hana Algül
- Medizinische Klinik und Poliklinik II, Universitätsklinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Yamashita T, Horibe M, Sanui M, Sasaki M, Sawano H, Goto T, Ikeura T, Hamada T, Oda T, Yasuda H, Ogura Y, Miyazaki D, Hirose K, Kitamura K, Chiba N, Ozaki T, Koinuma T, Oshima T, Yamamoto T, Hirota M, Masuda Y, Tokuhira N, Kobayashi M, Saito S, Izai J, Lefor AK, Iwasaki E, Kanai T, Mayumi T. Large Volume Fluid Resuscitation for Severe Acute Pancreatitis is Associated With Reduced Mortality: A Multicenter Retrospective Study. J Clin Gastroenterol 2019; 53:385-391. [PMID: 29688917 DOI: 10.1097/mcg.0000000000001046] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Although fluid resuscitation is critical in acute pancreatitis, the optimal fluid volume is unknown. The aim of this study is to evaluate the association between the volume of fluid administered and clinical outcomes in patients with severe acute pancreatitis (SAP). METHODS We conducted a multicenter retrospective study at 44 institutions in Japan. Inclusion criteria were age 18 years or older, and diagnosed with SAP from 2009 to 2013. Patients were stratified into 2 groups: administered fluid volume <6000 and ≥6000 mL in the first 24 hours. We evaluated the association between the 2 groups and clinical outcomes using multivariable logistic regression analysis. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of pancreatic infection and the need for surgical intervention. RESULTS We analyzed 1097 patients, and the mean fluid volume administered was 5618±3018 mL (mean±SD), with 708 and 389 patients stratified into the fluid <6000 mL and fluid ≥6000 mL groups, respectively. Overall in-hospital mortality was 12.3%. The fluid ≥6000 mL group had significantly higher mortality than the fluid <6000 mL group (univariable analysis, 15.9% vs. 10.3%; P<0.05). In multivariable logistic regression analysis, administration of ≥6000 mL of fluid within the first 24 hours was significantly associated with reduced mortality (odds ratio, 0.58; P<0.05). No significant association was found between the administered fluid volume and pancreatic infection, or between the volume administered and the need for surgical intervention. CONCLUSIONS In patients with SAP, administration of a large fluid volume within the first 24 hours is associated with decreased mortality.
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Affiliation(s)
- Takahiro Yamashita
- Emergency Medical Center, Fukuyama City Hospital, Zao-cho, Fukuyama City
- Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, Kanno-cho, Kakogawa City, Hyogo
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Musashidai, Fuchu City
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Amanumacho, Omiya-ku, Saitama
| | - Mitsuhito Sasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Tsukumodai, Suita
| | - Takashi Goto
- Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, Motomachi, Naka-ku, Hiroshima City, Hiroshima
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Shinmachi, Hirakata
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku
| | - Takuya Oda
- Department of General Internal Medicine, Iizuka Hospital, Yoshiomachi, Iizuka-shi
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Kyounancho, Musashino City
| | - Yuki Ogura
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Musashidai, Fuchu City
| | - Dai Miyazaki
- Advanced Emergency Medical and Critical Care Center, Japanese Red Cross Maebashi Hospital, Asahi-cho, Maebashi City, Gunma
| | - Kaoru Hirose
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Okamoto, Kamakura City, Kanagawa
| | - Katsuya Kitamura
- Division of Gastroentelology, Department of Medicine, Showa University School of Medicine, Hatanodai, Shinagawa-ku
| | - Nobutaka Chiba
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Kanda-Surugadai, Chiyoda-ku
| | - Tetsu Ozaki
- Department of Acute care and General Medicine, Saiseikai Kumamoto Hospital, Chikami, minami-ku, Kumamoto city, Kumamoto
| | - Toshitaka Koinuma
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba City, Chiba
| | - Tomonori Yamamoto
- Department of Traumatology and Critical Care Medicine, Osaka City University, Asahimachi, Abenoku, Osaka City, Osaka
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku University Hospital, Seiryo-cho, Aoba-ku
| | - Yukiko Masuda
- Emergency and Critical Care Center, National Hospital Organization Nagasaki Medical Center, Kubara, Omura, Nagasaki
| | - Natsuko Tokuhira
- Division of Intensive Care Medicine, University Hospital, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Mioko Kobayashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Kotobashi, Sumida-ku
| | - Shinjiro Saito
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Nishi-Shinbashi, Minato-ku, Tokyo
| | - Junko Izai
- Department of Surgery, Saka General Hospital, Nishiki-cho, Shiogama City, Miyagi
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka, Yahata Nishi, KitaKyushu, Fukuoka
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Shi J, Deng Q, Li Y, Zheng Z, Shangguan H, Li L, Huang F, Tang B. Homogeneous probing of lipase and α-amylase simultaneously by AIEgens. Chem Commun (Camb) 2019; 55:6417-6420. [DOI: 10.1039/c9cc01959f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An AIE dual-reactive supramolecular probe has been devised to simultaneously measure endogenous lipase and α-amylase activity in a homogeneous system. Fluorescence quantitative analysis of lipase and α-amylase in real biological samples enables rapid and accurate diagnosis of diseases.
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Affiliation(s)
- Jie Shi
- Hubei Key Laboratory of Lipid Chemistry and Nutrition
- Key Laboratory of Oilseeds Processing
- Ministry of Agriculture
- Oil Crops Research Institute
- Chinese Academy of Agricultural Sciences
| | - Qianchun Deng
- Hubei Key Laboratory of Lipid Chemistry and Nutrition
- Key Laboratory of Oilseeds Processing
- Ministry of Agriculture
- Oil Crops Research Institute
- Chinese Academy of Agricultural Sciences
| | - Ya Li
- Hubei Key Laboratory of Lipid Chemistry and Nutrition
- Key Laboratory of Oilseeds Processing
- Ministry of Agriculture
- Oil Crops Research Institute
- Chinese Academy of Agricultural Sciences
| | - Zhe Zheng
- Department of Modern Physics
- University of Science and Technology of China
- Hefei 230026
- China
| | - Huijuan Shangguan
- Hubei Key Laboratory of Lipid Chemistry and Nutrition
- Key Laboratory of Oilseeds Processing
- Ministry of Agriculture
- Oil Crops Research Institute
- Chinese Academy of Agricultural Sciences
| | - Lu Li
- College of Chemistry
- Chemical Engineering and Materials Science
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
| | - Fenghong Huang
- Hubei Key Laboratory of Lipid Chemistry and Nutrition
- Key Laboratory of Oilseeds Processing
- Ministry of Agriculture
- Oil Crops Research Institute
- Chinese Academy of Agricultural Sciences
| | - Bo Tang
- College of Chemistry
- Chemical Engineering and Materials Science
- Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong
- Key Laboratory of Molecular and Nano Probes
- Ministry of Education
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Shi C, Hou C, Zhu X, Peng Y, Guo F, Zhang K, Huang D, Li Q, Miao Y. New Predictor of Organ Failure in Acute Pancreatitis: CD4+ T Lymphocytes and CD19+ B Lymphocytes. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1012584. [PMID: 30627533 PMCID: PMC6304548 DOI: 10.1155/2018/1012584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/06/2018] [Accepted: 11/25/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Lymphocytes are one of the main effector cells in the inflammatory response of acute pancreatitis (AP). The purpose of the study was to evaluate whether peripheral blood lymphocyte (PBL) subsets at admission change during AP based on clinical outcomes and to explore whether these changes vary by aetiology of AP. Hence, we performed a prospective study to find a predictor in lymphocyte subsets that might allow easier, earlier, and more accurate prediction of clinical outcomes. METHODS Patients with AP were enrolled from December 2017 to June 2018 at the First Affiliated Hospital of Nanjing Medical University. Age, sex, clinical and biochemical parameters, and aetiology of AP were obtained at admission. PBL counts were assessed within 24 hours after admission. Clinical outcomes were observed as endpoints. The areas under the curve (AUCs) of different predictors were calculated using the receiver operating characteristic (ROC) curve. RESULTS Overall, 133 patients were included. Patients (n=24) with organ failure (OF) had significantly lower CD4+ T lymphocyte levels than those (n=109) with No OF (NOF) (39.60 (33.94-46.13) vs. 32.41 (26.51-38.00), P=0.004). The OF group exhibited significantly higher CD19+ B lymphocytes than the NOF group (16.07 (10.67-21.06) vs. 23.78 (17.84-29.45), P=0.001). Of the AP cases, 68.8% were caused by gallstones; 10.1% were attributed to alcohol; 16.5% were due to hyperlipidaemia; and 4.6% had other causes. Across all aetiologies, a lower CD4+ T lymphocyte level was significantly related to OF (P<0.05). However, CD19+ B lymphocytes were significant only in gallstone pancreatitis (P<0.05). The ROC curve results showed that the AUC values of CD4+T lymphocytes, CD19+ B lymphocytes, and combined CD4+T lymphocytes and CD19+ B lymphocytes were similar to those of traditional scoring systems, such as APACHEII and Ranson. CONCLUSIONS CD4+ T and CD19+ B lymphocytes during the early phase of AP can predict OF.
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Affiliation(s)
- Chenyuan Shi
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Chaoqun Hou
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiaole Zhu
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yunpeng Peng
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Feng Guo
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Kai Zhang
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Dongya Huang
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qiang Li
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yi Miao
- Pancreas Centre, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, Province, China
- Pancreas Institute, Nanjing Medical University, Nanjing, Jiangsu Province, China
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Qiu L, Zhou Y, Yu Q, Yu J, Li Q, Sun R. Decreased levels of regulatory B cells in patients with acute pancreatitis: association with the severity of the disease. Oncotarget 2018; 9:36067-36082. [PMID: 30546828 PMCID: PMC6281415 DOI: 10.18632/oncotarget.23911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/03/2017] [Indexed: 12/23/2022] Open
Abstract
Early stratification of the severity of acute pancreatitis (AP) is clinically important. Regulatory B cells have been found to be associated with disease activity of autoimmune diseases. However, the role of Regulatory B cells in AP remains unknown. We investigate the dynamic longitudinal changes in circulating IL-10-producing B cells (B10) and memory CD19+CD24hiCD27hi cells in patients with AP to evaluate their prediction utility for AP severity. B10, CD19+CD24hiCD27hi cells, inflammatory markers and cytokines were detected in patients with AP immediately after admission to the hospital (day 1), then on the third and seventh days. We observed decreases in lymphocytes, CD19+, B10, CD19+CD24hiCD27hi cells and lower mean fluorescence intensity (MFI) of CD80 and CD86 on B10 or CD19+CD24hiCD27hi cells in patients with AP, especially in those with severe acute pancreatitis (SAP). CD19+CD24hiCD27hi cells from patients with AP suppressed the cytokine productions of CD4+ T cells and CD14+ monocytes, but had impaired ability to induce regulatory T cells response. B10 and CD19+CD24hiCD27hi cells significantly increased in patients with mild acute pancreatitis (MAP) from day 1 to day 7, whereas these indexes remained stable in patients with SAP. B10 or CD19+CD24hiCD27hi cells were negatively correlated with the severity index (APACHE II score), inflammatory markers (C-reactive protein, CD64 index), and cytokines (IL-6, IL-17, TNF-α). Furthermore, receiver operating characteristic (ROC) curve analysis revealed that B10 and CD19+CD24hiCD27hi cells could predict the development of SAP. Thus, the detection of B10 and CD19+CD24hiCD27hi cells may be a practical way to improve the early assessment of AP severity.
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Affiliation(s)
- Liannv Qiu
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310004, China
| | - Yonglie Zhou
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310004, China
| | - Qinghua Yu
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310004, China
| | - Junde Yu
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310004, China
| | - Qian Li
- Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310004, China
| | - Renhua Sun
- Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310004, China
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120
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Okuda A, Ogura T, Imanishi M, Miyano A, Nishioka N, Higuchi K. Clinical Impact of Recombinant Soluble Thrombomodulin for Disseminated Intravascular Coagulation Associated with Severe Acute Cholangitis. Gut Liver 2018; 12:471-477. [PMID: 29699063 PMCID: PMC6027841 DOI: 10.5009/gnl17489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background/Aims Recently, recombinant human soluble thrombomodulin (rTM) has been developed as a new drug for disseminated intravascular coagulation (DIC). This study aims to evaluate the clinical benefit of rTM in patients with sepsis-induced DIC caused by acute cholangitis who underwent biliary drainage. Methods Patients were divided into two groups: the rTM therapy group and the non-rTM therapy group. The primary outcome was the DIC resolution rate at 7 days, and the secondary outcome was 28-day mortality rate. Results Thirty-five patients were treated by rTM, and 36 patients were treated without rTM for DIC. The rate of resolution of DIC at day 7 was significantly higher in the rTM group than in the non-rTM group (82.9% vs 55.6%, p=0.0012). Compared with the non-rTM group, the 28-day survival rate of the r-TM group was significantly higher (rTM vs non-rTM, 91.4% vs 69.4%, p=0.014). According to multivariate analysis, non-rTM (hazard ratio [HR], 2.681) and CRP (HR, 2.370) were factors related to decreased survival. Conclusions rTM treatment may have a positive impact on improving DIC and survival rates in patients with severe acute cholangitis.
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Affiliation(s)
- Atsushi Okuda
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Miyuki Imanishi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Akira Miyano
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Nobu Nishioka
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
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Shi J, Deng Q, Li Y, Zheng M, Chai Z, Wan C, Zheng Z, Li L, Huang F, Tang B. A Rapid and Ultrasensitive Tetraphenylethylene-Based Probe with Aggregation-Induced Emission for Direct Detection of α-Amylase in Human Body Fluids. Anal Chem 2018; 90:13775-13782. [DOI: 10.1021/acs.analchem.8b04244] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jie Shi
- Hubei Key Laboratory of Lipid Chemistry and Nutrition, Key Laboratory of Oilseeds Processing, Ministry of Agriculture, Oil Crops Research Institute, Chinese Academy of Agricultural Sciences, Wuhan 430062, China
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Shandong Provincial Key Laboratory of Clean Production of Fine Chemicals, Shandong Normal University, Jinan 250014, China
| | - Qianchun Deng
- Hubei Key Laboratory of Lipid Chemistry and Nutrition, Key Laboratory of Oilseeds Processing, Ministry of Agriculture, Oil Crops Research Institute, Chinese Academy of Agricultural Sciences, Wuhan 430062, China
| | - Ya Li
- Hubei Key Laboratory of Lipid Chemistry and Nutrition, Key Laboratory of Oilseeds Processing, Ministry of Agriculture, Oil Crops Research Institute, Chinese Academy of Agricultural Sciences, Wuhan 430062, China
| | - Mingming Zheng
- Hubei Key Laboratory of Lipid Chemistry and Nutrition, Key Laboratory of Oilseeds Processing, Ministry of Agriculture, Oil Crops Research Institute, Chinese Academy of Agricultural Sciences, Wuhan 430062, China
| | - Zhaofei Chai
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, The Chinese Academy of Sciences, Wuhan 430071, China
| | - Chuyun Wan
- Hubei Key Laboratory of Lipid Chemistry and Nutrition, Key Laboratory of Oilseeds Processing, Ministry of Agriculture, Oil Crops Research Institute, Chinese Academy of Agricultural Sciences, Wuhan 430062, China
| | - Zhe Zheng
- Department of Modern Physics, University of Science and Technology of China, Hefei 230026, China
| | - Lu Li
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Shandong Provincial Key Laboratory of Clean Production of Fine Chemicals, Shandong Normal University, Jinan 250014, China
| | - Fenghong Huang
- Hubei Key Laboratory of Lipid Chemistry and Nutrition, Key Laboratory of Oilseeds Processing, Ministry of Agriculture, Oil Crops Research Institute, Chinese Academy of Agricultural Sciences, Wuhan 430062, China
| | - Bo Tang
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Shandong Provincial Key Laboratory of Clean Production of Fine Chemicals, Shandong Normal University, Jinan 250014, China
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Abstract
OBJECTIVE The aim of this study was to determine the prevalence and type of thyroid hormone levels alterations in patients with acute pancreatitis (AP) and analyze if variations are useful AP progression predictors. METHODS Three groups of patients were analyzed: AP patients (n = 90), abdominal pain patients (n = 30), and healthy control subjects (n = 40). Usual blood parameters for AP diagnosis and prognosis, thyroid-stimulating hormone (or thyrotropin), FT4 (free thyroxine), FT3 (free triiodothyronine), and TT3 (total triiodothyronine) levels were analyzed. RESULTS Thyroid hormone level alterations were detected only within the AP group (41% of total cases), being the reduction in T3 levels the most frequently detected deviation (15.6% of FT3 and 8.3% of TT3 cases). Alterations were not influenced by age or sex. Free thyroxine average values were also significantly higher in the AP group, compared with the healthy control group (P = 0.0005), resulting as independent predictors of both severity and mortality. Mortality in this group was 50%, with deceased patients showing FT4 levels above the reference limit. CONCLUSIONS Our results show that FT4 level determination during the initial clinical evaluation of patients admitted to the emergency service with AP can be included as a severity indicator to help determine the differential care of these cases.
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Nivy R, Kaplanov A, Kuzi S, Mazaki-Tovi M, Yas E, Segev G, Ben-Oz J, Lavy E, Aroch I. A retrospective study of 157 hospitalized cats with pancreatitis in a tertiary care center: Clinical, imaging and laboratory findings, potential prognostic markers and outcome. J Vet Intern Med 2018; 32:1874-1885. [PMID: 30315665 PMCID: PMC6271303 DOI: 10.1111/jvim.15317] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/03/2018] [Accepted: 08/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pancreatitis in cats (FP) has been increasingly diagnosed in recent years, but clinical studies of large numbers of affected cats are scarce. OBJECTIVES To describe a large cohort of cats with FP requiring hospitalization. ANIMALS One hundred and fifty-seven client-owned cats. METHODS Retrospective study, including cats diagnosed with pancreatitis based on sonographic evidence, positive SNAP feline pancreatic lipase immunoreactivity test results, increased 1,2-o-dilauryl-rac-glycerol-glutaric Acid-(6'-methylresorufin ester)-lipase activity, histopathology, or some combination of these. RESULTS One-hundred and twenty-two cats (77.7%) survived to discharge. Median time from onset of clinical signs to presentation was longer (P = .003) in nonsurvivors. Causes of FP included recent general anesthesia, trauma, hemodynamic compromise, and organophosphate intoxication, but most cases (86.6%) were idiopathic. Ultrasonographic findings consistent with pancreatitis were documented in 134 cats, including pancreatomegaly (81.3%), decreased (31.3%), or increased (14.9%) pancreatic echogenicity, extra-hepatic biliary tract dilatation (24%), and increased peri-pancreatic echogenicity (13%). Lethargy (P = .003), pleural effusion (P = .003), hypoglycemia (P = .007), ionized hypocalcemia (P = .016), azotemia (P = .014), parenteral nutrition administration (P = .013), and persistent anorexia during hospitalization (P = .001) were more frequent in nonsurvivors, whereas antibiotics were more frequently administered to survivors (P = .023). Nevertheless, when Bonferroni's correction for multiple comparisons was applied, none of the variables was statistically significant. CONCLUSIONS AND CLINICAL IMPORTANCE Previously unreported, clinically relevant, potential prognostic factors, including hypoglycemia, azotemia, parenteral nutrition, and withholding antibacterial treatment were identified in this exploratory study. These preliminary results should be examined further in confirmatory studies.
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Affiliation(s)
- Ran Nivy
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Alina Kaplanov
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sharon Kuzi
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Einat Yas
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Jennifer Ben-Oz
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Eran Lavy
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Elzouki AN, Alsaed O, Saeed A, Ayash A, Khan FY. Incidence and epidemiological features of acute pancreatitis among adult inhabitants in Qatar. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:95-100. [PMID: 30301711 DOI: 10.5152/tjg.2018.17806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Acute pancreatitis (AP) is one of the most common gastrointestinal causes of hospital admission in Qatar. The aim of the present study was to investigate the epidemiological features and demographic characteristics of patients with AP and to estimate the annual incidence rates of this disease among adult inhabitants in Qatar. MATERIALS AND METHODS This retrospective study was conducted using the data collected by reviewing records of patients with AP admitted to the medical and surgical wards of Hamad GeneralHospital and Alkhor Hospital, Qatar from January 2007 to December 2012. Diagnosis of AP was based on abdominal pain suggestive of AP, serum lipase and/or amylase at least three times the upper limit of normal, and/or characteristic findings of AP on abdominal ultrasound or computed tomography. RESULTS A total of 382 AP events were reported in 334 patients. There were 250 (75%) males and 84 (25%) females. The mean age (±SD) of the patients was 56.8±18.7 years. Gallstone disease (40.6%) was the highest cause of AP, followed by alcohol consumption (28.5%) and idiopathic AP (20.7%). The mean annual incidence rate of AP was 5 per 100,000 adult inhabitants in Qatar from January 2007 to December 2012. The incidence rate among men was higher than that among women. Mortality rate was low (0.3%), and there were complications in 112 (29.3%) patients. CONCLUSION The annual incidence rate of AP is relatively low in Qatar and tends to behave similar to many European countries in etiology, which can be explained by population structure. Gallstone and alcohol consumption are the main causes, and idiopathic AP is responsible for more cases than expected.
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Affiliation(s)
- Abdel-Naser Elzouki
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Omar Alsaed
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Abazar Saeed
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Ahmed Ayash
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Fahmi Yousef Khan
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
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Abstract
OBJECTIVES Severe acute pancreatitis is a highly lethal disease caused by systemic inflammatory response syndrome, leading to multiple organ failure. We recently showed that histidine-rich glycoprotein (HRG) supplemental therapy ameliorated septic acute respiratory distress syndrome due to unnecessary neutrophil activation and immunothrombosis formation. Here, we evaluated the effect of HRG on lung inflammation followed by pancreatitis in a severe acute pancreatitis mouse model. METHODS Mice received intraperitoneal injections of cerulein 7 times (100 μg/kg each) at 1-hour intervals to induce acute pancreatitis. Immediately after the first cerulein injection, phosphate-buffered saline, human serum albumin (20 mg/kg), or HRG (20 mg/kg) was intravenously injected. One hour after the last cerulein injection, phosphate-buffered saline or lipopolysaccharide (5 mg/kg) was intravenously injected into the tail vein. We evaluated lung inflammatory level after pancreatitis. RESULTS We observed significantly decreased plasma HRG levels in an acute pancreatitis mouse model. Histidine-rich glycoprotein treatment inhibited lung edema and the accumulation of neutrophil in severe acute pancreatitis, but HRG did not directly affect pancreatitis. Moreover, HRG suppressed tumor necrosis factor α, inducible nitric oxide synthase, interleukin 6, and neutrophil elastase mRNA expression and myeloperoxidase activity in the lung. CONCLUSIONS These data suggested that HRG ameliorated lung inflammation secondary to pancreatitis.
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RNA sequence analysis reveals pathways and candidate genes associated with liver injury in a rat pancreatitis model. Pancreatology 2018; 18:753-763. [PMID: 30150111 DOI: 10.1016/j.pan.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/25/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The morbidity and mortality associated with acute pancreatitis (AP) are largely attributable to abnormalities that occur in distant organs, such as liver and lungs. Pancreatitis-associated liver injury (PALI) remains a serious and even fatal complication during the progression of AP. However, the exact pathophysiological mechanism is still unclear. METHODS In the present study, we used, for the first time, RNA-seq method to reveal pathways and candidate genes associated with PALI in rats. AP was induced by retrograde injection of sodium taurocholate (5%) into the biliopancreatic duct. The RNA-seq results of selected genes were validated by RT-PCR and immunohistochemistry assay. RESULTS GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analysis indicated that Toll like receptor 4 (TLR4) signaling pathway and transforming growth factor β1 (TGF-β1) and p38 mitogen-activated protein kinase (MAPK) signaling pathway (TGF-β1-p38 MAPK) were involved in the course of PALI. In addition, other factors were also found to be involved in the course of PALI, such as the decreased antioxidant activity, excessive production of inflammatory mediators and alterations in liver metabolism. CONCLUSIONS The study sheds some new insight on our understanding of the pathophysiology of PALI and provides some clues to the identification of potential therapeutic targets.
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Case BM, Jensen KK, Bakis G, Enestvedt BK, Shaaban AM, Foster BR. Endoscopic Interventions in Acute Pancreatitis: What the Advanced Endoscopist Wants to Know. Radiographics 2018; 38:2002-2018. [PMID: 30265612 DOI: 10.1148/rg.2018180066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Endoscopic interventions play an important role in the modern management of pancreatic fluid collections. Successful management of pancreatitis is dependent on proper classification of the disease and its local complications. The 2012 revised Atlanta classification divides acute pancreatitis into subtypes of necrotizing pancreatitis and interstitial edematous pancreatitis (IEP) on the basis of the radiologic presence or absence of necrosis, respectively. Local complications of IEP include acute pancreatic fluid collections and pseudocysts, which contain fluid only and are differentiated by the time elapsed since the onset of symptoms. Local complications of necrotizing pancreatitis include acute necrotic collections and walled-off necrosis, which contain nonliquefied necrotic debris and are differentiated by the time elapsed since the onset of symptoms. Endoscopic techniques are used to treat local complications of pancreatitis, often in a step-up approach, by which less invasive techniques are preferred initially with potential subsequent use of more invasive procedures, dependent on the patient's clinical response and collection evolution. Common interventions performed by the advanced endoscopist include endoscopic transmural drainage and endoscopic transmural necrosectomy. However, some collections require a multimodal approach with adjunctive placement of percutaneous drainage catheters or the use of videoscopic-assisted retroperitoneal débridement. Additional endoscopic interventions may be required in the setting of pancreatic or biliary duct stones or strictures. Common complications of endoscopic intervention in the setting of pancreatitis include bleeding, infection, perforation, and stent migration. This article reviews the classification of acute pancreatitis, familiarizes radiologists with the common endoscopic techniques used in its management, and improves identification of the clinically relevant imaging findings and procedural complications related to endoscopic interventions in pancreatitis. ©RSNA, 2018.
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Affiliation(s)
- Brendan M Case
- From the Department of Diagnostic Radiology (B.M.C., K.K.J., B.R.F.) and Department of Medicine, Division of Gastroenterology (B.K.E.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland Gastroenterology Center, Portland, Maine (G.B.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Kyle K Jensen
- From the Department of Diagnostic Radiology (B.M.C., K.K.J., B.R.F.) and Department of Medicine, Division of Gastroenterology (B.K.E.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland Gastroenterology Center, Portland, Maine (G.B.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Gene Bakis
- From the Department of Diagnostic Radiology (B.M.C., K.K.J., B.R.F.) and Department of Medicine, Division of Gastroenterology (B.K.E.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland Gastroenterology Center, Portland, Maine (G.B.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Brintha K Enestvedt
- From the Department of Diagnostic Radiology (B.M.C., K.K.J., B.R.F.) and Department of Medicine, Division of Gastroenterology (B.K.E.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland Gastroenterology Center, Portland, Maine (G.B.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Akram M Shaaban
- From the Department of Diagnostic Radiology (B.M.C., K.K.J., B.R.F.) and Department of Medicine, Division of Gastroenterology (B.K.E.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland Gastroenterology Center, Portland, Maine (G.B.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Bryan R Foster
- From the Department of Diagnostic Radiology (B.M.C., K.K.J., B.R.F.) and Department of Medicine, Division of Gastroenterology (B.K.E.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; Portland Gastroenterology Center, Portland, Maine (G.B.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
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Radovanović-Dinić B, Tešić-Rajković S, Ignjatovic A, Grgov S. Thrombin activatable fibrinolysis inhibitor as an indicator of the severity of acute pancreatitis. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:488-493. [PMID: 30249565 DOI: 10.5152/tjg.2018.17666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Thrombin Activatable Fibrinolysis Inhibitor (TAFI), in addition to suppressing fibrinolysis, can be involved as a natural anti-inflammatory molecule in the inflammatory process in acute pancreatitis (AP). The goal of this study was to discover the significance of early determination of the values of TAFI in the assessment of the severity of AP. MATERIALS AND METHODS The prospective study included 92 patients with AP. In accordance with the revised Atlanta classification, we divided all patients into 3 groups (I-mild AP, II- moderate AP and III-severe AP). All patients were further classified into group A (mild AP) and group B (moderate and severe AP) with the aim of separating the patients with complicated and potentially bad prognosis. Biochemical markers, inflammatory biomarkers, coagulation parameters and TAFI were analyzed in all patients. RESULTS The level of TAFI were significantly higher among the patients with the complicated form (group B) of AP (p=0.002). The analysis of the ROC curve in regard to the inflammatory biomarkers (fibronectin and CRP) has shown that TAFI possesses the best discriminatory ability for complicated forms of AP (AUC=0.724, p=0.013), with the sensitivity of 83.30% and the specificity of 56.00%. CONCLUSION The level of TAFI in plasma is higher in patients with moderate or severe AP. Determining the level of TAFI as a single parameter has a greater significance in the early estimation of the severity of AP than inflammatory biomarkers that we have analyzed.
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Affiliation(s)
- Biljana Radovanović-Dinić
- Clinic for Gastroenterology and Hepatology, Clinical Centre, Niš, Serbia; University of Niš School of Medicine, Niš, Serbia
| | | | - Aleksandra Ignjatovic
- University of Niš School of Medicine, Niš, Serbia; Department of Medical Statistics, University of Niš School of Medicine, Niš, Serbia
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Kiss L, Fűr G, Mátrai P, Hegyi P, Ivány E, Cazacu IM, Szabó I, Habon T, Alizadeh H, Gyöngyi Z, Vigh É, Erőss B, Erős A, Ottoffy M, Czakó L, Rakonczay Z. The effect of serum triglyceride concentration on the outcome of acute pancreatitis: systematic review and meta-analysis. Sci Rep 2018; 8:14096. [PMID: 30237456 PMCID: PMC6147944 DOI: 10.1038/s41598-018-32337-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/05/2018] [Indexed: 12/16/2022] Open
Abstract
Elevated serum triglyceride concentration (seTG, >1.7 mM or >150 mg/dL) or in other words hypertriglyceridemia (HTG) is common in the populations of developed countries. This condition is accompanied by an increased risk for various diseases, such as acute pancreatitis (AP). It has been proposed that HTG could also worsen the course of AP. Therefore, in this meta-analysis, we aimed to compare the effects of various seTGs on the severity, mortality, local and systemic complications of AP, and on intensive care unit admission. 16 eligible studies, including 11,965 patients were retrieved from PubMed and Embase. The results showed that HTG significantly elevated the odds ratio (OR = 1.72) for severe AP when compared to patients with normal seTG (<1.7 mM). Furthermore, a significantly higher occurrence of pancreatic necrosis, persistent organ failure and renal failure was observed in groups with HTG. The rates of complications and mortality for AP were significantly increased in patients with seTG >5.6 mM or >11.3 mM versus <5.6 mM or <11.3 mM, respectively. We conclude that the presence of HTG worsens the course and outcome of AP, but we found no significant difference in AP severity based on the extent of HTG.
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Affiliation(s)
- Lóránd Kiss
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Gabriella Fűr
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Péter Mátrai
- Institute for Translational Medicine and Szentagothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine and Szentagothai Research Center, Medical School, University of Pécs, Pécs, Hungary
- MTASZTE Translational Gastroenterology Research Group, University of Szeged, Szeged, Hungary
| | - Emese Ivány
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Irina Mihaela Cazacu
- Institute for Translational Medicine and Szentagothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Imre Szabó
- Department of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Habon
- Department of Cardiology and Angiology, First Department of Medicine and Szentagothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Hussain Alizadeh
- Department of Haematology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Gyöngyi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Éva Vigh
- Department of Radiology, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine and Szentagothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Adrienn Erős
- Institute for Translational Medicine and Szentagothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Máté Ottoffy
- Institute for Translational Medicine and Szentagothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Rakonczay
- Department of Pathophysiology, University of Szeged, Szeged, Hungary.
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Early Predictors of Abdominal Hemorrhage Among Critically Ill Patients With Pancreatitis: A Prospective Cohort Study. Pancreas 2018; 47:1027-1032. [PMID: 30045171 DOI: 10.1097/mpa.0000000000001135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To establish incidence, risk factors, and prognostic implications of abdominal hemorrhage (AH) among critically ill patients with acute pancreatitis (AP). METHODS Prospective cohort study in 46 intensive care units aimed at describing the characteristics of critically ill patients with AP (Epidemiología de la Pancreatitis Aguda en Medicina Intensiva Study). Adult patients with AP and at least 1 organ failure were included. The presence of AH was established either by using computed tomography, magnetic resonance imaging, or by direct visualization during surgery. Statistical analyses were carried out using multivariate logistic regression. RESULTS Three hundred seventy-four patients were studied. Most were men (62.6%), with a mean (standard deviation) age of 60.4 (15.6) years. Most episodes (56.4%) of AP were severe, and 28.9% died during their hospital stay. Thirty-eight patients (10.2%; 95% confidence interval, 7.3%-13.7%) developed AH. The odds of presenting AH was influenced by age, the underlying cause of pancreatitis, and the presence of shock or respiratory failure on admission. CONCLUSIONS Abdominal hemorrhages were common among critically ill patients with pancreatitis. These early predictors may be of use in detecting patients at risk of developing them.
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Zhang H, Chen GY, Xiao L, Ma X, Shi L, Wang T, Yan HT, Zou H, Chen Q, Tang LJ, Liu WH. Ultrasonic/CT image fusion guidance facilitating percutaneous catheter drainage in treatment of acute pancreatitis complicated with infected walled-off necrosis. Pancreatology 2018; 18:635-641. [PMID: 29954676 DOI: 10.1016/j.pan.2018.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the firs-line treatment for acute pancreatitis (AP) related infectious walled-off necrosis (WON), percutaneous catheter drainage (PCD) are usually accomplished under CT or US guidance, either of which has certain disadvantages. It is necessary to verify the clinical effects of using US and CT images fusion as guidance of PCD. METHODS The total 94 consecutive AP patients with infected WON from January of 2013 to January of 2017 were included. Among these patients with infected WON, 48 received PCD under simple US guidance (US-PCD) and 46 under US/CT images fusion guidance (US/CT-PCD). The clinical data consisting of puncture data, drainage effectiveness indicators, intervention complications were collected. RESULTS The demographic characteristics and disease related characteristics of two groups were comparable. After 48 h of PCD treatment, the US/CT-PCD group achieved a significantly higher imaging effective rate, and significantly lower inflammatory response indexes and severity score, than the US-PCD group (P < 0.05). The US/CT-PCD group required fewer puncture times and drainage tubes and lower rate of advanced treatment, showing higher operational success rate than the US-PCD group (P < 0.05). Moreover, the US/CT-PCD group exhibited significantly fewer puncture related complications, lower hospital stay, intubation time, and hospitalization expenses than the US-PCD group (P < 0.05). CONCLUSION PCD treatment under the US/CT images fusion guidance is a reliable intervention with definite clinical effects for AP complicated with infected WON.
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Affiliation(s)
- Hui Zhang
- General Surgery Center, Chengdu Military General Hospital, China
| | - Guang-Yu Chen
- General Surgery Center, Chengdu Military General Hospital, China
| | - Le Xiao
- General Surgery Center, Chengdu Military General Hospital, China
| | - Xiao Ma
- General Surgery Center, Chengdu Military General Hospital, China
| | - Li Shi
- General Surgery Center, Chengdu Military General Hospital, China
| | - Tao Wang
- General Surgery Center, Chengdu Military General Hospital, China
| | - Hong-Tao Yan
- General Surgery Center, Chengdu Military General Hospital, China
| | - Hong Zou
- General Surgery Center, Chengdu Military General Hospital, China
| | - Qi Chen
- General Surgery Center, Chengdu Military General Hospital, China
| | - Li-Jun Tang
- General Surgery Center, Chengdu Military General Hospital, China.
| | - Wei-Hui Liu
- General Surgery Center, Chengdu Military General Hospital, China; Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, 610083, China.
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Yuan L, Zhu L, Zhang Y, Chen H, Kang H, Li J, Zhao X, Wan M, Miao Y, Tang W. Effect of Da-Cheng-Qi decoction for treatment of acute kidney injury in rats with severe acute pancreatitis. Chin Med 2018; 13:38. [PMID: 30013616 PMCID: PMC6045888 DOI: 10.1186/s13020-018-0195-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/09/2018] [Indexed: 02/05/2023] Open
Abstract
Background The traditional Chinese formula Da-Cheng-Qi-decoction (DCQD) has been used to treat acute pancreatitis for decades. DCQD could ameliorate the disease severity and the complications of organ injuries, including those of the liver and lungs. However, the pharmacological effects in the kidney, a target organ, are still unclear. This study aimed to investigate the herbal tissue pharmacology of DCQD for acute kidney injury (AKI) in rats with severe acute pancreatitis (SAP). Methods Rats were randomly divided into the sham-operation group (SG), the model group (MG) and the low-, medium- and high-dose treatment groups (LDG, MDG, and HDG, respectively). Sodium taurocholate (3.5%) was retrogradely perfused into the biliopancreatic duct to establish the model of SAP in rats. Different doses of DCQD were administered to the treatment groups 2 h after the induction of SAP. The major components of DCQD in kidney tissues were detected by HPLC–MS/MS. Inflammatory mediators in the kidney tissues, as well as serum creatinine (Scr), blood urea nitrogen (BUN) and pathologic scores, were also evaluated. Results Ten components of DCQD were detected in the kidneys of the treatment groups, and their concentrations increased dose-dependently. Compared with the SG, the levels of inflammatory mediators, Scr, BUN and pathological scores in the MG were obviously increased (p < 0.05). The high dose of DCQD showed a maximal effect in downregulating the pro-inflammatory mediators interleukin-6 (IL)-6 and tumour necrosis factor-α (TNF-α), upregulating anti-inflammatory mediators IL-4 and IL-10 in the kidney and alleviating the pathological damages. DCQD decreased the pancreas and kidney pathological scores of rats with SAP, especially in the HDG (p < 0.05). Compared with the MG, the level of Scr in the HDG was significantly decreased (p < 0.05). Conclusions DCQD ameliorated AKI in rats with SAP via regulating the inflammatory response, which might be closely related to the distribution of its components in the kidney. Electronic supplementary material The online version of this article (10.1186/s13020-018-0195-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ling Yuan
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Lv Zhu
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Yumei Zhang
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Huan Chen
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Hongxin Kang
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Juan Li
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Xianlin Zhao
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Meihua Wan
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Yifan Miao
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
| | - Wenfu Tang
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People's Republic of China
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Predictive value of serum cyclophilin A concentrations after acute pancreatitis. Clin Chim Acta 2018; 484:237-245. [PMID: 29883632 DOI: 10.1016/j.cca.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cyclophilin A is identified as a biomarker for inflammation. We elucidated prognostic significance of serum cyclophilin A (CypA) concentrations in acute pancreatitis (AP). METHODS In this prospective and observational study, serum CypA concentrations were quantified in 210 AP patients and 100 healthy controls. We recorded local complication, in-hospital mortality and organ failure. Disease severity was assessed using the traditional predictors, namely Acute Physiology and Chronic Health Care Evaluation II score, Ranson score, multiple organ dysfunction score and sequential organ failure assessment score. RESULTS Serum CypA concentrations were significantly lower in controls than in AP group. CypA concentrations after AP were highly correlated with the traditional predictors and other inflammatory mediators, including blood erythrocyte sedimentation rate, procalcitonin levels, white blood cell count and C-reactive protein levels. Serum CypA emerged as an independent predictor for in-hospital local complication, organ failure and mortality. Under receiver operating characteristic curve, serum CypA possessed similar prognostic ability, as compared to the traditional predictors. Its predictive ability was almost similar to that of procalcitonin levels and significantly exceeded those of the other inflammatory mediators. Also, it significantly improved prognostic performance of the traditional predictors. CONCLUSIONS Increased serum CypA concentrations have close relation to the severity, inflammation and prognosis, substantializing CypA as a potential prognostic biomarker of AP.
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Calycosin alleviates cerulein-induced acute pancreatitis by inhibiting the inflammatory response and oxidative stress via the p38 MAPK and NF-κB signal pathways in mice. Biomed Pharmacother 2018; 105:599-605. [PMID: 29890468 DOI: 10.1016/j.biopha.2018.05.080] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 01/30/2023] Open
Abstract
Acute pancreatitis (AP) is a common acute abdominal disease accompanied by systemic inflammatory response syndrome, and could even be complicated by multiple-organ damage. This study aimed to examine whether calycosin, an isoflavone isolated from Radix astragali with antioxidant and anti-inflammatory activity, could protect against AP induced by cerulein. To this end, Balb/C mice were injected with cerulein (50 μg/kg) to establish the animal model of AP. Calycosin (25 and 50 mg/kg, p.o.) was administered 1 h prior to the first cerulein injection. After the last injection of cerulein, the mice were sacrificed and blood was obtained for cytokine analysis. The pancreas was removed for morphological examination, myeloperoxidase (MPO) and malondialdehyde (MDA) analyses, immunohistochemistry, and western blot analysis. Calycosin treatment reversed the increased serum levels of amylase and lipase, alleviated the pathological damage in the pancreas, and decreased the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β in mice with AP. Additionally, calycosin significantly reduced cerulein-induced pancreatic edema, inhibited MPO activity and increased superoxide dismutase (SOD) activity, and inhibited the expression of NF-κB/p65 and phosphorylation of the inhibitor of NF-κB (IκBα) and p38 MAPK. These results suggested that calycosin protects against AP by exerting anti-inflammatory and anti-oxidative stress effects via the p38 MAPK and NF-κB signal pathways. Calycosin's benefits for AP patients need to be explored further.
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135
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Brown TT, Prahlow JA. Postmortem Serum Amylase and Lipase Analysis in the Diagnosis of Acute Pancreatitis. Acad Forensic Pathol 2018; 8:311-323. [PMID: 31240044 DOI: 10.1177/1925362118782071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/13/2018] [Indexed: 12/26/2022]
Abstract
The diagnosis of acute pancreatitis, which can occur due to natural and nonnatural causes, is usually made at autopsy based on gross and microscopic examination. However, some pathologists choose to measure serum amylase and lipase levels in postmortem blood samples, which may provide corroborating evidence of acute pancreatitis when evaluated in the context of the autopsy findings. A small series of autopsy cases of deaths related to acute pancreatitis with corresponding postmortem serum amylase and lipase levels and a review of the literature are used to highlight the potential benefits and interpretation issues of postmortem serum amylase and lipase. In autopsies without decomposition, elevated postmortem serum amylase (greater than 1000 U/L) and lipase can provide supportive evidence of acute pancreatitis as a cause of death. However, relying on postmortem serum amylase and lipase alone to diagnose acute pancreatitis is insufficient and unreliable. Rather, one must have the gross and histologic evidence of acute pancreatitis. Acad Forensic Pathol. 2018 8(2): 311-323.
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Zhao Q, Wei Y, Pandol SJ, Li L, Habtezion A. STING Signaling Promotes Inflammation in Experimental Acute Pancreatitis. Gastroenterology 2018; 154:1822-1835.e2. [PMID: 29425920 PMCID: PMC6112120 DOI: 10.1053/j.gastro.2018.01.065] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Acute pancreatitis (AP) is characterized by severe inflammation and acinar cell death. Transmembrane protein 173 (TMEM173 or STING) is a DNA sensor adaptor protein on immune cells that recognizes cytosolic nucleic acids and transmits signals that activate production of interferons and the innate immune response. We investigated whether leukocyte STING signaling mediates inflammation in mice with AP. METHODS We induced AP in C57BL/6J mice (control) and C57BL/6J-Tmem173gt/J mice (STING-knockout mice) by injection of cerulein or placement on choline-deficient DL-ethionine supplemented diet. In some mice, STING signaling was induced by administration of a pharmacologic agonist. AP was also induced in C57BL/6J mice with bone marrow transplants from control or STING-knockout mice and in mice with disruption of the cyclic GMP-AMP synthase (Cgas) gene. Pancreata were collected, analyzed by histology, and acini were isolated and analyzed by flow cytometry, quantitative polymerase chain reaction, immunoblots, and enzyme-linked immunosorbent assay. Bone-marrow-derived macrophages were collected from mice and tested for their ability to detect DNA from dying acinar cells in the presence and absence of deoxyribonuclease (DNaseI). RESULTS STING signaling was activated in pancreata from mice with AP but not mice without AP. STING-knockout mice developed less severe AP (less edema, inflammation, and markers of pancreatic injury) than control mice, whereas mice given a STING agonist developed more severe AP than controls. In immune cells collected from pancreata, STING was expressed predominantly in macrophages. Levels of cGAS were increased in mice with vs without AP, and cGAS-knockout mice had decreased edema, inflammation, and other markers of pancreatic injury upon induction of AP than control mice. Wild-type mice given bone marrow transplants from STING-knockout mice had less pancreatic injury and lower serum levels of lipase and pancreatic trypsin activity following induction of AP than mice given wild-type bone marrow. DNA from dying acinar cells activated STING signaling in macrophages, which was inhibited by addition of DNaseI. CONCLUSIONS In mice with AP, STING senses acinar cell death (by detecting DNA from dying acinar cells) and activates a signaling pathway that promotes inflammation. Macrophages express STING and activate pancreatic inflammation in AP.
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Affiliation(s)
- Qinglan Zhao
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Yi Wei
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Stephen J. Pandol
- Cedars-Sinai Medical Center and Department of Veterans Affairs, Los Angeles, California
| | - Lingyin Li
- Biochemistry Department and the ChEM-H institute, Stanford University, Stanford, California
| | - Aida Habtezion
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
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García-Hernández V, Sánchez-Bernal C, Schvartz D, Calvo JJ, Sanchez JC, Sánchez-Yagüe J. A tandem mass tag (TMT) proteomic analysis during the early phase of experimental pancreatitis reveals new insights in the disease pathogenesis. J Proteomics 2018; 181:190-200. [PMID: 29678717 DOI: 10.1016/j.jprot.2018.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/08/2018] [Accepted: 04/13/2018] [Indexed: 01/15/2023]
Abstract
Changes in the protein expression occurring within the initiation phase of acute pancreatitis (AP) might be vital in the development of this complex disease. However, the exact mechanisms involved in the onset of AP remains elusive and most of our knowledge about the pathobiology of AP comes from animal models. We performed in a rat pancreatitic model a high-throughput shotgun proteomic profiling of the soluble and whole membrane fractions from the pancreas during the early phase of cerulein (Cer)-induced AP. We identified 997 proteins, of which 353 were significantly different (22, 276 or 55 in both, the soluble or the membrane fractions, respectively). Gene Ontology and KEGG PATHWAY analyses revealed that these proteins were implicated in molecular mechanisms relevant to AP pathogenesis, including vesicle-mediated and protein transport, lysosomal and mitochondrial impairment or proteolysis. Numerous metabolic processes were downregulated apparently to reduce energy consumption, and a remarkable increase in inflammatory and stress responses was also highlighted. The proteomic data were verified by immunoblotting of 11 and 7 different soluble or membrane-associated proteins, either novel (VPS29 and MCTS1) or known factors in AP. Also, our first observation of the imbalance of some COP proteins during AP early phase deserves further characterization. BIOLOGICAL SIGNIFICANCE AP is one of the most important pathological inflammatory states of the exocrine pancreas but its pathophysiology remains incompletely understood, especially the early acinar events. Proteomic analysis of pancreatic subcellular fractions simplifies protein maps and helps in the identification of new protein alterations and biomarkers characterizing pancreatic tissue damage. Our shotgun approach has not been previously used to profile the early proteomic alterations of the disease, which are considered crucial for its development and for the founding of clinical procedures. Furthermore, our subcellular fractionation protocol allowed us to detect changes in membrane proteins so far overlooked in the proteomic study of AP. Accordingly, using TMT proteomics and bioinformatic tools, we were able to detect significant changes in protein expression related to many pathobiological pathways of acute pancreatitis as from the early phase of the disease. To our knowledge, some of these changes, such as the imbalance of some COP proteins, have never been described in this disease.
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Affiliation(s)
- Violeta García-Hernández
- Department of Biochemistry and Molecular Biology, University of Salamanca, Salamanca 37007, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca 37007, Spain
| | - Carmen Sánchez-Bernal
- Department of Biochemistry and Molecular Biology, University of Salamanca, Salamanca 37007, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca 37007, Spain
| | - Domitille Schvartz
- Translational Biomarker Group, Department of Human Protein Sciences, University Medical Center, 1211 Geneva, Switzerland
| | - José J Calvo
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca 37007, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca 37007, Spain
| | - Jean-Charles Sanchez
- Translational Biomarker Group, Department of Human Protein Sciences, University Medical Center, 1211 Geneva, Switzerland
| | - Jesús Sánchez-Yagüe
- Department of Biochemistry and Molecular Biology, University of Salamanca, Salamanca 37007, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca 37007, Spain.
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Abstract
OBJECTIVES Acute pancreatitis (AP) is severe in up to 20% of patients, with a high mortality rate. Quantification of serum TH1 and TH2 cytokines may provide objective evidence to assess the severity of AP and predict its course. METHODS One hundred seventeen patients were studied, measuring serum concentrations of interleukin (IL)1β, IL2, IL4, IL5, IL6, IL10, IL12p70, IL13, IL18, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN) γ, and tumor necrosis factor (TNF) α. RESULTS Significant differences were found between patients with severe AP and those with mild or moderately severe AP in IFN-γ (P < 0.001), IL6 (P < 0.001), TNF-α (P = 0.002), GM-CSF (P < 0.001), IL4 (P = 0.002), IL1b (P = 0.017), and IL13 (P < 0.001) concentrations. Interferon-γ, IL6, and TNF-α were associated with severe AP, whereas GM-CSF, IL4, IL1b, and IL13 were associated with mild or moderately severe AP. The IL13/IFNγ ratio was significantly higher in patients with mild AP (P = 7.36 × 10). CONCLUSIONS A TH1 profile was associated with severe AP and a TH2 profile with mild or moderately severe AP. We report an IL13/IFNγ ratio of potential value to predict the prognosis in AP.
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Mesenchymal Stromal Cell Therapy for Pancreatitis: A Systematic Review. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3250864. [PMID: 29743979 PMCID: PMC5878867 DOI: 10.1155/2018/3250864] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/31/2017] [Indexed: 12/19/2022]
Abstract
Background Based on animal studies, adult mesenchymal stromal cells (MSCs) are promising for the treatment of pancreatitis. However, the best type of this form of cell therapy and its mechanism of action remain unclear. Methods We searched the PubMed, Web of Science, Scopus, Google Scholar, and Clinical Trials.gov websites for studies using MSCs as a therapy for both acute and chronic pancreatitis published until September 2017. Results We identified 276 publications; of these publications, 18 met our inclusion criteria. In animal studies, stem cell therapy was applied more frequently for acute pancreatitis than for chronic pancreatitis. No clinical trials were identified. MSC therapy ameliorated pancreatic inflammation in acute pancreatitis and pancreatic fibrosis in chronic pancreatitis. Bone marrow and umbilical cord MSCs were the most frequently administered cell types. Due to the substantial heterogeneity among the studies regarding the type, source, and dose of MSCs used, conducting a meta-analysis was not feasible to determine the best type of MSCs. Conclusion The available data were insufficient for determining the best type of MSCs for the treatment of acute or chronic pancreatitis; therefore, clinical trials investigating the use of MSCs as therapy for pancreatitis are not warranted.
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140
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Zhang M, Ding L, Wang X, Hou J, Li M, Jiang Y, He X, Cui M, Hu F, Zhang X, Yang J, Guo X, Zhao H, Gao P. Circulating CD14 +CD163 +CD115 + M2 monocytes are associated with the severity of new onset severe acute pancreatitis in Chinese patients. Int Immunopharmacol 2018. [PMID: 29518744 DOI: 10.1016/j.intimp.2018.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the role of monocytes in the pathogenesis of severe acute pancreatitis (SAP), it remains unclear how different subtypes of monocytes regulate and contribute to this pathogenesis. METHODS We examined the numbers of different subsets of monocytes by flow cytometry in 21 SAP, 15 mild acute pancreatitis (MAP) and 13 healthy controls (HC). The concentrations of plasma cytokines were assessed by cytometric bead array. Disease severity was evaluated based on the acute physiology and chronic health evaluation (APACHE) II score and plasma C-reactive proteins (CRP) levels. RESULTS Compared with the numbers in MAP patients and HC, we observed that the numbers of CD14+CD163-, CD14+CD163-MAC387+, CD14+CD163-IL-12+ M1 monocytes, and CD115+, CD204+, IL-10+ M2 monocytes were significantly increased in SAP patients. In addition, these patients showed higher plasma levels of interleukin (IL)-12 and IL-10. Furthermore, the number of CD14+CD163-, CD14+CD163-MAC387+ M1 monocytes and the plasma IL-12 concentration showed a positive association with the CRP level, while the number of CD204+, IL-10+ M2 monocytes and the plasma IL-10 concentration showed a positive correlation with the APACHE II score. Importantly, the CD115+ M2 subset displayed a positive correlation with both the CRP level and APACHE II score, and treatment of SAP significantly reduced the number of this subset. CONCLUSIONS The CD14+CD163+CD115+ M2 monocyte count appears to be important factor in determining the severity and prognosis of SAP. Both the pro- and anti-inflammatory monocytes appear to participate in the pathogenesis of SAP.
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Affiliation(s)
- Manli Zhang
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital, Jilin University, Changchun 130021, Jilin Province, China; Department of Central Laboratory, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Lili Ding
- Intensive Care Unit, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Xinrui Wang
- Department of Central Laboratory, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China; Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jie Hou
- Department of Central Laboratory, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Man Li
- Department of Central Laboratory, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Yanfang Jiang
- Department of Central Laboratory, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Xiuting He
- Department of Geriatrics, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Meizi Cui
- Department of Geriatrics, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Feng Hu
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Xiuna Zhang
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Jingyuan Yang
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital, Jilin University, Changchun 130021, Jilin Province, China
| | - Xiaohe Guo
- Department of Gastroenterology, The First Hospital, Xinxiang Medical College, Xinxiang 453100, Henan Province, China
| | - Huiying Zhao
- Department of Central Laboratory, The First Hospital, Jilin University, Changchun 130021, Jilin Province, China.
| | - Pujun Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China.
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141
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Cheng Y, Gong J, Ding X, Liu Z, Gong J, Zeng Z. Continuous veno‐venous hemofiltration for severe acute pancreatitis. Cochrane Database Syst Rev 2018; 2018:CD012959. [PMCID: PMC6491106 DOI: 10.1002/14651858.cd012959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of CVVH in people suffering from severe acute pancreatitis, compare the effects of different CVVH techniques, and evaluate the optimal time for delivery of CVVH.
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Affiliation(s)
- Yao Cheng
- The Second Affiliated Hospital, Chongqing Medical UniversityDepartment of Hepatobiliary SurgeryChongqingChina
| | - Junhua Gong
- First Affiliated Hospital of Kunming Medical UniversityOrgan Transplant CenterNo. 295, Xi Chang RoadKunmingChina650032
| | - Xiong Ding
- The Second Affiliated Hospital, Chongqing Medical UniversityDepartment of Hepatobiliary SurgeryChongqingChina
| | - Zuojin Liu
- The Second Affiliated Hospital, Chongqing Medical UniversityDepartment of Hepatobiliary SurgeryChongqingChina
| | - Jianping Gong
- The Second Affiliated Hospital, Chongqing Medical UniversityDepartment of Hepatobiliary SurgeryChongqingChina
| | - Zhong Zeng
- First Affiliated Hospital of Kunming Medical UniversityOrgan Transplant CenterNo. 295, Xi Chang RoadKunmingChina650032
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Abstract
BACKGROUND AND AIM Predicting severe pancreatitis is important for early aggressive management of patients with acute pancreatitis (AP). Despite the established role of diabetes mellitus (DM) in the risk of AP, the impact of DM on the clinical outcome in AP has not been fully elucidated. The objective of this study was to assess the risk of mortality and severity in AP among patients with type-2 DM. METHODS Patients diagnosed with first attacks of AP were enrolled from January 2013 to June 2015. RESULTS A total of 201 patients (63.2% male, mean age, 59.4 y) with AP were included. Etiologies included gallstones (51.2%), alcohol (37.3%), hypertriglyceridemia (2%), and idiopathic causes (9.5%). There were 54 AP patients (26.9%) with type-2 DM. Severity indices in AP, such as Atlanta Classification (severe), Ranson score, and Bedside Index of Severity in Acute Pancreatitis, were higher in subjects with DM than those without DM. Prevalence of intensive care unit admission and mortality were higher in AP patients with DM compared with those without DM. The association between DM and increased risk of mortality in AP remained statistically significant even after adjustments for confounding factors and Atlanta Classification (odds ratio, 7.76, 95% confidence interval, 1.26-47.63, P=0.027). CONCLUSIONS Type-2 DM was associated with severity and increased mortality in patients with AP. Our findings provide evidence of the potential role of DM in the pathogenesis and management of severe AP.
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143
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Zhu ZD, Yu T, Liu HJ, Jin J, He J. SOCE induced calcium overload regulates autophagy in acute pancreatitis via calcineurin activation. Cell Death Dis 2018; 9:50. [PMID: 29352220 PMCID: PMC5833430 DOI: 10.1038/s41419-017-0073-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is characterized by inflammation, edema, vacuolization and necrosis, which has significant morbidity and lethality. The pathogenesis of AP has not been established completely. An early and critical feature of AP is the aberrant signaling of Calcium (Ca2+) within the pancreatic acinar cell, termed Ca2+ overload. Store-operated Ca2+ (SOC) channels are the principal Ca2+ influx channels that contribute to Ca2+ overload in pancreatic acinar cells. Store-operated Ca2+ entry (SOCE) has been proved to be a key pathogenic step in AP development that leads to trypsin activation, inflammation and vacuolization. However, the molecular mechanisms are still poorly understood. By establishing Ca2+ overload model and mouse AP model using caerulein, we found that caerulein triggered SOCE via inducing interaction between STIM1 and Orai1, which activated calcineurin (CaN); CaN activated the nuclear factor of activated T cells (NFAT) and transcription factor EB (TFEB), thus promoting the transcriptional activation of multiple chemokines genes and autophagy-associated genes respectively. To the best of our knowledge, this is the first evidence showing that SOCE activates TFEB via CaN activation, which may have noticeable longer-term effects on autophagy and vacuolization in AP development. Our findings reveal the role for SOCE/CaN in AP development and provide potential targets for AP treatment.
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Affiliation(s)
- Zhen-Dong Zhu
- Department of Histology and Embryology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Yu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Jing Liu
- Department of Histology and Embryology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Jin
- Department of Histology and Embryology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun He
- Department of Histology and Embryology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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de-Madaria E, Molero X, Bonjoch L, Casas J, Cárdenas-Jaén K, Montenegro A, Closa D. Oleic acid chlorohydrin, a new early biomarker for the prediction of acute pancreatitis severity in humans. Ann Intensive Care 2018; 8:1. [PMID: 29330618 PMCID: PMC5768584 DOI: 10.1186/s13613-017-0346-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/22/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The early prediction of the severity of acute pancreatitis still represents a challenge for clinicians. Experimental studies have revealed the generation of specific halogenated lipids, in particular oleic acid chlorohydrin, in the early stages of acute pancreatitis. We hypothesized that the levels of circulating oleic acid chlorohydrin might be a useful early prognostic biomarker in acute pancreatitis in humans. METHODS In a prospective, multicenter cohort study, plasma samples collected within 24 h after presentation in the emergency room from 59 patients with acute pancreatitis and from 9 healthy subjects were assessed for oleic acid chlorohydrin levels. RESULTS Pancreatitis was mild in 30 patients, moderately severe in 16 and severe in 13. Oleic acid chlorohydrin levels within 24 h after presentation were significantly higher in patients that later progressed to moderate and severe acute pancreatitis. Using 7.49 nM as the cutoff point, oleic acid chlorohydrin distinguished mild from moderately severe-to-severe pancreatitis with high sensitivity/specificity (96.6/90.0%) and positive/negative predictive values (90.3/96.4%). Using 32.40 nM as the cutoff value sensitivity, specificity, positive and negative predictive values were all 100% for severe acute pancreatitis. It was found to be a better prognostic marker than BISAP score, hematocrit at 48 h, SIRS at admission, persistent SIRS or C-reactive protein at 48 h. CONCLUSIONS Oleic acid chlorohydrin concentration in plasma is elevated in patients with acute pancreatitis on admission and correlates with a high degree with the final severity of the disease, indicating that it has potential to serve as an early prognostic marker for acute pancreatitis severity.
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Affiliation(s)
- Enrique de-Madaria
- Pancreatic Unit, Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain
| | - Xavier Molero
- Exocrine Pancreatic Diseases Research Group, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | - Laia Bonjoch
- Department of Experimental Pathology, IIBB-CSIC, IDIBAPS, c/Rosselló 161, 7°, 08036 Barcelona, Spain
| | - Josefina Casas
- RUBAM, Department of Biomedicinal Chemistry, IQAC-CSIC, Barcelona, Spain
| | - Karina Cárdenas-Jaén
- Pancreatic Unit, Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain
| | - Andrea Montenegro
- Exocrine Pancreatic Diseases Research Group, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | - Daniel Closa
- Department of Experimental Pathology, IIBB-CSIC, IDIBAPS, c/Rosselló 161, 7°, 08036 Barcelona, Spain
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145
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Picardo S, So K, Venugopal K, Chin M. Vedolizumab-induced acute pancreatitis: the first reported clinical case. BMJ Case Rep 2018; 2018:bcr-2017-222554. [PMID: 29305366 DOI: 10.1136/bcr-2017-222554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Drug-induced acute pancreatitis (DIAP) is a rare, but clinically significant diagnosis. Vedolizumab, an α4β7 integrin inhibitor, which was approved in 2015 for treatment of moderate to severe inflammatory bowel disease, is a well-tolerated medication with a favourable safety profile and minimal serious adverse events in premarketing clinical trials. We present the first reported case of acute pancreatitis directly attributable to vedolizumab.
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Affiliation(s)
- Sherman Picardo
- Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Kenji So
- Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Kannan Venugopal
- Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marcus Chin
- Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia, Australia
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146
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Abstract
Mesenchymal stem cells (MSCs) have attracted attention as a cell source for regenerative medicine. In particular, MSCs have an anti-inflammatory effect by secreting several kinds of bioactive molecules. MSC therapy is now being applied to various gastrointestinal diseases, such as graft-versus-host disease, inflammatory bowel disease, and liver cirrhosis. Therefore, MSC therapy has the potential to be a novel treatment for acute and chronic pancreatitis by suppressing inflammation. Several studies have investigated the effect of MSC therapy on acute and chronic pancreatitis, but the underlying mechanisms remain unknown. In this review, we summarize the present status of MSC therapy for acute and chronic pancreatitis.
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Affiliation(s)
- Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita15 Nishi7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Shunsuke Ohnishi
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita15 Nishi7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masaki Kuwatani
- Division of Endoscopy, Hokkaido University Hospital, Kita14 Nishi5, Kita-ku, Sapporo, 060-8648, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita15 Nishi7, Kita-ku, Sapporo, 060-8638, Japan
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147
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Kaplan M, Ates I, Oztas E, Yuksel M, Akpinar MY, Coskun O, Kayacetin E. A New Marker to Determine Prognosis of Acute Pancreatitis: PLR and NLR Combination. J Med Biochem 2018; 37:21-30. [PMID: 30581338 PMCID: PMC6294107 DOI: 10.1515/jomb-2017-0039] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022] Open
Abstract
Background We aimed to investigate the prognostic importance of platelet-lymphocyte ratio (PLR) and neutro - phil-lymphocyte ratio(NLR) combination for patients diagnosed with acute pancreatitis and its relationship with mortality. Methods This retrospective study was included 142 patients diagnosed with acute pancreatitis. Ranson, Atlanta and BISAP 0h, 24h and 48h scores of the patients were calculated by examining their patient files. The patients were divided into three groups as low-risk, medium-risk and high-risk patients according to their PLR and NLR levels. Results The number of patients with acute pancreatitis complications such as necrotizing pancreatitis, acute renal failure, sepsis and cholangitis was significantly higher in the high-risk group compared to other groups. Mortality rate was found to be 90% in the high-risk group, 16% in the medium-risk group, and 1.9% in the low-risk group. The number of patients with a Ranson score of 5 and 6, a severe Atlanta score, a BISAP 0h score of 3 and 4, a BISAP 24h and 48h score of 4 and 5 was higher in the high-risk group compared to other groups. PLR-NLR combination, Atlanta and Ranson scores, and C-reactive protein level were determined to be independent risk factors predicting mortality in stepwise regression model. PLR-NLR combination had the highest area under curve value in terms of predicting acute claspancreatitis prognosis and had a similar diagnostic discrimination with other scoring systems. Conclusion In our study it was found that PLR-NLR combination had a similar prognostic importance with other scoring systems used to determine acute pancreatitis prognosis.
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Affiliation(s)
- Mustafa Kaplan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Ihsan Ates
- Ankara Numune Training and Research Hospital, Department of Internal Medicine,Ankara, Turkey
| | - Erkin Oztas
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Mahmut Yuksel
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Muhammed Yener Akpinar
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Orhan Coskun
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Ertugrul Kayacetin
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
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148
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Wang Y, Cao LK, Wei Y, Song B. The Value of Modified Renal Rim Grade in Predicting Acute Kidney Injury Following Severe Acute Pancreatitis. J Comput Assist Tomogr 2018; 42:680-687. [PMID: 29787498 DOI: 10.1097/rct.0000000000000749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To retrospectively determine the value of modified renal rim grade (MRRG) in predicting acute kidney injury (AKI) in the early phase of severe acute pancreatitis (SAP). METHODS This institutional review board-approved retrospective study included patients with SAP who underwent abdominal contrast-enhanced computed tomography (CT) within 48 hours after disease onset. Modified renal rim grade, renal rim grade, CT severity index, modified CT severity index, extrapancreatic inflammation on CT scores, and posterior pararenal (PPR) space involvement were assessed. Clinical data, including bedside index of severity in acute pancreatitis and New Japanese Severity Scoring system scores, were collected. Primary end points were AKI and mortality. Scores were evaluated by receiver operating characteristic curve analysis. Correlational analyses between MRRG scores and the other scores were performed with Spearman analysis. RESULT One hundred five consecutive patients were enrolled in our study. The areas under the curve (AUCs) of MRRG in predicting AKI (0.90) and mortality (0.83) were comparable to extrapancreatic inflammation on CT (0.89 and 0.85, P > 0.05) and were higher than those of the other CT scores (P < 0.05). Modified renal rim grade score of greater than 4 yielded sensitivities and specificities of 81% and 89% for predicting AKI and 88% and 66% for mortality. Modified renal rim grade correlated moderately with bedside index of severity in acute pancreatitis (Spearman r = 0.47) and New Japanese Severity Scoring system (r = 0.43) scores. Besides, the prevalence of PPR space involvement in nonrecovery AKI patients was higher than that in recovery patients (94% vs 36%, P < 0.05). CONCLUSIONS Modified renal rim grade is well correlated with the occurrence of AKI and mortality in SAP. The PPR space involvement is a promising prognostic factor for nonrecovery of AKI in SAP patients.
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Affiliation(s)
- Yi Wang
- From the Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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149
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Soares FS, Amaral FC, Silva NLC, Valente MR, Santos LKR, Yamashiro LH, Scheffer MC, Castanheira FVES, Ferreira RG, Gehrke L, Alves-Filho JC, Silva LP, Báfica A, Spiller F. Antibiotic-Induced Pathobiont Dissemination Accelerates Mortality in Severe Experimental Pancreatitis. Front Immunol 2017; 8:1890. [PMID: 29375557 PMCID: PMC5770733 DOI: 10.3389/fimmu.2017.01890] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/11/2017] [Indexed: 12/23/2022] Open
Abstract
Although antibiotic-induced dysbiosis has been demonstrated to exacerbate intestinal inflammation, it has been suggested that antibiotic prophylaxis may be beneficial in certain clinical conditions such as acute pancreatitis (AP). However, whether broad-spectrum antibiotics, such as meropenem, influence the dissemination of multidrug-resistant (MDR) bacteria during severe AP has not been addressed. In the currently study, a mouse model of obstructive severe AP was employed to investigate the effects of pretreatment with meropenem on bacteria spreading and disease outcome. As expected, animals subjected to biliopancreatic duct obstruction developed severe AP. Surprisingly, pretreatment with meropenem accelerated the mortality of AP mice (survival median of 2 days) when compared to saline-pretreated AP mice (survival median of 7 days). Early mortality was associated with the translocation of MDR strains, mainly Enterococcus gallinarum into the blood stream. Induction of AP in mice with guts that were enriched with E. gallinarum recapitulated the increased mortality rate observed in the meropenem-pretreated AP mice. Furthermore, naïve mice challenged with a mouse or a clinical strain of E. gallinarum succumbed to infection through a mechanism involving toll-like receptor-2. These results confirm that broad-spectrum antibiotics may lead to indirect detrimental effects during inflammatory disease and reveal an intestinal pathobiont that is associated with the meropenem pretreatment during obstructive AP in mice.
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Affiliation(s)
- Fernanda S Soares
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Flávia C Amaral
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Natália L C Silva
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Matheus R Valente
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Lorena K R Santos
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Lívia H Yamashiro
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Mara C Scheffer
- Microbiology Laboratory, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Fernanda V E S Castanheira
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Raphael G Ferreira
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Laura Gehrke
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - José C Alves-Filho
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Luciano P Silva
- Embrapa Genetic Resources and Biotechnology, Brasilia, Brazil.,Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - André Báfica
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Fernando Spiller
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Pharmacology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
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150
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Chen Y, Xie CL, Hu R, Shen CY, Zeng M, Wu CQ, Chen TW, Chen C, Tang MY, Xue HD, Jin ZY, Zhang XM. Genetic Polymorphisms: A Novel Perspective on Acute Pancreatitis. Gastroenterol Res Pract 2017; 2017:5135172. [PMID: 29333155 PMCID: PMC5733231 DOI: 10.1155/2017/5135172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/10/2017] [Indexed: 12/15/2022] Open
Abstract
Acute pancreatitis (AP) is a complex disease that results in significant morbidity and mortality. For many decades, it has compelled researchers to explore the exact pathogenesis and the understanding of the pathogenesis of AP has progressed dramatically. Currently, premature trypsinogen activation and NF-κB activation for inflammation are two remarkable hypotheses for the mechanism of AP. Meanwhile, understanding of the influence of genetic polymorphisms has resulted in tremendous development in the understanding of the advancement of complex diseases. Now, genetic polymorphisms of AP have been noted gradually and many researchers devote themselves to this emerging area. In this review, we comprehensively describe genetic polymorphisms combined with the latest hypothesis of pathogenesis associated with AP.
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Affiliation(s)
- Yong Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chao Lian Xie
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ran Hu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Cheng Yi Shen
- Sichuan Key Laboratory of Medical Imaging and Department of Pathophysiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Mei Zeng
- Biology Group, North Sichuan Medical College, Nanchong, China
| | - Chang Qiang Wu
- Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Tian Wu Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chen Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Meng Yue Tang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hua Dan Xue
- Radiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Yu Jin
- Radiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Ming Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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