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Faria MÂF. Effects of a novel osteopathic visceral technique for the pancreas on pain and range of motion in a patient with neck pain: Case report. J Bodyw Mov Ther 2024; 39:195-200. [PMID: 38876625 DOI: 10.1016/j.jbmt.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/27/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Neck pain is a leading cause of disability worldwide. Visceral referred pain is a common form of disease-induced pain, with visceral nociception being referred to somatic tissues. OBJECTIVE The aim of this case report was to evaluate the immediate and long term effects of a novel osteopathic visceral technique (OVT) on pain and cervical range of motion (CROM) in a patient with nonspecific neck pain (NS-NP). METHOD A case of a 47-year-old female suffering with NS-NP for four months. The patient had sought physiotherapy treatment several times, and occasionally used anti-inflammatory medication to relieve symptoms. The patient presented muscle cervical tenderness and hyperalgesia over the spinous processes of C3-C4 spinal segments with limited CROM. A novel osteopathic visceral manipulation (OVM) technique was applied in the epigastric region targeting the pancreas. Immediately after the treatment, the patient reported reduction in pain evaluated with the numerical evaluation scale (NRS), and a clinically significant increase in pressure pain threshold (PPT) in C3 spinous process. Improvement in CROM was also observed. The post-treatment improvements have been maintained at 1-month of follow-up assessment. CONCLUSION A single OVT was effective in reducing cervical pain and increasing CROM in a patient with NS-NP caused by a viscerosomatic reflex. The results of this case study provides preliminary evidence that OVM can produce hypoalgesia in somatic tissues with segmentally related innervation. This finding encourages future research to gain a better understanding of the mechanisms of regional inhibitory interdependence involving the viscerosomatic reflexes of OVM.
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Lee D, Koo Y, Chae Y, Choi Y, Yun T, Kang B, Yang M, Kim H. Serum 25-hydroxyvitamin D, vitamin D receptor, and vitamin D binding protein concentrations in dogs with acute pancreatitis compared to healthy control dogs. J Vet Intern Med 2023; 37:1694-1702. [PMID: 37496238 PMCID: PMC10473002 DOI: 10.1111/jvim.16809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Previous studies have documented vitamin D imbalance in dogs with acute pancreatitis (AP), but no studies have investigated serum vitamin D receptor (VDR) and vitamin D-binding protein (VDBP) concentrations. OBJECTIVES Compare serum 25-hydroxyvitamin D (25[OH]D), VDR, and VDBP concentrations in healthy dogs and dogs with AP and identify correlations between these concentrations with ionized calcium, C-reactive protein (CRP), and canine-specific pancreatic lipase (Spec cPL) concentrations. ANIMALS Twenty-two dogs with AP and 20 healthy control dogs. METHODS Prospective cross-sectional study. Serum 25(OH)D concentrations were measured using a chemiluminescence immunoassay, and VDR and VDBP concentrations were measured using a ELISA kit designed for dogs. RESULTS Serum concentrations of 25(OH)D were lower in dogs with AP (mean ± SD, 66.1 ± 39.2 ng/mL) than in controls (96.8 ± 30.4 ng/mL; P = .01), and VDR concentrations were lower in dogs with AP (5.3 ± 3.5 ng/mL) than in controls (7.4 ± 2.5 ng/mL; P = .03). No difference was observed in serum VDBP concentrations between the groups. Serum VDR concentrations differed between survivors (median [interquartile range] = 6.6 [4.3-8.2] ng/mL) and nonsurvivors (2.7 [0.5-3.5] ng/mL; P = .01). Negative correlations were observed among serum VDR, CRP (rs = -0.55), and Spec cPL (rs = -0.47) concentrations in dogs with AP. CONCLUSIONS AND CLINICAL IMPORTANCE Dogs with AP had lower serum 25(OH)D and VDR concentrations than controls. Additionally, our study suggests a potential role of VDR expression in the inflammatory process of AP in dogs.
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Affiliation(s)
- Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
| | - Yeongeun Choi
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
| | - Byeong‐Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
| | - Mhan‐Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongju 28644Republic of Korea
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Gianesini G, Drigo M, Zoia A. Immune-Mediated Hemolytic Anemia and Clinically Suspected Acute Pancreatitis in Dogs, a Pilot Study. Top Companion Anim Med 2023; 56-57:100821. [PMID: 37802244 DOI: 10.1016/j.tcam.2023.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/17/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023]
Abstract
Acute pancreatitis can be a complication of massive hemolysis, above all when intravascular in nature. Therefore, the aim of this study was to investigate the association between canine immune mediated hemolytic anemia (IMHA) and clinically suspected acute pancreatitis (CSAP) and the role of calculated free plasma hemoglobin (Hbfp) in CSAP occurrence/development. In this cohort study the records of 95 dogs with IMHA and 95 sick dogs with pathologies other than IMHA were compared for CSAP occurrence/development. At presentation, 12/95 dogs with IMHA met criteria for CSAP, while only 3/95 sick control dogs met these criteria (χ2 =1.58, P = .008). Within 7 days of hospitalization 9 additional dogs with IMHA had developed CSAP. The Hbfp was calculated and compared for dogs with IMHA that had/developed CSAP and for those without CSAP. In dogs with IMHA, a calculated Hbfp concentration ≥ 0.08 g/dL resulted in an increased relative risk (RR) of having/developing CSAP (RR = 2.54, 95% CI, 1.51-4.29; P = .003). No significant effect on short-term prognosis in dogs with IMHA was found between those having/developing CSAP and those without CSAP. This study showed that dogs with IMHA have an increased risk of having CSAP and Hbfp concentration may be involved in the pathogenesis of acute pancreatitis.
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Affiliation(s)
- Giulia Gianesini
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano, Italy
| | - Michele Drigo
- Department of Medicina Animale, Produzione e Salute, Padua University, Legnaro, Italy
| | - Andrea Zoia
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano, Italy.
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Jandel AN, Heilmann RM, Sander H, Steiner JM, Grützner N, Xenoulis PG. Serum α 1-Proteinase Inhibitor, Calprotectin, and S100A12 Concentrations in the Characterization of Pancreatitis in Dogs. Vet Sci 2023; 10:428. [PMID: 37505833 PMCID: PMC10385135 DOI: 10.3390/vetsci10070428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Miniature Schnauzers are predisposed to develop pancreatitis, with familial hypertriglyceridemia (HTG) described as a potential risk factor. Diagnosing pancreatitis in dogs is based on the integration of serum canine-specific pancreatic lipase (cPLI) concentration, clinical presentation, and diagnostic imaging findings. However, markers of systemic inflammation and antiprotease activity have not been extensively investigated in the characterization and prognostication of pancreatitis in dogs. Serum concentrations of alpha1-proteinase inhibitor (α1PI; as a marker of systemic antiprotease response) and calprotectin and S100A12 (as markers of systemic inflammation) were measured in serum samples from 35 Miniature Schnauzers diagnosed with pancreatitis (serum cPLI concentration >400 μg/L, clinical signs, abdominal imaging findings). These markers were evaluated for possible associations with patient characteristics, clinical presentation, risk factors for pancreatitis, and outcome. The study showed that biomarkers of systemic inflammation and antiprotease activity are commonly increased in Miniature Schnauzers with pancreatitis. Whereas serum calprotectin and S100A12 concentrations were found to have limited utility in differentiating pancreatitis presentations, serum α1PI concentrations and potentially also the serum calprotectin-to-S100A12 ratio might be non-invasive surrogate markers of disease severity in dogs with pancreatitis.
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Affiliation(s)
- Annina N Jandel
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, DE-04103 Leipzig, Germany
| | - Romy M Heilmann
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, DE-04103 Leipzig, Germany
- Gastrointestinal Laboratory, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Henri Sander
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, DE-04103 Leipzig, Germany
| | - Jörg M Steiner
- Gastrointestinal Laboratory, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Niels Grützner
- Ruminant and Swine Clinic, Free University of Berlin, DE-14165 Berlin, Germany
- VetaRegio GmbH, DE-06366 Köthen, Germany
| | - Panagiotis G Xenoulis
- Gastrointestinal Laboratory, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, 43100 Karditsa, Greece
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Pantoja BTDS, Carvalho RC, Miglino MA, Carreira ACO. The Canine Pancreatic Extracellular Matrix in Diabetes Mellitus and Pancreatitis: Its Essential Role and Therapeutic Perspective. Animals (Basel) 2023; 13:ani13040684. [PMID: 36830471 PMCID: PMC9952199 DOI: 10.3390/ani13040684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 02/18/2023] Open
Abstract
Diabetes mellitus and pancreatitis are common pancreatic diseases in dogs, affecting the endocrine and exocrine portions of the organ. Dogs have a significant role in the history of research related to genetic diseases, being considered potential models for the study of human diseases. This review discusses the importance of using the extracellular matrix of the canine pancreas as a model for the study of diabetes mellitus and pancreatitis, in addition to focusing on the importance of using extracellular matrix in new regenerative techniques, such as decellularization and recellularization. Unlike humans, rabbits, mice, and pigs, there are no reports in the literature characterizing the healthy pancreatic extracellular matrix in dogs, in addition to the absence of studies related to matrix components that are involved in triggering diabetes melittus and pancreatitis. The extracellular matrix plays the role of physical support for the cells and allows the regulation of various cellular processes. In this context, it has already been demonstrated that physiologic and pathologic pancreatic changes lead to ECM remodeling, highlighting the importance of an in-depth study of the changes associated with pancreatic diseases.
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Affiliation(s)
- Bruna Tássia dos Santos Pantoja
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo 05508-270, SP, Brazil
| | - Rafael Cardoso Carvalho
- Department of Animal Science, Center for Agricultural and Environmental Sciences, Federal University of Maranhao, Chapadinha 65500-000, MA, Brazil
| | - Maria Angelica Miglino
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo 05508-270, SP, Brazil
| | - Ana Claudia Oliveira Carreira
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo 05508-270, SP, Brazil
- Center for Natural and Human Sciences, Federal University of ABC, Santo Andre 09280-550, SP, Brazil
- Correspondence: or ; Tel.: +55-11-983229615
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Cridge H, Lim SY, Algül H, Steiner JM. New insights into the etiology, risk factors, and pathogenesis of pancreatitis in dogs: Potential impacts on clinical practice. J Vet Intern Med 2022; 36:847-864. [PMID: 35546513 PMCID: PMC9151489 DOI: 10.1111/jvim.16437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 12/11/2022] Open
Abstract
While most cases of pancreatitis in dogs are thought to be idiopathic, potential risk factors are identified. In this article we provide a state‐of‐the‐art overview of suspected risk factors for pancreatitis in dogs, allowing for improved awareness and detection of potential dog‐specific risk factors, which might guide the development of disease prevention strategies. Additionally, we review important advances in our understanding of the pathophysiology of pancreatitis and potential areas for therapeutic manipulation based thereof. The outcome of pathophysiologic mechanisms and the development of clinical disease is dependent on the balance between stressors and protective mechanisms, which can be evaluated using the critical threshold theory.
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Affiliation(s)
- Harry Cridge
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Sue Yee Lim
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, Texas, USA
| | - Hana Algül
- Gastrointestinal Cancer and Inflammatory Research Laboratory, Technical University of Munich, Munich, Germany
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, Texas, USA
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Bar-Nathan M, Chen H, Rimer D, Segev G. Long-term outcome of dogs recovering from acute kidney injury: 132 cases. J Vet Intern Med 2022; 36:1024-1031. [PMID: 35478193 PMCID: PMC9151474 DOI: 10.1111/jvim.16435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Information regarding long‐term outcome of dogs recovering from acute kidney injury (AKI) is limited. Objectives Determine the long‐term outcome of dogs recovering from AKI and identify predictors for serum creatinine concentration (sCr) normalization and long‐term outcome. Animals One hundred thirty‐two dogs with AKI that survived ≥30 days postdischarge. Methods Retrospective study. Search of medical records of dogs diagnosed with AKI that survived to discharge. Follow‐up data were retrieved from medical records and by telephone interviews with the owners or primary care veterinarians or both. Results Estimated median survival time (MST) was 1322 days (95% confidence interval [CI], 1147‐1626), and 76% of the dogs were alive at last contact. Normalization of sCr was documented in 55% of the dogs at discharge and in additional 20% during the follow‐up period. The proportion of dogs with sCr normalization decreased with increase in AKI grade (P = .02). Long‐term survival was not associated with sCr normalization (P = .63). Etiology was associated with the long‐term outcome (P = .004). Conclusion and Clinical Importance Long‐term survival of dogs with AKI is longer than previously described. Normalization of sCr in 99 dogs (75%) occurred, either at discharge or within the follow‐up period. Normalization of sCr was not associated with long‐term survival. Estimated MST of dogs with sCr normalization was not different compared with dogs that developed azotemic chronic kidney disease (CKD), presumably because of slow CKD progression rate. Etiology is an important factor determining sCr normalization and long‐term survival, emphasizing the importance of the reversibility of renal injury rather than its severity.
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Affiliation(s)
- Mali Bar-Nathan
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Dar Rimer
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Barton JC, Mäntylä Noble PJ, O'Connell EM. Acute kidney injury manifesting as renal tubular acidosis with proximal and distal renal tubular dysfunction in a dog with acute pancreatitis. J Vet Emerg Crit Care (San Antonio) 2022; 32:524-531. [PMID: 35129879 PMCID: PMC9545851 DOI: 10.1111/vec.13186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Abstract
Objective To describe the clinical presentation and management of a critically ill dog with profound renal tubular acidosis (RTA) with proximal and distal renal tubular dysfunction. Case Summary A 3‐year‐old neutered female Border Terrier was presented with frequent regurgitation resulting from acute pancreatitis with severe ileus. Venous acid–base analysis and complete urinalysis confirmed the presence of normal anion gap metabolic acidosis with inappropriately alkaline urine (pH 8), consistent with distal RTA. Urinalysis, urine amino acids, and urinary fractional excretion of electrolytes revealed glycosuria (with normoglycemia), aminoaciduria, and increased fractional excretion of sodium, calcium, and phosphate consistent with generalized proximal renal tubulopathy or Fanconi syndrome. The dog responded well to supportive care and alkaline therapy and made a complete recovery. New or Unique Information Provided To the authors’ knowledge, this is the first description of RTA with proximal and distal renal tubular dysfunction in the veterinary literature. Furthermore, the authors hypothesize that the transient RTA was a manifestation of acute kidney injury secondary to acute pancreatitis, the first report of this in the literature.
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Affiliation(s)
- James C Barton
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Peter-John Mäntylä Noble
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Erin M O'Connell
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
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Rimer D, Chen H, Bar-Nathan M, Segev G. Acute kidney injury in dogs: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome. J Vet Intern Med 2022; 36:609-618. [PMID: 35103347 PMCID: PMC8965273 DOI: 10.1111/jvim.16375] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common, potentially fatal condition. OBJECTIVES To characterize the etiologies, clinical and clinicopathologic findings, hospitalization period, and outcome of dogs with AKI and to identify markers of negative prognosis. ANIMALS Two hundred forty-nine client-own dogs diagnosed with AKI and hospitalized at a veterinary teaching hospital. METHODS Retrospective study. Search of medical records for dogs with AKI. RESULTS Common clinical signs included lethargy (225/249, 90%), anorexia (206/249, 83%), and vomiting (168/249, 68%). Etiologies included ischemic/inflammatory (144/249, 58%), infectious (19/249, 8%), nephrotoxicosis (14/249, 6%), or other (13/249, 5%). Hospital-acquired AKI was diagnosed in 9% (23/249) of the dogs. Median presentation and peak serum creatinine (sCr) concentrations were 4 mg/dL (range, 1.1-37.9) and 4.6 mg/dL (range, 1.1-43.1), respectively. Dogs were classified to AKI grades as follows: Grade I, 6 (2%), Grade II, 38 (15%), Grade III, 89 (36%), Grade IV, 77 (31%), and Grade V, 39 (16%). One hundred and sixty-four (66%) dogs survived. There was a positive association between death and AKI grade (P = .009). The case fatality rate was higher among dogs with anuria compared with dogs without anuria (50% vs 28%, respectively; odds ratio [95% confidence interval]: 2.5 [1.39-4.6]; P = .002). Forty-seven (18.8%) dogs underwent hemodialysis, of which 60% survived. CONCLUSION AND CLINICAL IMPORTANCE Two-thirds of dogs with AKI survived. Hospital-acquired AKI was common. The severity of AKI, as reflected by presence of anuria, AKI grade, and other body organs involvement, was associated with the outcome.
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Affiliation(s)
- Dar Rimer
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Mali Bar-Nathan
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Cridge H, Twedt DC, Marolf AJ, Sharkey LC, Steiner JM. Advances in the diagnosis of acute pancreatitis in dogs. J Vet Intern Med 2021; 35:2572-2587. [PMID: 34751442 PMCID: PMC8692219 DOI: 10.1111/jvim.16292] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022] Open
Abstract
In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.
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Affiliation(s)
- Harry Cridge
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - David C Twedt
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado, USA
| | - Angela J Marolf
- Department of Environmental and Radiologic Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Leslie C Sharkey
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Gori E, Pierini A, Lippi I, Citi S, Mannucci T, Marchetti V. Evaluation of diagnostic and prognostic usefulness of abdominal ultrasonography in dogs with clinical signs of acute pancreatitis. J Am Vet Med Assoc 2021; 259:631-636. [PMID: 34448616 DOI: 10.2460/javma.259.6.631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report abdominal ultrasonography (AUS) findings in dogs with clinical signs of acute pancreatitis (AP) during the first 2 days of hospitalization and to compare AUS findings with severity of disease and mortality rate. ANIMALS 37 client-owned dogs with clinical signs of AP. PROCEDURES Dogs suspected of having AP with complete medical records, AUS examinations performed throughout the first 2 days of hospitalization, and available frozen surplus serum samples for quantitative measurement of canine pancreatic lipase (cPL) concentrations at hospital admission met the criteria for study inclusion. Dogs were grouped as AUS+ or AUS- on the basis of positive or negative findings for AP on AUS, respectively. Abdominal ultrasonography findings of AP were stratified (as mild, moderate, or severe) by use of an AUS severity index, and a canine acute pancreatitis severity score was calculated. RESULTS 24 of 37 (64.8%) dogs had AUS findings of AP at hospital admission, whereas 10 had positive findings for AP on AUS within 2 days of hospitalization. Three (8%) dogs were AUS- but had serum cPL concentrations > 400 μg/L (ie, values considered diagnostic for AP). On the AUS severity index, 5 of 34 (14.7%) AUS+ dogs had mild findings, 18 (52.9%) AUS+ dogs had moderate findings, and 11 (32.4%) AUS+ dogs had severe findings. Severe findings were associated with a higher risk of death than mild and moderate findings. A significant association was found between canine acute pancreatitis severity scores and mortality rates. CONCLUSIONS AND CLINICAL RELEVANCE For dogs with clinical signs of AP, repeated AUS examinations during hospitalization should be performed, severe findings on the AUS severity index may indicate an increased risk of death, and serum cPL concentrations may increase earlier than findings on AUS of AP.
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Nivy R, Kuzi S, Yochai A, Aroch I, Bruchim Y. Evaluation of serum histone concentrations and their associations with hemostasis, markers of inflammation, and outcome in dogs with naturally occurring acute pancreatitis. Am J Vet Res 2021; 82:701-711. [PMID: 34432516 DOI: 10.2460/ajvr.82.9.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare serum concentrations of histones and inflammatory markers in dogs with acute pancreatitis and healthy control dogs, investigate associations of these variables with coagulation test results and survival (vs nonsurvival) to hospital discharge, and examine the prognostic utility of clinical findings and routine laboratory and coagulation tests in affected dogs. ANIMALS 36 dogs. PROCEDURES Dogs with findings consistent with acute pancreatitis (n = 29) and healthy control dogs (7) were enrolled in a prospective, observational study. Serum concentrations of histones, interleukin (IL)-6, and tumor-necrosis factor-α were assessed for all dogs. Clinical (including ultrasonographic) findings, relevant history, routine laboratory and coagulation test results, and outcomes were recorded for dogs with pancreatitis. Variables were assessed to determine an association with outcome for affected dogs and hospitalization time for survivors; histone concentrations and markers of inflammation were compared among survivors, nonsurvivors, and controls. Correlation between quantitative variables was investigated. RESULTS Serum histone and IL-6 concentrations did not differentiate survivors (n = 23) from nonsurvivors (6); IL-6 concentrations in affected dogs were correlated with 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester lipase activity (rS = 0.436) and hospitalization time (rS = 0.528). Pancreatitis-associated peritoneal fluid, obtundation, and jaundice were more common, and serum bilirubin concentration, serum alanine aminotransferase and aspartate aminotransferase activities, and prothrombin and activated partial thromboplastin times were greater in nonsurvivors than in survivors. Thromboelastometric changes consistent with hypercoagulability were detected in survivors; hypocoagulability was detected in 2 nonsurvivors. CONCLUSIONS AND CLINICAL RELEVANCE Serum histone concentrations were not associated with presence of acute pancreatitis or outcome for affected dogs. Further research is needed to investigate the clinical and therapeutic implications of hypocoagulability, hepatocellular injury, and pancreatitis-associated peritoneal fluid in affected dogs.
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Affiliation(s)
- Ran Nivy
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel.,From the Department of Internal Medicine, Ben-Shemen Specialist Referral Center, Ben-Shemen, Israel
| | - Sharon Kuzi
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel
| | - Avital Yochai
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel
| | - Itamar Aroch
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel
| | - Yaron Bruchim
- From the Emergency and Critical Care, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel.,From the Department of Internal Medicine, Ben-Shemen Specialist Referral Center, Ben-Shemen, Israel
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Bjørnkjær-Nielsen KA, Bjørnvad CR. Corticosteroid treatment for acute/acute-on-chronic experimental and naturally occurring pancreatitis in several species: a scoping review to inform possible use in dogs. Acta Vet Scand 2021; 63:28. [PMID: 34256804 PMCID: PMC8276032 DOI: 10.1186/s13028-021-00592-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
Acute pancreatitis in dogs is a prevalent disease characterised by mild to severe inflammation. Treatment with anti-inflammatory corticosteroids has been widely debated but is not generally recommended in veterinary medicine. The objective of the present study was to present current evidence on the effect of corticosteroid treatment for acute/acute-on-chronic pancreatitis across species. These findings were then used to evaluate if and how corticosteroid treatment could influence disease outcome in canine acute/acute-on-chronic pancreatitis. A scoping review was performed by searching the Agricola, CAB Abstracts, MEDLINE and Embase databases to identify relevant articles published before June 24, 2021. The inclusion criteria were English language, original research published in a peer-reviewed journal, and investigation of corticosteroid treatment effects on acute/acute-on-chronic pancreatitis by the outcome parameters clinical score, circulating CRP level, hospitalisation duration, mortality and pancreas histopathology. Research on any species was considered. Studies were rated based on the level of evidence, and methodological quality was evaluated based on similarity between groups at baseline, risk of bias and study group size. The reporting method was based on the PRISMA extension for scoping reviews. One thousand nine hundred fifty-four studies were identified, and 31 met the inclusion criteria. Five were canine studies, with 4 investigating experimentally induced pancreatitis; 5 were human clinical studies; and 21 were rodent studies of experimentally induced pancreatitis. The level of evidence ranged between randomised controlled trials and case series, the estimated risk of bias ranged from low to high, and the sample sizes ranged from very small to moderate. Evidence indicates that adding corticosteroid to symptomatic treatment of acute/acute-on-chronic canine pancreatitis could have a positive influence on disease outcome. However, the analysed evidence was based on several species, including both naturally occurring and experimentally induced pancreatitis; thus, the authors suggest that large randomised controlled studies should be performed in dogs with spontaneously occurring acute/acute-on-chronic pancreatitis to further elucidate a potential benefit of corticosteroid treatment.
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Serum Concentration of Inflammatory Cytokines in Dogs with Suspected Acute Pancreatitis. Vet Sci 2021; 8:vetsci8030051. [PMID: 33803665 PMCID: PMC8003073 DOI: 10.3390/vetsci8030051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 01/23/2023] Open
Abstract
Acute pancreatitis is an acute inflammatory process in the pancreas that is common in dogs. This study was designed to compare cytokines between healthy dogs and dogs with suspected acute pancreatitis. For the canine cytokine antibody array, three healthy dogs and three dogs with suspected acute pancreatitis were included. Interleukin (IL)-2, IL-6, IL-10, GM-CSF, and TNF-α were not detected in either group based on the results. Conversely, IL-8 (p = 0.035), Monocyte Chemoattractant Protein-1 (MCP)-1 (p = 0.0138), Receptor for Advanced Glycation Endproducts (RAGE) (p = 0.0079), and stem cell factor (SCF) (p = 0.034) were significantly increased in dogs with suspected acute pancreatitis. However, vascular endothelial growth factor (VEGF) (p = 0.6971) did not differ significantly between groups. For the canine serum Enzyme-Linked Immunosorbent Assay (ELISA), eight healthy dogs and eight dogs with suspected acute pancreatitis were included. ELISA revealed that IL-8 (p < 0.0001), MCP-1 (p < 0.0001), RAGE (p = 0.006), and SCF (p = 0.0002) were all significantly upregulated in the experimental group. We confirmed multiple patterns of cytokines in suspected acute pancreatitis of dogs via canine cytokine antibody array using a small quantity of serum. After this procedure, we reevaluated the cytokines, which were significantly increased in dogs with suspected acute pancreatitis, by ELISA, with more samples. Through this study, we confirmed that MCP-1, RAGE, and SCF were newly suggested factors in dogs with suspected acute pancreatitis.
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Forman MA, Steiner JM, Armstrong PJ, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. ACVIM consensus statement on pancreatitis in cats. J Vet Intern Med 2021; 35:703-723. [PMID: 33587762 PMCID: PMC7995362 DOI: 10.1111/jvim.16053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022] Open
Abstract
Background Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges. Objective To summarize the current literature as it relates to etiology, pathogenesis, diagnosis, and management of pancreatitis in cats and to arrive at clinically relevant suggestions for veterinary clinicians that are based on evidence, and where such evidence is lacking, based on consensus of experts in the field. Animals None. Methods A panel of 8 experts in the field (5 internists, 1 radiologist, 1 clinical pathologist, and 1 anatomic pathologist), with support from a librarian, was formed to assess and summarize evidence in the peer reviewed literature and complement it with consensus clinical recommendations. Results There was little literature on the etiology and pathogenesis of spontaneous pancreatitis in cats, but there was much in the literature about the disease in humans, along with some experimental evidence in cats and nonfeline species. Most evidence was in the area of diagnosis of pancreatitis in cats, which was summarized carefully. In contrast, there was little evidence on the management of pancreatitis in cats. Conclusions and Clinical Importance Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available, and recognizing that acute pancreatitis is far easier to diagnose than chronic pancreatitis. Although both forms of pancreatitis can be managed successfully in many cats, management measures are far less clearly defined for chronic pancreatitis.
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Affiliation(s)
- Marnin A Forman
- Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - P Jane Armstrong
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Melinda S Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Louisiana, USA
| | - Steve L Hill
- Flagstaff Veterinary Internal Medicine Consulting, Flagstaff, Arizona, USA
| | | | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
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Zhang L, Wu Z, Tong Z, Yao Q, Wang Z, Li W. Vagus Nerve Stimulation Decreases Pancreatitis Severity in Mice. Front Immunol 2021; 11:595957. [PMID: 33519809 PMCID: PMC7840568 DOI: 10.3389/fimmu.2020.595957] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background Vagus nerve stimulation (VNS) is effective in reducing inflammation in various diseases, such as rheumatoid arthritis, colitis and acute kidney injury. The anti-inflammatory effect of vagus nerve in these diseases necessitates the interactions of neural activation and α7 nicotinic acetylcholine receptors (α7nAChRs) on splenic macrophages. In this study, we aimed to investigate the effect of VNS on severity in experimental acute pancreatitis (AP). Methods Two independent AP models were used, which induced in ICR mice with caerulein or pancreatic duct ligation (PDL). Thirty minutes after modeling, the left cervical carotid sheath containing the vagus nerve was electrically stimulated for 2 min. Plasma lipase and amylase activities, TNF-α levels and pancreas histologic damage were evaluated. In caerulein mice, the percentages of α7nAChR+ macrophage in pancreas and spleen were assessed by flow cytometry. Furthermore, splenectomy and adoptive transfer of VNS-conditioned α7nAChR splenocytes were performed in caerulein mice to evaluate the role of spleen in the protective effect of VNS. Results VNS reduced plasma lipase and amylase activities, blunted the concentrations of TNF-α and protected against pancreas histologic damage in two AP models. Survival rates were improved in the PDL model after VNS. In caerulein AP mice, VNS increased the percentages of α7nAChR+ macrophages in pancreas and spleen. Adoptive transfer of VNS-treated α7nAChR splenocytes provided protection against pancreatitis in recipient mice. However, splenectomy did not abolish the protective effect of VNS. Conclusions VNS reduces disease severity and attenuates inflammation in AP mice. This effect is independent of spleen and is probably related to α7nAChR on macrophage.
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Affiliation(s)
- Luyao Zhang
- Department of Pathology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiyang Wu
- Department of Critical Care Medicine, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qi Yao
- Department of Pathology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ziyu Wang
- Department of Pathology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Dunaevich A, Chen H, Musseri D, Kuzi S, Mazaki-Tovi M, Aroch I, Segev G. Acute on chronic kidney disease in dogs: Etiology, clinical and clinicopathologic findings, prognostic markers, and survival. J Vet Intern Med 2020; 34:2507-2515. [PMID: 33044036 PMCID: PMC7694831 DOI: 10.1111/jvim.15931] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) and acute exacerbation of CKD (ACKD) are common in dogs. OBJECTIVE To characterize the etiology, clinical and laboratory findings, and short- and long-term prognosis of dogs with ACKD. ANIMALS One hundred dogs with ACKD. METHODS Medical records of dogs diagnosed with ACKD admitted to a veterinary teaching hospital were retrospectively reviewed. RESULTS The most common clinical signs included anorexia (84%), lethargy (77%), vomiting (55%) and diarrhea (37%). Presumptive etiology included inflammatory causes (30%), pyelonephritis (15%), ischemic causes (7%), other (3%), or unknown (45%). Median hospitalization time was 5 days (range, 2-29 days) and was significantly longer in survivors (6 days; range, 2-29 days) compared with nonsurvivors (4 days; range, 2-20 days; P < .001). Mortality rate was 35%. International Renal Interest Society (IRIS) acute kidney injury (AKI) grade at presentation was associated (P = .009) with short-term survival, but presumptive etiology was not (P = .46). On multivariable analysis; respiratory rate (P = .01), creatine kinase (CK) activity (P = .005) and serum creatinine concentration (SCR; P = .04) at presentation were associated with short-term outcome. Median survival time of dogs discharged was 105 days (95% confidence interval [CI], 25-184), with 35 and 8 dogs surviving up to 6 and 12 months, respectively. Presumptive etiology (P = .16) and SCR (P = .59) at discharge were not predictors of long-term survival. CONCLUSION AND CLINICAL IMPORTANCE Short-term outcome of dogs with ACKD is comparable to those with AKI but long-term prognosis is guarded. The IRIS AKI grade at presentation is a prognostic indicator of short-term outcome.
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Affiliation(s)
- Asia Dunaevich
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Danielle Musseri
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sharon Kuzi
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Kuzi S, Mazaki-Tovi M, Suchodolski JS, Rimer D, Lidbury JA, Steiner JM, Buono A, Nivy R, Segev G, Aroch I. Protease inhibitors, inflammatory markers, and their association with outcome in dogs with naturally occurring acute pancreatitis. J Vet Intern Med 2020; 34:1801-1812. [PMID: 32893923 PMCID: PMC7517856 DOI: 10.1111/jvim.15895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Acute pancreatitis (AP) presumably is associated with pancreatic protease activation, protease inhibitor (PI) depletion, and inflammatory mediator secretion. Objectives Examine PIs and inflammatory mediator concentrations in dogs with AP and their association with death. Animals Thirty‐one dogs diagnosed with AP based on clinical signs, ultrasonographic findings, and increased canine pancreatic lipase immunoreactivity (cPLI) and 51 healthy control dogs. Methods Antithrombin and α2‐antiplasmin activity (ATA and α2AP, respectively) and concentrations of α1‐proteinase inhibitor (α1PI), α2‐macroglobulin (α2MG), C‐reactive protein (CRP), interleukins (ILs)‐2,6,8 and tumor necrosis factor‐α (TNF‐α) were prospectively measured. Severity of AP was assessed by clinical severity scoring systems. Results Mortality rate was 19%. Antithrombin activity was lower (P = .004) and maximal CRP, IL‐6, and TNF‐α concentrations higher (P < .04) in the AP group compared to the controls, whereas IL‐2, IL‐8, α1PI, and α2AP concentrations did not differ between groups. Serum α2MG concentration was not reliably detected. Serum cPLI, CRP, and IL‐6 concentrations were significantly and positively correlated. The ATA was lower (P = .04), and canine acute pancreatitis severity (CAPS) scores higher (P = .009) in nonsurvivors compared to survivors. Higher CAPS scores were associated (P < .05) with decreased ATA and increased cPLI, CRP, and IL‐6 concentrations. Conclusions and Clinical Importance Systemic inflammation in dogs with AP is manifested by increased inflammatory mediator concentrations, correlating with cPLI and CRP concentrations. Hypoantithrombinemia is associated with death. Serum concentrations of α2AP and α1PI are less useful prognostic markers. The CAPS score is a useful prognostic marker in dogs with AP.
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Affiliation(s)
- Sharon Kuzi
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, USA
| | - Dar Rimer
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Jonathan A Lidbury
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, USA
| | - Agostino Buono
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, USA
| | - Ran Nivy
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
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Gori E, Pierini A, Lippi I, Ceccherini G, Perondi F, Marchetti V. Evaluation of C-reactive protein/albumin ratio and its relationship with survival in dogs with acute pancreatitis. N Z Vet J 2020; 68:345-348. [PMID: 32539626 DOI: 10.1080/00480169.2020.1780995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: To evaluate the association between the C-reactive protein (CRP)/albumin (ALB) ratio and survival in dogs with acute pancreatitis and its use as a prognostic marker for survival. Methods: Medical records of a veterinary referral hospital in Italy were retrospectively searched for dogs that were admitted with acute pancreatitis between January 2015 and April 2019, in which the concentrations of CRP and ALB in serum were measured at admission. The CRP/ALB ratio was calculated and the time between admission and discharge or death was recorded. Mortality rates overall and for dogs that died within 2 days of admission were calculated. A univariable Cox proportional hazard model was used to assess the relationship between survival time and CRP/ALB ratio. Results: Seventy-one dogs were included in the study. Of these, 19 died within 2 days of presentation; an early mortality rate of 26.8%, while 27 died before discharge for an overall mortality rated of 38%. Dogs with higher CRP/ALB ratio had a significantly greater mortality rate than dogs with lower CRP/ALB ratio: for every 1-unit increase in CRP/ALB ratio, the hazard of death over the study period increased by 130% (hazard ratio = 2.34; 95% CI = 1.53-3.58; p < 0.001). The optimal CRP/ALB ratio cut-off point for predicting mortality was 0.56, with a sensitivity and specificity of 88.9% and 68.2%, respectively (AUC = 0.82; p < 0.001). Conclusions: As in humans, the CRP/ALB ratio, may be a promising, though not particularly specific, prognostic marker for increased risk of death in dogs with acute pancreatitis.
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Affiliation(s)
- E Gori
- Veterinary Teaching Hospital "Mario Modenato", Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
| | - A Pierini
- Veterinary Teaching Hospital "Mario Modenato", Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
| | - I Lippi
- Veterinary Teaching Hospital "Mario Modenato", Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
| | - G Ceccherini
- Veterinary Teaching Hospital "Mario Modenato", Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
| | - F Perondi
- Veterinary Teaching Hospital "Mario Modenato", Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
| | - V Marchetti
- Veterinary Teaching Hospital "Mario Modenato", Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
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Gori E, Pierini A, Lippi I, Meucci V, Perondi F, Marchetti V. Evaluation of Symmetric Dimethylarginine (SDMA) in Dogs with Acute Pancreatitis. Vet Sci 2020; 7:vetsci7020072. [PMID: 32492828 PMCID: PMC7356378 DOI: 10.3390/vetsci7020072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 01/02/2023] Open
Abstract
Symmetric dimethylarginine (SDMA) is considered an important biomarker of kidney dysfunction. The aims of the study were to evaluate SDMA in dogs with acute pancreatitis (AP) and its relationship with the presence of kidney injury and mortality. A cohort study including fifty-four dogs with AP diagnosed using compatible clinical and laboratory parameters, abnormal SNAP cPL and compatible abdominal ultrasound within 48 h from admission, was conducted. Dogs with history of renal and/or urinary diseases were excluded, along with dogs exposed to nephrotoxic drugs. Serum urea and creatinine and urinary output (UO) were recorded. Acute kidney injury (AKI) was diagnosed and graded using International Renal Interest Society (IRIS) guidelines. SDMA was measured using high performance liquid chromatography. Fifty-four dogs were included and divided in non-AKI (n = 37) and AKI dogs (n = 17). Twenty-three dogs (14 non-AKI) had SDMA > 15 μg/dL. Median SDMA was higher in AKI dogs than non-AKI dogs (25.7 vs. 13.93 μg/dL; p = 0.03). Dogs with normal creatinine (AP and AKI 1 dogs) had SDMA above reference range in 38% and 33% of cases, respectively. In AKI dogs, SDMA and creatinine were positively correlated (p = 0.006 r = 0.7). SDMA was not significantly different between survivors and non-survivors. Although further studies are warranted, SDMA may be a useful tool in canine AP, as a high SDMA may be related to subclinical kidney impairment.
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Chen H, Dunaevich A, Apfelbaum N, Kuzi S, Mazaki-Tovi M, Aroch I, Segev G. Acute on chronic kidney disease in cats: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome. J Vet Intern Med 2020; 34:1496-1506. [PMID: 32445217 PMCID: PMC7379052 DOI: 10.1111/jvim.15808] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022] Open
Abstract
Background Chronic kidney disease (CKD) and acute decompensation of CKD (ACKD) are common in cats. Objectives To characterize the etiology, clinical and clinicopathologic findings, and the short‐ and long‐term prognosis of feline ACKD. Animals One hundred cats with ACKD. Methods Retrospective study, search of medical records for cats with ACKD. Results Common clinical signs included anorexia (85%), lethargy (60%), weight loss (39%), and vomiting (27%). Suspected etiologies included ureteral obstruction (11%), renal ischemia (9%), pyelonephritis (8%), others (6%), or unknown (66%). Hospitalization duration was longer in survivors versus nonsurvivors (median = 7 days, range = 2‐26 versus median = 3 days, range = 2‐20, respectively, P < .001). The survival rate to discharge was 58%. Age, serum creatinine, urea, and phosphorous concentrations were higher and venous blood pH was lower in nonsurvivors. However, only serum phosphorus remained associated with the short‐term outcome in the multivariable model (P = .02; 95% confidence interval = 1.03‐1.39). Survivors had a median survival time of 66 days after discharge. Serum creatinine concentrations at presentation as well as at discharge were associated with long‐term survival (P < .002 for both). Conclusions The short‐term prognosis of ACKD is comparable to acute kidney injury, while the long‐term prognosis is guarded.
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Affiliation(s)
- Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Asia Dunaevich
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Naama Apfelbaum
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sharon Kuzi
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Gori E, Pierini A, Lippi I, Meucci V, Perondi F, Marchetti V. Evaluation of asymmetric dimethylarginine as an inflammatory and prognostic marker in dogs with acute pancreatitis. J Vet Intern Med 2020; 34:1144-1149. [PMID: 32378771 PMCID: PMC7255674 DOI: 10.1111/jvim.15785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/06/2020] [Indexed: 01/06/2023] Open
Abstract
Background Asymmetric dimethylarginine (ADMA) has been proposed as a severity marker in humans with acute pancreatitis (AP). Objectives To evaluate ADMA in dogs with AP compared with healthy dogs and its association with severity of disease, mortality, and indicators of the systemic inflammatory response syndrome (SIRS), including serum C‐reactive protein (CRP) concentration, WBC count, and band neutrophils. Animals Fifty‐four dogs with AP and a control group (CG) of 28 healthy dogs. Methods Cohort study including dogs with AP diagnosed using clinical and laboratory variables, abnormal canine pancreatic lipase (cPL) concentration, and compatible abdominal ultrasound examination findings performed within 48 hours of admission. Canine AP severity (CAPS) was calculated. Serum concentration of ADMA was measured using high performance liquid chromatography. Blood donor‐, staff‐, and student‐owned dogs were enrolled in the CG. Results Dogs with AP had higher median admission serum ADMA concentrations compared with the CG (62 versus 48.5 μg/dL; P = .003). Dogs with CAPS ≥11 had higher serum ADMA concentrations than did dogs with CAPS <11 (92 versus 54.6 μg/dL P = .009). Univariable analysis for mortality, CAPS score, band neutrophils, CRP, and ADMA were included in multivariable logistic regression, in which only ADMA was associated with mortality (P = .02). Survivors had a significant decrease in ADMA at first reevaluation compared to admission (P = .02). Conclusions and Clinical Importance Because serum ADMA concentrations were higher in AP dogs compared with the CG, it may have value as a biomarker in the diagnosis of AP in dogs. In addition, because ADMA was associated with mortality, it may have prognostic value.
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Affiliation(s)
- Eleonora Gori
- Veterinary Teaching Hospital "Mario Modenato," Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Alessio Pierini
- Veterinary Teaching Hospital "Mario Modenato," Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Ilaria Lippi
- Veterinary Teaching Hospital "Mario Modenato," Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Valentina Meucci
- Veterinary Teaching Hospital "Mario Modenato," Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Francesca Perondi
- Veterinary Teaching Hospital "Mario Modenato," Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Veronica Marchetti
- Veterinary Teaching Hospital "Mario Modenato," Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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23
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Animal models to study the role of pulmonary intravascular macrophages in spontaneous and induced acute pancreatitis. Cell Tissue Res 2020; 380:207-222. [DOI: 10.1007/s00441-020-03211-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/30/2020] [Indexed: 12/14/2022]
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Kim H, Kim HJ, Kang JH, Kang BT, Yang MP. Evaluation of serum C-reactive protein and high mobility group box 1 concentrations in 22 dogs with acute pancreatitis: a pilot study. Vet Q 2020; 39:122-130. [PMID: 31401946 PMCID: PMC6830977 DOI: 10.1080/01652176.2019.1655178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: High mobility group box 1 (HMGB1) is an important mediator of systemic inflammatory response syndrome (SIRS) in humans with severe acute pancreatitis (AP), but there is little information regarding its role in dogs. Aim: To compare the serum concentrations of C-reactive protein (CRP) and HMGB1 in healthy dogs and those with AP with or without SIRS. Methods: The study included 22 dogs with AP and 20 healthy dogs. CRP and HMGB1 were assessed by ELISA. Statistical analyses were conducted by non-parametric tests. Results: Median (interquartile range) serum CRP and HMGB1 concentrations were significantly (P < 0.05) higher in dogs with AP [60.56 (14.50-140.10) µg/mL and 0.35 (0.03-1.12) ng/mL, respectively] than in healthy dogs [2.23 (1.75-5.14) µg/mL and 0.02 (0.01-0.05) ng/mL, respectively]. After the recommended treatments for AP, serum CRP concentration in AP dogs significantly decreased, but that of HMGB1 in AP dogs significantly increased. There was also a significant difference in median serum HMGB1 concentration between AP dogs with and without SIRS. The use of serum HMGB1 concentration of 0.35 ng/mL to distinguish AP dogs with and without SIRS was associated with a sensitivity of 87.5% and a specificity of 71.5%. A positive correlation was identified between HMGB1 and clinical severity of AP. All AP dogs had a positive outcome during hospitalization [6.0 (1.5-6.0) days]. Conclusion: Results indicate that HMGB1 might be a useful biomarker for the progression of AP and may play a role in progression of AP into SIRS in dogs.
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Affiliation(s)
- Hakhyun Kim
- Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University , Cheongju , Chungbuk , Republic of Korea
| | - Hyung-Jin Kim
- Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University , Cheongju , Chungbuk , Republic of Korea
| | - Ji-Houn Kang
- Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University , Cheongju , Chungbuk , Republic of Korea
| | - Byeong-Teck Kang
- Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University , Cheongju , Chungbuk , Republic of Korea
| | - Mhan-Pyo Yang
- Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University , Cheongju , Chungbuk , Republic of Korea
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Gori E, Pierini A, Lippi I, Boffa N, Perondi F, Marchetti V. Urinalysis and Urinary GGT-to-Urinary Creatinine Ratio in Dogs with Acute Pancreatitis. Vet Sci 2019; 6:vetsci6010027. [PMID: 30871245 PMCID: PMC6466379 DOI: 10.3390/vetsci6010027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 01/14/2023] Open
Abstract
In acute pancreatitis (AP), kidney injury (KI) can occur. Urinalysis and some urinary biomarkers have been proposed as prognostic tools in human AP. The aim of the study was to evaluate urinalysis and urinary GGT-to-urinary creatinine (uGGT/uCr) in canine AP and their association with possible outcomes. AP diagnosis was based on clinical and laboratory parameters, abnormal SNAP® cPL™ test and compatible imaging. Urinary KI (uKI) was defined if dogs had urinary casts and/or proteinuria. Dogs (n = 70) were divided in survivors and non-survivors according to the 15-day outcome. Data were analyzed using statistical software. Seventy dogs were retrospectively included, of which 24 dogs (34%) died. uKI was detected in 36 dogs (37%) which was associated with mortality (p = 0.01, Odds ratio (OR) 3.9, 95% CI 1.3–11.56). Non-survivors showed higher dipstick bilirubin levels than survivors (p = 0.0022). By excluding active sediments, urine protein-to-creatinine ratio (UPC) ≥2 was associated with mortality (p = 0.001, OR 47.5, 95% CI 4–571.9). The uGGT/uCr was available in 40 dogs, although no association of this factor with any outcome was found. The UPC ≥2 can be a negative prognostic factor in canine AP and further studies on uGGT/uCr are warranted.
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Affiliation(s)
- Eleonora Gori
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56121 Pisa, Italy.
| | - Alessio Pierini
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56121 Pisa, Italy.
| | - Ilaria Lippi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56121 Pisa, Italy.
| | - Noemi Boffa
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56121 Pisa, Italy.
| | - Francesca Perondi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56121 Pisa, Italy.
| | - Veronica Marchetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56121 Pisa, Italy.
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Fabrès V, Dossin O, Reif C, Campos M, Freiche V, Maurey C, Pilot-Storck F, Desquilbet L, Benchekroun G. Development and validation of a novel clinical scoring system for short-term prediction of death in dogs with acute pancreatitis. J Vet Intern Med 2019; 33:499-507. [PMID: 30770578 PMCID: PMC6430934 DOI: 10.1111/jvim.15421] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Acute pancreatitis (AP) is associated with a high death rate in dogs, but accurate predictors of early death are still lacking. Objectives To develop a scoring system for prediction of short‐term case fatality in dogs with AP. Animals One hundred sixty‐nine dogs with AP including 138 dogs in the training cohort and 31 dogs in the validation cohort. Methods Multicenter, retrospective cohort study. Survival analysis was used to assess the associations with short‐term death (within 30 days after admission). Independent predictors of death were identified by a stepwise selection method and used for the score calculation. Results Death rate within 30 days after admission was 33% in the training cohort. Four independent risk factors for short‐term death were identified in the training cohort: presence of systemic inflammatory response syndrome, coagulation disorders, increased creatinine and ionized hypocalcemia. Canine Acute Pancreatitis Severity (CAPS) score was developed to predict short‐term death, integrating these 4 factors in a weighted way. A simplified version of CAPS score (sCAPS) including respiratory rate instead of SIRS was also assessed. The area under the receiver‐operating characteristic curve (AUC) of CAPS and sCAPS scores was 0.92 in the training cohort with an optimal cutoff of 11 (sensitivity, 89%; specificity, 90%) and 6 (sensitivity, 96%; specificity, 77%), respectively. CAPS and sCAPS score were validated in the validation cohort with respective AUC of 0.91 and 0.96. Conclusions and Clinical Importance We propose 2 scoring systems that allow early and accurate prediction of short‐term death in dogs with AP.
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Affiliation(s)
- Virginie Fabrès
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Olivier Dossin
- Department of Clinical Sciences, Université de Toulouse ENVT, Toulouse, France.,IRSD, Université de Toulouse INSERM, INRA, ENVT, UPS, Toulouse, France
| | - Clémence Reif
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Miguel Campos
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,Division of Small Animal Internal Medicine, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland.,U955 - IMRB, Team 10 - Biology of the neuromuscular system, Inserm, UPEC, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, France
| | - Valerie Freiche
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Christelle Maurey
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Fanny Pilot-Storck
- U955 - IMRB, Team 10 - Biology of the neuromuscular system, Inserm, UPEC, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, France
| | - Loïc Desquilbet
- U955 - IMRB, Team 10 - Biology of the neuromuscular system, Inserm, UPEC, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, France.,Department of Biostatistic and Epidemiology, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, France
| | - Ghita Benchekroun
- Department of Internal Medicine, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,U955 - IMRB, Team 10 - Biology of the neuromuscular system, Inserm, UPEC, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, France
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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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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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Takada K, Palm CA, Epstein SE, Cowgill LD. Assessment of Canine Pancreas-Specific Lipase and Outcomes in Dogs with Hemodialysis-Dependent Acute Kidney Injury. J Vet Intern Med 2018; 32:722-726. [PMID: 29469974 PMCID: PMC5867007 DOI: 10.1111/jvim.15047] [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] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/06/2017] [Accepted: 12/20/2017] [Indexed: 12/24/2022] Open
Abstract
Background Renal replacement therapies can be life‐saving for dogs with severe acute kidney injury (AKI), however, comorbidities including pancreatitis might affect outcome. Hypothesis/Objectives To investigate the prevalence of pancreas‐specific lipase (Spec cPL) measurements consistent with pancreatitis (≥400 μg/L) in dogs undergoing intermittent hemodialysis (IHD) for treatment of AKI and to determine whether there were associations between 30‐days outcomes and Spec cPL measurements. Animals Fifty‐three client‐owned dogs presented to teaching hospitals between November 2008 and September 2016 that underwent IHD. Methods Retrospective medical record review from dogs that received IHD for management of AKI and also had a Spec cPL measurement. Association between survival, dialysis‐dependency, and Spec cPL measurements was assessed. Results Forty of 53 (76%) dogs were alive at 30‐days and 33/53(62%) had a Spec cPL result ≥400 μg/L. Spec cPL was not significantly different either between surviving (635.5 μg/L, range 29–1,001) and nonsurviving dogs (860 μg/L, range 56–1,001; P = 0.75) or between dialysis‐dependent (1,001 μg/L, range 177–1,001) and nondialysis‐dependent dogs (520 μg/L, range 29–1,001; P = 0.08). Spec cPL ≥400 μg/L was not significantly associated either with survival (P = 0.74) or dialysis‐dependency (P = 0.33). Conclusions and Clinical Importance Results revealed a high prevalence of Spec cPL ≥400 μg/L in dogs with AKI treated with IHD. No significant associations between Spec cPL and survival or dialysis‐dependency in dogs with AKI at 30 days were identified in the current study, however, the latter could be due to lack of power in this study.
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Affiliation(s)
- K Takada
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, CA
| | - C A Palm
- The Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - S E Epstein
- The Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - L D Cowgill
- The Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA
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30
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Schueler RO, White G, Schueler RL, Steiner JM, Wassef A. Canine pancreatic lipase immunoreactivity concentrations associated with intervertebral disc disease in 84 dogs. J Small Anim Pract 2018; 59:305-310. [PMID: 29355958 DOI: 10.1111/jsap.12818] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 11/28/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the differences in serum canine pancreatic lipase immunoreactivity between dogs with intervertebral disc herniation and healthy control dogs. MATERIALS AND METHODS Eighty-four client-owned dogs with intervertebral disc herniation, diagnosed by neurologic examination and imaging, and 18 healthy control dogs. Samples of whole blood were collected within 90 minutes of admission. Serum canine pancreatic lipase immunoreactivity concentrations were measured by a commercial immunoassay and evaluated for association with intervertebral disc herniation, signalment, neurolocalisation and the preadmission administration of glucocorticosteriods or non-steroidal anti-inflammatory drugs. RESULTS Serum canine pancreatic lipase immunoreactivity concentrations were statistically increased in dogs with intervertebral disc herniation (P<0·01, n=38). A subgroup of dogs (19/38) with elevated canine pancreatic lipase immunoreactivity concentrations was re-evaluated between 2 and 4 weeks later, and 15 had resolution of clinical signs and values less than 200 μg/L. Serum canine pancreatic lipase immunoreactivity concentrations were not significantly correlated with clinical gastrointestinal disease, neurolocalisation or the preadmission administration of corticosteroids or non-steroidal anti-inflammatory drugs. CLINICAL SIGNIFICANCE These results suggest that serum canine pancreatic lipase immunoreactivity concentrations are significantly elevated in dogs with intervertebral disc herniation.
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Affiliation(s)
- R O Schueler
- Veterinary Neurology and Rehabilitation Center, Westminster, Maryland, 21158, USA
| | - G White
- Fresno Veterinary Specialty and Emergency Center, Fresno, California, 93710, USA
| | - R L Schueler
- Veterinary Neurology and Rehabilitation Center, Westminster, Maryland, 21158, USA
| | - J M Steiner
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, 77843, USA
| | - A Wassef
- Fresno Veterinary Specialty and Emergency Center, Fresno, California, 93710, USA
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31
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Cain CL, Bradley CW, Mauldin EA. Clinical and histologic features of acute-onset erythroderma in dogs with gastrointestinal disease: 18 cases (2005–2015). J Am Vet Med Assoc 2017; 251:1439-1449. [DOI: 10.2460/javma.251.12.1439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zhu L, Li JY, Zhang YM, Kang HX, Chen H, Su H, Li J, Tang WF. Pharmacokinetics and pharmacodynamics of Shengjiang decoction in rats with acute pancreatitis for protecting against multiple organ injury. World J Gastroenterol 2017; 23:8169-8181. [PMID: 29290653 PMCID: PMC5739923 DOI: 10.3748/wjg.v23.i46.8169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the pharmacokinetics and pharmacodynamics of Shengjiang decoction (SJD) in rats with acute pancreatitis (AP) for protecting against multiple organ injury.
METHODS An AP model was established by retrograde perfusion of 3.5% sodium taurocholate into the biliopancreatic duct, and a control group (CG) received 0.9% sodium chloride instead. Twelve male Sprague-Dawley rats were randomly divided into a CG treated with SJD (CG + SJD) and a model group treated with SJD (MG + SJD), both of which were orally administered with SJD (5 g/kg) 2 h after surgery. Blood samples were collected via the tail vein at 10, 20, and 40 min and 1, 2, 3, 4, 6, 8, and 12 h after a single dose of SJD to detect its main components using high-performance liquid chromatography-tandem mass spectrometry. The pharmacokinetic parameters were compared. In the pharmacodynamic experiment, 18 male Sprague-Dawley rats were randomly divided into a CG, an AP model group (MG), and an SJD treated AP group (SJDG). Serum amylase, lipase, and inflammatory cytokines were measured, and heart, lung, liver, spleen, pancreas, kidney, and intestine tissues were collected for pathological examination.
RESULTS The MG + SJD displayed significantly shorter mean residence time (MRT) and higher clearance (CL) for emodin and aloe-emodin; significantly shorter time of maximum concentration and T1/2 and a lower area under curve (AUC) for aloe-emodin; a significantly higher AUC and lower CL for rhein; and longer MRT and lower CL for chrysophanol than the CG + SJD. In the pharmacodynamic experiment, the amylase, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α levels in the MG were higher than those in the CG (P < 0.05). After the herbal decoction treatment, the SJDG had higher IL-10 and lower TNF-α levels than the MG (P < 0.05). The MG had the highest pathological scores, and the pathological scores of the lung, pancreas, kidney, and intestine in the SJDG were significantly lower than those in the MG (P < 0.05).
CONCLUSION AP may have varying effects on the pharmacokinetics of the major SJD components in rats. SJD might alleviate pathological injuries of the lung, pancreas, kidney, and intestine in rats with AP via regulating pro- and anti- inflammatory responses, which might guide the clinical application of SJD for AP treatment.
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Affiliation(s)
- Lv Zhu
- Sichuan Provincial Pancreatitis Center, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jun-Yi Li
- Department of Traditional Chinese Medicine, Wuhan Union Hospital, Wuhan 430000, Hubei Province, China
| | - Yu-Mei Zhang
- Sichuan Provincial Pancreatitis Center, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong-Xin Kang
- Sichuan Provincial Pancreatitis Center, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Huan Chen
- Sichuan Provincial Pancreatitis Center, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hang Su
- Sichuan Provincial Pancreatitis Center, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Juan Li
- Sichuan Provincial Pancreatitis Center, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Fu Tang
- Sichuan Provincial Pancreatitis Center, Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Marchetti V, Gori E, Lippi I, Luchetti E, Manca ML, Pierini A. Elevated serum creatinine and hyponatraemia as prognostic factors in canine acute pancreatitis. Aust Vet J 2017; 95:444-447. [DOI: 10.1111/avj.12638] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/05/2016] [Accepted: 01/09/2017] [Indexed: 12/13/2022]
Affiliation(s)
- V Marchetti
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - E Gori
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - I Lippi
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - E Luchetti
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
| | - ML Manca
- Department of Clinical and Experimental Medicine; University of Pisa; Italy
| | - A Pierini
- Veterinary Teaching Hospital “Mario Modenato”, Department of Veterinary Sciences; University of Pisa, via Livornese Lato monte, San Piero a Grado; 56122 Pisa Italy
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Heilmann RM, Grützner N, Thames BE, Steiner JM, Barr JW. Serum alpha 1 -proteinase inhibitor concentrations in dogs with systemic inflammatory response syndrome or sepsis. J Vet Emerg Crit Care (San Antonio) 2017; 27:674-683. [PMID: 29068553 DOI: 10.1111/vec.12674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/08/2016] [Accepted: 04/27/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether the concentration of serum canine alpha1 -proteinase inhibitor (cα1 -PI) has diagnostic or prognostic utility in dogs with sepsis or noninfectious systemic inflammatory response syndrome (SIRS). DESIGN Prospective, observational study from May to December 2010. SETTING University teaching hospital ICU. ANIMALS Sixty-nine client-owned dogs: 19 dogs with SIRS or sepsis and 50 healthy control dogs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Serum and plasma samples were collected from dogs with SIRS or sepsis on the day of hospital admission and once on the following 2 days, and on a single day in healthy controls. Patients were assessed using the 10-parameter Acute Patient Physiologic and Laboratory Evaluation (APPLEfull ) and 5-parameter (APPLEfast ) score. Serum cα1 -PI concentrations were measured, compared among groups of dogs, and evaluated for a correlation with the concentration of serum C-reactive protein, plasma interleukin-6, tumor necrosis factor-α, the APPLE scores, and survival to discharge. Serum cα1 -PI concentrations were significantly lower in dogs with SIRS/sepsis (P < 0.001) than in healthy controls. While day 1 serum cα1 -PI concentrations did not differ between dogs with SIRS and those with sepsis (P = 0.592), septic dogs had significantly lower serum cα1 -PI concentrations on days 2 (P = 0.017) and 3 (P = 0.036) than dogs with SIRS. Serum cα1 -PI concentrations did not differ between survivors and nonsurvivors (P = 1.000), but were inversely correlated with the APPLEfull score (ρ = -0.48; P = 0.040) and plasma interleukin-6 concentrations (ρ = -0.50; P = 0.037). CONCLUSIONS These results suggest a role of cα1 -PI as a negative acute phase protein in dogs. The concentration of serum cα1 -PI at the time of hospital admission does not have utility to identify dogs with sepsis from those with noninfectious SIRS, but may be a useful surrogate marker for early stratification of illness severity.
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Affiliation(s)
- Romy M Heilmann
- Gastrointestinal Laboratory, College Station, TX.,the Department of Small Animal Clinical Sciences, College Station, TX
| | - Niels Grützner
- Gastrointestinal Laboratory, College Station, TX.,College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX.,the Farm Animal Clinic, Vetsuisse Faculty Berne, University of Berne, Bremgartenstrasse, Switzerland
| | - Brittany E Thames
- the Department of Small Animal Clinical Sciences, College Station, TX.,the Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Jörg M Steiner
- Gastrointestinal Laboratory, College Station, TX.,the Department of Small Animal Clinical Sciences, College Station, TX
| | - James W Barr
- the Department of Small Animal Clinical Sciences, College Station, TX
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Kim DI, Kim H, Son P, Kang JH, Kang BT, Yang MP. Serum 25-hydroxyvitamin D concentrations in dogs with suspected acute pancreatitis. J Vet Med Sci 2017; 79:1366-1373. [PMID: 28659537 PMCID: PMC5573823 DOI: 10.1292/jvms.16-0647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The present study aimed to determine whether circulating serum concentrations of
25-hydroxyvitamin D [25-(OH) D] differed between healthy dogs and dogs with acute
pancreatitis (AP). Twenty-two healthy dogs and twenty client-owned dogs with AP were
enrolled in the study. Serum concentrations of 25-(OH) D, blood ionized calcium (iCa), and
serum C-reactive protein (CRP) were measured. Concentrations of serum 25-(OH) D and blood
iCa in dogs with AP were significantly lower than those of healthy dogs, and serum
concentrations of CRP in dogs with AP were significantly higher than those of healthy
dogs. A significant difference in 25-(OH) D serum concentrations was observed between
survivor and non-survivor dogs with AP. After resolution of clinical signs, concentrations
of serum 25-(OH) D, blood iCa, and serum CRP did not differ compared to those before
treatment. This study shows that dogs with AP exhibit decreased 25-(OH) D levels, which
might be associated with calcium imbalances and mortality rate in canine AP.
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Affiliation(s)
- Dong-In Kim
- College of Veterinary Medicine and Veterinary Medical Center, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
| | - Hakhyun Kim
- College of Veterinary Medicine and Veterinary Medical Center, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
| | - Purum Son
- College of Veterinary Medicine and Veterinary Medical Center, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
| | - Ji-Houn Kang
- College of Veterinary Medicine and Veterinary Medical Center, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
| | - Byeong-Teck Kang
- College of Veterinary Medicine and Veterinary Medical Center, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
| | - Mhan-Pyo Yang
- College of Veterinary Medicine and Veterinary Medical Center, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
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Zhang ML, Jiang YF, Wang XR, Ding LL, Wang HJ, Meng QQ, Gao PJ. Different phenotypes of monocytes in patients with new-onset mild acute pancreatitis. World J Gastroenterol 2017; 23:1477-1488. [PMID: 28293095 PMCID: PMC5330833 DOI: 10.3748/wjg.v23.i8.1477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the numbers of different subsets of monocytes and their associations with the values of clinical measures in mild acute pancreatitis (MAP) patients.
METHODS The study included one group of 13 healthy controls and another group of 24 patients with new-onset MAP. The numbers of different subsets of monocytes were examined in these two groups of subjects by flow cytometry. The concentrations of plasma interleukin (IL)-10 and IL-12 were determined by cytometric bead array. The acute physiology and chronic health evaluation (APACHE) II scores of individual patients were evaluated, and the levels of plasma C-reactive protein (CRP) as well as the activities of amylase and lipase were measured.
RESULTS In comparison with that in the controls, significantly increased numbers of CD14+CD163-, CD14+CD163-MAC387+ M1 monocytes, but significantly reduced numbers of CD14+CD163+IL-10+ M2 monocytes were detected in the MAP patients (P < 0.01 or P < 0.05). Furthermore, significantly higher levels of plasma IL-10 and IL-12 were observed in the MAP patients (P < 0.01 for all). More importantly, the levels of plasma CRP were positively correlated with the numbers of CD14+CD163- (R = 0.5009, P = 0.0127) and CD14+CD163-MAC387+ (R = 0.5079, P = 0.0113) M1 monocytes and CD14+CD163+CD115+ M2 monocytes (R = 0.4565, P = 0.0249) in the patients. The APACHE II scores correlated with the numbers of CD14+CD163+CD115+ (R = 0.4581, P = 0.0244) monocytes and the levels of plasma IL-10 (R = 0.4178, P = 0.0422) in the MAP patients. However, there was no significant association among other measures tested in this population.
CONCLUSION Increased numbers of CD14+CD163- and CD14+ CD163-MAC387+ monocytes may contribute to the pathogenesis of MAP, and increased numbers of CD14+CD163+CD115+ monocytes may be a biomarker for evaluating the severity of MAP.
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Bettac L, Denk S, Seufferlein T, Huber-Lang M. Complement in Pancreatic Disease-Perpetrator or Savior? Front Immunol 2017; 8:15. [PMID: 28144242 PMCID: PMC5239781 DOI: 10.3389/fimmu.2017.00015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/05/2017] [Indexed: 12/13/2022] Open
Abstract
The complement system is a major pillar of the humoral innate immune system. As a first line of defense against pathogens, it mediates early inflammatory response and links different branches of humoral and cellular immunity. Disorders affecting the exocrine pancreas, such as acute pancreatitis, potentially lead to a life-threatening systemic inflammatory response with aberrant activation of complement and coagulation cascades. Pancreatic proteases can activate key effectors of the complement system, which in turn drive local and systemic inflammation. Beyond that, the extent of pancreas–complement interaction covers complex pro- and anti-inflammatory mechanisms, which to this day remain to be fully elucidated. This review provides a comprehensive overview of the pathophysiological role of complement in diseases of the exocrine pancreas, based on existing experimental and clinical data. Participation of complement in acute and chronic pancreatitis is addressed, as well as its role in tumor immunology. Therapeutic strategies targeting complement in these diseases have long been proposed but have not yet arrived in the clinical setting.
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Affiliation(s)
- Lucas Bettac
- Department of Internal Medicine I, University Hospital of Ulm , Ulm , Germany
| | - Stephanie Denk
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm , Ulm , Germany
| | - Thomas Seufferlein
- Department of Internal Medicine I, University Hospital of Ulm , Ulm , Germany
| | - Markus Huber-Lang
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Ulm , Ulm , Germany
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Bolton TA, Cook A, Steiner JM, Fosgate GT. Pancreatic Lipase Immunoreactivity in Serum of Dogs with Diabetic Ketoacidosis. J Vet Intern Med 2016; 30:958-63. [PMID: 27155726 PMCID: PMC5084790 DOI: 10.1111/jvim.13955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 03/07/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022] Open
Abstract
Background Diabetic ketoacidosis (DKA) is a relatively common endocrine disorder in dogs and is routinely associated with concurrent pancreatic injury. Objectives The aims of this study were to determine the prevalence of pancreatic injury in dogs with DKA based on measurement of pancreatic lipase immunoreactivity in serum (PLI); compare demographic, clinicopathologic, and ultrasonographic findings in dogs with and without evidence of concurrent pancreatic injury; determine the impact of pancreatic injury on duration of hospitalization and short‐term outcome. Animals One hundred and nineteen dogs with DKA with or without concurrent pancreatic injury. Methods Retrospective study. Dogs with DKA were divided into three groups on the basis of PLI results: positive for pancreatic injury (PLIpos), negative for pancreatic injury (PLIneg), and not tested (PLIna). Demographics, clinicopathologic test results, findings on abdominal ultrasonography (AUS), duration of hospitalization, and short‐term outcome were compared between the three groups. Results Based on serum PLI activity, 45 dogs (73%) with DKA had evidence of concurrent pancreatic injury. Median total carbon dioxide was significantly lower in the PLIpos dogs compared to the PLIneg dogs. There was fair agreement (κ = 0.26) between serum PLI activity and AUS. Evidence of pancreatic injury was not associated with significantly longer periods of hospitalization (PLIpos median 6 days, range 4–7 days, PLIneg median 4 days, range 3–6 days) and did not influence short‐term outcome (PLIpos failure to survive to discharge 11/45, 24%, PLIneg failure to survive to discharge 2/17, 12%). Clinical Importance Concurrent pancreatic injury is common in dogs with DKA, but did not affect prognosis in this population of dogs.
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Affiliation(s)
- T A Bolton
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - A Cook
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - J M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - G T Fosgate
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
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Hulsebosch SE, Palm CA, Segev G, Cowgill LD, Kass PH, Marks SL. Evaluation of Canine Pancreas-Specific Lipase Activity, Lipase Activity, and Trypsin-Like Immunoreactivity in an Experimental Model of Acute Kidney Injury in Dogs. J Vet Intern Med 2015; 30:192-9. [PMID: 26678019 PMCID: PMC4913627 DOI: 10.1111/jvim.13806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 09/02/2015] [Accepted: 11/10/2015] [Indexed: 01/19/2023] Open
Abstract
Background Diagnosis of pancreatitis in dogs is complicated by extrapancreatic disorders that can alter the results of laboratory tests. Extrapancreatic disorders can also affect the diagnosis of exocrine pancreatic insufficiency (EPI). The effects of acute kidney injury (AKI) on pancreas‐specific lipase activity (Spec cPL® Test), serum lipase activity and trypsin‐like immunoreactivity (TLI) in dogs have not been evaluated. Hypothesis/Objectives Serum Spec cPL, lipase activity, and TLI concentrations will increase secondary to decreased kidney function. Animals Five purpose‐bred dogs. Methods Experimental prospective study. Gentamicin was used to induce AKI in 5 purpose‐bred dogs. Serum samples were collected for measurement of creatinine, Spec cPL, lipase activity and TLI over 60 days, during both induction of, and recovery from, AKI. Results All dogs developed and recovered from AKI. Six of 52 (12%) serum Spec cPL concentrations were increased (2 in the equivocal zone and 4 consistent with pancreatitis) in 2 of 5 (40%) dogs. Two of 51 (4%) serum lipase activity values were increased in 2 of 5 dogs. Serum TLI was increased above the reference range in 17 of 50 (34%) samples in 3 of 5 dogs. For all biomarkers, there was no consistent correlation with increases in serum creatinine concentration. Conclusions and Clinical Importance Decreased renal excretion during experimental AKI did not cause consistent and correlated increases in serum Spec cPL, lipase activity, or TLI in this cohort of dogs.
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Affiliation(s)
- S E Hulsebosch
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - C A Palm
- Department of Medicine & Epidemiology, School of Veterinary Medicine, Davis, CA
| | - G Segev
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - L D Cowgill
- Department of Medicine & Epidemiology, School of Veterinary Medicine, Davis, CA
| | - P H Kass
- Department of Population, Health & Reproduction, School of Veterinary Medicine, Davis, CA
| | - S L Marks
- Department of Medicine & Epidemiology, School of Veterinary Medicine, Davis, CA
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Xenoulis PG. Diagnosis of pancreatitis in dogs and cats. J Small Anim Pract 2015; 56:13-26. [PMID: 25586803 DOI: 10.1111/jsap.12274] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 04/13/2014] [Accepted: 06/09/2014] [Indexed: 12/23/2022]
Abstract
Pancreatitis is the most common disorder of the exocrine pancreas in both dogs and cats. Ante-mortem diagnosis of canine and feline pancreatitis can be challenging. The clinical picture of dogs and cats with pancreatitis varies greatly (from very mild to severe or even fatal) and is characterised by non-specific findings. Complete blood count, serum biochemistry profile and urinalysis should always be performed in dogs and cats suspected of having pancreatitis, although findings are not-specific for pancreatitis. Serum amylase and lipase activities and trypsin-like immunoreactivity (TLI) concentrations have no or only limited clinical value for the diagnosis of pancreatitis in either dogs or cats. Conversely, serum pancreatic lipase immunoreactivity (PLI) concentration is currently considered to be the clinicopathological test of choice for the diagnosis of canine and feline pancreatitis. Abdominal radiography is a useful diagnostic tool for the exclusion of other diseases that may cause similar clinical signs to those of pancreatitis. Abdominal ultrasonography can be very useful for the diagnosis of pancreatitis, but this depends largely on the clinician's experience. Histopathological examination of the pancreas is considered the gold standard for the diagnosis and classification of pancreatitis, but it is not without limitations. In clinical practice, a combination of careful evaluation of the animal's history, serum PLI concentration and abdominal ultrasonography, together with pancreatic cytology or histopathology when indicated or possible, is considered to be the most practical and reliable means for an accurate diagnosis or exclusion of pancreatitis compared with other diagnostic modalities.
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Affiliation(s)
- P G Xenoulis
- Clinic of Medicine, Faculty of Veterinary Medicine, University of Thessaly, Karditsa 43100, Greece; Animal Medical Center of Athens, Athens, Greece
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Mansfield C, Beths T. Management of acute pancreatitis in dogs: a critical appraisal with focus on feeding and analgesia. J Small Anim Pract 2015; 56:27-39. [PMID: 25586804 DOI: 10.1111/jsap.12296] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 12/31/2022]
Abstract
Knowledge about acute pancreatitis has increased recently in both the medical and veterinary fields. Despite this expansion of knowledge, there are very few studies on treatment interventions in naturally occurring disease in dogs. As a result, treatment recommendations are largely extrapolated from experimental rodent models or general critical care principles. General treatment principles involve replacing fluid losses, maintaining hydrostatic pressure, controlling nausea and providing pain relief. Specific interventions recently advocated in human medicine include the use of neurokinin-1 antagonists for analgesia and early interventional feeding. The premise for early feeding is to improve the health of the intestinal tract, as unhealthy enterocytes are thought to perpetuate systemic inflammation. The evidence for early interventional feeding is not supported by robust clinical trials to date, but in humans there is evidence that it reduces hospitalisation time and in dogs it is well tolerated. This article summarises the major areas of management of acute pancreatitis in dogs and examines the level of evidence for each recommendation.
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Affiliation(s)
- C Mansfield
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia
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Rademacher N, Schur D, Gaschen F, Kearney M, Gaschen L. CONTRAST-ENHANCED ULTRASONOGRAPHY OF THE PANCREAS IN HEALTHY DOGS AND IN DOGS WITH ACUTE PANCREATITIS. Vet Radiol Ultrasound 2015; 57:58-64. [PMID: 26332486 DOI: 10.1111/vru.12285] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/25/2015] [Accepted: 06/03/2015] [Indexed: 12/14/2022] Open
Abstract
Pancreatitis is the most frequent disease affecting the exocrine pancreas in dogs and reliable diagnostic techniques for predicting fatal complications are lacking. Contrast-enhanced ultrasound (CEUS) improves detection of tissue perfusion as well as organ lesion vascular pattern. Objectives of this prospective case control study were to compare perfusion characteristics and enhancement patterns of the pancreas in healthy dogs and dogs with pancreatitis using CEUS. Ten healthy dogs and eight dogs with pancreatitis were selected based on physical examination, abdominal ultrasound, and blood analysis findings. A CEUS study of the pancreas was performed for each dog and two observers who were aware of clinical status used advanced ultrasound quantification software to analyze time-intensity curves. Perfusion patterns were compared between healthy and affected dogs. In dogs with acute pancreatitis, mean pixel and peak intensity of the pancreatic parenchyma was significantly higher than that of normal dogs (P = 0.05) in between 6 and 60 s (P = <0.0001-0.046). This corresponds to a 311% increase in mean pixel intensity in dogs with acute pancreatitis compared to healthy dogs. Wash-in rates were greater and had a consistently steeper slope to peak in dogs with pancreatitis as opposed to healthy dogs. All dogs with pancreatitis showed a decrease in pixel intensity 10-15 days after the initial examination (P = 0.011) and their times to peak values were prolonged compared to the initial exam. Findings from the current study supported the use of CEUS for diagnosing pancreatitis, pancreatic necrosis, and disease monitoring following therapy in dogs.
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Affiliation(s)
- Nathalie Rademacher
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - David Schur
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - Frédéric Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - Michael Kearney
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
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Mansfield C. Practical Interpretation and Application of Exocrine Pancreatic Testing in Small Animals. Clin Lab Med 2015; 35:535-54. [PMID: 26297402 DOI: 10.1016/j.cll.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The pancreas remains a difficult organ to evaluate using laboratory methods alone. No single laboratory test is diagnostic of pancreatitis (chronic or acute) without other diagnostic modalities concurring with the diagnosis or ruling out other diseases. The diagnosis of pancreatitis is particularly difficult in cats, and pancreatitis often occurs with other diseases. The use of pancreatic cytology may be useful in diagnosing both inflammation and neoplasia. Exocrine pancreatic insufficiency (EPI) can be relatively easily diagnosed when clinically manifested by the measurement of trypsinlike immunoreactivity. Diagnosis is more difficult when EPI is subclinical.
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Affiliation(s)
- Caroline Mansfield
- Faculty of Veterinary Science, The University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia.
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Davison LJ. Diabetes mellitus and pancreatitis - cause or effect? J Small Anim Pract 2015; 56:50-9. [DOI: 10.1111/jsap.12295] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/30/2014] [Accepted: 08/02/2014] [Indexed: 02/06/2023]
Affiliation(s)
- L. J. Davison
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES and Wellcome Trust Centre for Human Genetics; University of Oxford; Oxford OX3 7BN
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Paek J, Kang JH, Kim HS, Lee I, Seo KW, Yang MP. Serum adipokine concentrations in dogs with acute pancreatitis. J Vet Intern Med 2014; 28:1760-9. [PMID: 25312217 PMCID: PMC4895644 DOI: 10.1111/jvim.12437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 06/11/2014] [Accepted: 07/23/2014] [Indexed: 01/15/2023] Open
Abstract
Background Limited information is available about the role of adipokines in the development and progression of acute pancreatitis (AP) in dogs. Objectives To determine whether the circulating concentrations of adipokines differed between healthy dogs and dogs with AP, and whether the circulating concentrations differed between AP survivors and AP nonsurvivors. Animals Twenty‐eight healthy dogs and 25 client‐owned dogs with AP. Methods Prospective observational cohort study of 25 client‐owned dogs with newly diagnosed AP and 28 otherwise healthy dogs with similar body condition scores. The serum concentrations of leptin, adiponectin, resistin, visfatin, interleukin (IL)‐1β, IL‐6, IL‐10, IL‐18, and tumor necrosis factor (TNF)‐α were measured. Results The serum concentrations of leptin (P = .0021), resistin (P = .0010), visfatin (P < .0001), IL‐1β (P < .0001), IL‐6 (P = .0002), IL‐10 (P < .0001), and IL‐18 (P < .0001) were significantly higher in dogs with AP than healthy dogs, whereas the adiponectin concentration (P = .0011) was significantly lower. There were significant differences in the serum concentrations of leptin (P = .028) and adiponectin (P = .046) in survivors and nonsurvivors. After the disappearance of clinical signs, the concentrations of resistin (P = .037) and IL‐1β (P = .027) decreased significantly, whereas the serum concentrations of leptin (P > .999), adiponectin (P = .11), visfatin (P = .83), IL‐6 (P = .82), IL‐10 (P = .82), IL‐18 (P = .56), and TNF‐α (P = .94) did not differ significantly. Conclusion and Clinical Importance This study showed that dysregulation of adipokines might be involved in the pathogenesis of AP. In addition, leptin and adiponectin are likely to be associated with mortality rate in AP.
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Affiliation(s)
- J Paek
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea
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Induction of m2 polarization in primary culture liver macrophages from rats with acute pancreatitis. PLoS One 2014; 9:e108014. [PMID: 25259888 PMCID: PMC4178066 DOI: 10.1371/journal.pone.0108014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/24/2014] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Systemic inflammatory response syndrome (SIRS), a major process of severe acute pancreatitis (SAP), usually occurs after various activated proinflammatory cytokines, which are produced by macrophages such as liver macrophages. Macrophages can secrete not only proinflammatory mediators but also inhibitory inflammatory cytokines such as IL-10, leading to two different functional states defined as “polarization”. The main purpose of this study was to demonstrate the polarization of liver macrophages during severe acute pancreatitis and to explore whether the polarization of these activated Liver macrophages could be reversed in vitro. Methods Liver macrophages were isolated from rats with acute pancreatitis. These primary culture macrophages were treated with IL-4 or regulatory T cells in vitro to reverse their polarization and was evaluated by measuring M1/M2 marker expression using real time PCR and immunofluorescence staining. Results Acute pancreatitis was induced successfully by intra-pancreatic ductal injection of 5% sodium taurocholate. The liver macrophages demonstrated M1 polarization from 4 h to 16 h after the onset of acute pancreatitis. However, after IL-4 or Treg treatment, the polarization of the liver macrophages was reversed as indicated by increased expression of M2 markers and reduced expression of M1 markers. Furthermore, the effect of Treg on modulating macrophage polarization was slightly better than that of IL-4 in vitro. Conclusion Liver macrophages, a pivotal cell type in the pathogenesis of SAP, become M1 polarized during pancreatic inflammation. Treatment of these cells with IL-4 and Treg can reverse this activation in vitro. This method of altering macrophage polarization could be a prospective therapy for SAP.
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Lott K, Mansfield C, Abraham LA. Acute chylous peritonitis associated with acute pancreatitis in a Staffordshire bull terrier. N Z Vet J 2014; 63:125-6. [PMID: 25105758 DOI: 10.1080/00480169.2014.948093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- K Lott
- a University of Melbourne Veterinary Teaching Hospital , 250 Princes Highway, Werribee VIC 3030 , Australia
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48
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Jensen KB, Chan DL. Nutritional management of acute pancreatitis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2014; 24:240-50. [PMID: 24690138 DOI: 10.1111/vec.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 02/17/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review current and emerging nutritional approaches in the management of acute pancreatitis (AP) in people, dogs, and cats, and to provide a framework for further investigation in this field. DATA SOURCES Veterinary retrospective studies and reviews, human prospective clinical trials and reviews, and experimental animal studies focusing on nutritional management during AP. SUMMARY Nutritional management is an important part of the treatment plan for patients with AP. In human medicine, the general approach for providing nutrition in patients with AP has changed in recent years and favors enteral over parenteral nutrition with an emphasis on early enteral nutrition (EN). Although there are limited data available, there is increasing evidence in the veterinary literature that supports the beneficial role of EN in AP and contradicts previous assumptions about poor tolerance to enteral feeding in this patient population. Parenteral nutrition may be appropriate alone or in combination with EN as a temporary measure in malnourished patients that do not tolerate adequate EN; however, enteral feeding should be attempted first in most cases. Immunonutrition is being investigated for its positive role in modulating pancreatic inflammation and improving gut barrier function in cases of human AP. CONCLUSIONS The nutritional management of veterinary patients with AP remains challenging. Based on clinical evidence in people, experimental animal studies, and preliminary studies in dogs and cats, the choice of EN over parenteral nutritional support during AP in dogs and cats appears to be beneficial and well tolerated. Optimization of nutritional therapies in dogs and cats including the use of immunonutrition during AP warrants further investigation.
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Affiliation(s)
- Kristine B Jensen
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, United Kingdom
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Mansfield C. Practical Interpretation and Application of Exocrine Pancreatic Testing in Small Animals. Vet Clin North Am Small Anim Pract 2013; 43:1241-60, v-vi. [DOI: 10.1016/j.cvsm.2013.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zhang L, Zhang J, Shea K, Xu L, Tobin G, Knapton A, Sharron S, Rouse R. Autophagy in pancreatic acinar cells in caerulein-treated mice: immunolocalization of related proteins and their potential as markers of pancreatitis. Toxicol Pathol 2013; 42:435-57. [PMID: 23640381 DOI: 10.1177/0192623313486967] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Drug-induced pancreatitis (DIP) is an underdiagnosed condition that lacks sensitive and specific biomarkers. To better understand the mechanisms of DIP and to identify potential tissue biomarkers, we studied experimental pancreatitis induced in male C57BL/6 mice by intraperitoneal injection of caerulein (10 or 50 μg/kg) at 1-hr intervals for a total of 7 injections. Pancreata from caerulein-treated mice exhibited consistent acinar cell autophagy and apoptosis with infrequent necrosis. Kinetic assays for serum amylase and lipase also showed a dose-dependent increase. Terminal deoxynucleotidyl transferase-mediated biotin-dNTP nick labeling (TUNEL) detected dose-dependent acinar cell apoptosis. By light microscopy, autophagy was characterized by the formation of autophagosomes and autolysosomes (ALs) within the cytoplasm of acinar cells. Immunohistochemical studies with specific antibodies for proteins related to autophagy and pancreatic stress were conducted to evaluate these proteins as potential biomarkers of pancreatitis. Western blots were used to confirm immunohistochemical results using pancreatic lysates from control and treated animals. Autophagy was identified as a contributing process in caerulein-induced pancreatitis and proteins previously associated with autophagy were upregulated following caerulein treatment. Autophagosomes and ALs were found to be a common pathway, in which cathepsins, lysosome-associated membrane protein 2, vacuole membrane protein 1, microtubule-associated protein 1 light chain 3 (LC3), autophagy-related protein 9, Beclin1, and pancreatitis-associated proteins were simultaneously involved in response to caerulein stimulus. Regenerating islet-derived 3 gamma (Reg3γ), a pancreatic acute response protein, was dose-dependently induced in caerulein-treated mice and colocalized with the autophagosomal marker, LC3. This finding supports Reg3γ as a candidate biomarker for pancreatic injury.
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Affiliation(s)
- Leshuai Zhang
- 1Division of Drug Safety Research, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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