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Xu Q, Fu X, Xiu Z, Yang H, Men X, Liu M, Xu C, Li B, Zhao S, Xu H. Interleukin‑22 alleviates arginine‑induced pancreatic acinar cell injury via the regulation of intracellular vesicle transport system: Evidence from proteomic analysis. Exp Ther Med 2023; 26:578. [PMID: 38023358 PMCID: PMC10655043 DOI: 10.3892/etm.2023.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Acute pancreatitis (AP) is a severe inflammatory condition characterized by the activation of pancreatic enzymes within acinar cells, leading to tissue damage and inflammation. Interleukin (IL)-22 is a potential therapeutic agent for AP owing to its anti-inflammatory properties and ability to promote tissue repair. The present study evaluated the differentially expressed proteins in arginine-induced pancreatic acinar cell injury following treatment with IL-22, and the possible mechanisms involved in IL-22-mediated alleviation of AP. AR42J cells were stimulated using L-arginine to establish an acinar cell injury model in vitro and the damaged cells were subsequently treated with IL-22. The characteristics of the model and the potential therapeutic effects of IL-22 were examined by CCK-8 assay, flow cytometry, TUNEL assay, transmission electron microscopy and ELISA. Differentially expressed proteins in cells induced by arginine and treated with IL-22 were assessed using liquid chromatography-mass spectrometry. The identified proteins were further subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis to elucidate their functional roles. The present study demonstrated that arginine-stimulated cells showed significant pathological changes resembling those in AP, which were alleviated after IL-22 treatment. Proteomic analysis then demonstrated that in IL-22-treated cells, proteins related to the formation and fusion of autophagosomes with lysosomes were significantly downregulated, whereas endocytosis related proteins were enriched in the upregulated proteins. After IL-22 treatment, western blotting demonstrated reduced expression of autophagy-associated proteins. In conclusion, by inhibiting the formation and fusion of autophagosomes with lysosomes, IL-22 may have mitigated premature trypsinogen activation, subsequently minimizing acinar cell injury induced by L-arginine. This was accompanied by concurrent upregulation of endocytosis, which serves a pivotal role in sustaining regular cellular material transport and signal propagation. This research underscored the potential of IL-22 in mitigating arginine-induced AR42J injury, which could be valuable in refining treatment strategies for AP.
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Affiliation(s)
- Qianqian Xu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Xinjuan Fu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
- Gastroenterology Center, Qingdao Hiser Hospital Affiliated to Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, Shandong 266033, P.R. China
| | - Zhigang Xiu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Hongli Yang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Xiaoxiao Men
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Mingyue Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Changqin Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Bin Li
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Shulei Zhao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Hongwei Xu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, P.R. China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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Omayone TP, Ijomone OM, Oloyede SB, Okunola ST, Aigoro ZO, Esukpa VU, Dinakin SO. Modulatory action of Moringa oleifera Lam. on L-arginine induced acute pancreatitis. J Basic Clin Physiol Pharmacol 2023; 34:707-715. [PMID: 34606706 DOI: 10.1515/jbcpp-2021-0149] [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: 05/18/2021] [Accepted: 09/08/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Acute pancreatitis (AP) is an inflammatory disease of the pancreas with high morbidity and mortality. This study investigates the effect of Moring oleifera (MO) on L-arginine-induced AP in Wistar rats. METHODS Male Wistar rats were randomly divided into seven groups. Control, AP, Magnesium groups, all fed with standard rat diet, MO leaf groups (5% MLF and 15% MLF), and MO seed groups (5% MSD and 15% MSD) were fed with five or 15% MO leaf or seed supplemented diet for four weeks prior to induction of AP. AP was induced by administration of double doses of L-arginine (320 mg/100 g i.p.) at 1 h interval. All animals were sacrificed 72 h thereafter. RESULTS Weekly mean feed consumption and body weight were significantly higher in MO groups compared to the control. Amylase level, MDA, MPO, and NO were significantly higher in the AP group than in the control but decreased in Mg and MO groups. While CAT, SOD, GSH, and SH-group were significantly depleted in AP groups, which was attenuated in MO groups. Rats in AP groups showed severe inflammation, necrosis, and edema. These effects were significantly improved in MO groups resulting in lower histological scores compared to the AP group. CONCLUSIONS Pretreatment with MO could attenuate AP via its antioxidant and anti-inflammatory action.
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Affiliation(s)
- Tosan Peter Omayone
- Department of Physiology, School of Health and Health Technology, Federal University of Technology Akure, Akure, Nigeria
| | - Omamuyovwi Meashack Ijomone
- Department of Anatomy, School of Health and Health Technology, Federal University of Technology Akure, Akure, Nigeria
| | - Solomon Babatunde Oloyede
- Department of Physiology, School of Health and Health Technology, Federal University of Technology Akure, Akure, Nigeria
| | - Salihaat Toyin Okunola
- Department of Physiology, School of Health and Health Technology, Federal University of Technology Akure, Akure, Nigeria
| | - Zainab Oluwabukola Aigoro
- Department of Physiology, School of Health and Health Technology, Federal University of Technology Akure, Akure, Nigeria
| | - Victory Uwuma Esukpa
- Department of Physiology, School of Health and Health Technology, Federal University of Technology Akure, Akure, Nigeria
| | - Samuel Oluwaseun Dinakin
- Department of Physiology, School of Health and Health Technology, Federal University of Technology Akure, Akure, Nigeria
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3
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Orellana-Donoso M, Milos-Brandenberg D, Benavente-Urtubia A, Guerra-Loyola J, Bruna-Mejias A, Nova-Baeza P, Becerra-Farfán Á, Sepulveda-Loyola W, Luque-Bernal RM, Valenzuela-Fuenzalida JJ. Incidence and Clinical Implications of Anatomical Variations in the Pancreas and Its Ductal System: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:1710. [PMID: 37629567 PMCID: PMC10455790 DOI: 10.3390/life13081710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE This systematic review analyzes the anatomical variants in the pancreas and its ductal system to report on their association with pancreatic pathologies. METHODS We conducted a search of the MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception to July 2023. The methodological quality was assessed with the Anatomical Quality Assessment (AQUA) tool. Finally, the pooled prevalence was estimated using a random effects model. RESULTS 55 studies were found that met the eligibility criteria. The overall prevalence of pancreas divisum (PD) was 18% (95% CI = 15-21%). The prevalence of PD associated with pancreatitis was 30% (95% CI = 1-61%). CONCLUSIONS An anatomical variant of the pancreas such as PD may be the cause of bile duct obstruction, resulting in various clinical complications, such as pancreatitis. Hence, knowing this variant is extremely important for surgeons, especially for those who treat the gastroduodenal region.
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Affiliation(s)
- Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7500000, Chile;
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Daniel Milos-Brandenberg
- Escuela de Medicina, Facultad Ciencias de la Salud, Universidad del Alba, Santiago 8320000, Chile;
| | - Andoni Benavente-Urtubia
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Javier Guerra-Loyola
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Alejandro Bruna-Mejias
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Álvaro Becerra-Farfán
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8370993, Chile;
| | - Walter Sepulveda-Loyola
- Faculty of Health and Social Sciences, Universidad de las Américas, Santiago 8370040, Chile;
| | - Ricardo Miguel Luque-Bernal
- Unidad de Anatomía, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111221, Colombia;
| | - Juan José Valenzuela-Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago 8370040, Chile
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4
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Venegas-Tamayo AR, Peña-Veites OM, Hernández-González MA, Barrientos-Alvarado C. Decreased HDL-C Levels as a Predictor of Organ Failure in Acute Pancreatitis in the Emergency Department. Life (Basel) 2023; 13:1602. [PMID: 37511976 PMCID: PMC10381343 DOI: 10.3390/life13071602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
High-density lipoprotein cholesterol (HDL-C) is reported as a biomarker of systemic inflammation and multi-organ failure (MOF), which has been rarely investigated in acute pancreatitis (AP), a frequent condition in the emergency department (ED). The objective was to study the predictive capacity of the decrease in HDL-C to the progression of MOF in AP in the ED; analyzing 114 patients with AP for one year in a longitudinal and prospective study, AP severity was obtained by the Atlanta classification, in relation to modified Marshall and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and clinical and laboratory parameters in a 48 h hospital stay. The area under the receiver operating characteristic (ROC) curve was used to estimate the validity of the predictor and define optimal cut-off points. It was found that AP was classified as severe in 24.5%, mainly for biliary etiology (78.9%) and female sex (73.6%). As a biomarker, HDL-C decreased from 31.6 to 29.5 mg/dL in a 48 h stay (p < 0.001), correlating negatively with the increase in severity index > 2 and the modified Marshall (p < 0.032) and BISAP (p < 0.009) scores, finding an area under the ROC curve with a predictive capacity of 0.756 (95% CI, 0.614-0.898; p < 0.004) and a cut-off point of 28.5 mg/dL (sensitivity: 79%, specificity: 78%), demonstrating that the decrease in HDL-C levels serves as a useful indicator with a predictive capacity for MOF in mild to severe AP, during a 48 h hospital stay in the ED.
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Affiliation(s)
- Ana Rocío Venegas-Tamayo
- High Specialty Medical Unit No. 1, National Medical Center of Bajío, Mexican Social Security Institute, Leon 37320, Guanajuato, Mexico
| | - Olga Mariel Peña-Veites
- High Specialty Medical Unit No. 1, National Medical Center of Bajío, Mexican Social Security Institute, Leon 37320, Guanajuato, Mexico
| | - Martha Alicia Hernández-González
- High Specialty Medical Unit No. 1, National Medical Center of Bajío, Mexican Social Security Institute, Leon 37320, Guanajuato, Mexico
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Pourfridoni M, Khan MAB, Khalil‐Khan A, Mohammad Bagheri Rafsanjani A, Askarpour H. Elevated troponin level and nonspecific ST‐segment and T‐wave changes in a suspected acute pancreatitis patient, post‐SARS‐Cov‐2 infection: A case report. Clin Case Rep 2022; 10:e6628. [PMID: 36419581 PMCID: PMC9676116 DOI: 10.1002/ccr3.6628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
The case report describes a post‐COVID‐19 patient with severe right upper quadrant (RUQ) pain, moderate epigastric pain, high troponin levels, and nonspecific ST‐segment and T‐wave changes on electrocardiogram (ECG).
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Affiliation(s)
| | - Moien A. B. Khan
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences United Arab Emirates University Al‐Ain United Arab Emirates
- Primary Care NHS Northwest London London, Sheffield UK
| | - Alam Khalil‐Khan
- Department of Academic Unit of Primary Medical Care The University of Sheffield Sheffield UK
| | | | - Hedyeh Askarpour
- Clinical Research Development Center of Imam Khomeini Hospital Jiroft University of Medical Sciences Jiroft Iran
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6
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Wu F, She D, Ao Q, Zhang S, Li J. Aggressive intravenous hydration protocol of Lactated Ringer's solution benefits patients with mild acute pancreatitis: A meta-analysis of 5 randomized controlled trials. Front Med (Lausanne) 2022; 9:966824. [PMID: 36160176 PMCID: PMC9492986 DOI: 10.3389/fmed.2022.966824] [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: 06/11/2022] [Accepted: 08/22/2022] [Indexed: 01/30/2023] Open
Abstract
Objective The aim of this meta-analysis was to determine the role of an aggressive intravenous hydration protocol of Lactated Ringer's solution in patients with mild acute pancreatitis (MAP). Methods A systematic search was conducted in PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure (CNKI) to identify randomized controlled trials (RCTs) published before August 19, 2022. The clinical outcomes were evaluated using the standard mean difference (SMD), mean difference (MD), risk ratio (RR), and 95% confidence interval (CI). The primary outcome was clinical improvement, while the secondary outcomes were the development of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), relief of epigastric abdominal pain, and length of hospital stay (LoH). Statistical analysis was performed with RevMan 5.4. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group system was used to determine the quality of evidences. Results There were five RCTs with 370 MAP patients included, and the overall methodological quality was moderate. Aggressive hydration protocol was comparable to standard hydration protocol in terms of clinical improvement (RR = 1.33, 95%CI = 0.95-1.87, P = 0.10; very low evidence). Fewer events of SIRS (RR = 0.48, 95%CI = 0.31-0.72, P < 0.001; low evidence) and MODS (RR = 0.34, 95%CI = 0.13-0.91, P = 0.03; moderate evidence) were reported in patients receiving aggressive hydration protocol. Meanwhile, aggressive hydration protocol also significantly relieved epigastric abdominal pain (SMD = -0.53, 95%CI = -0.81 to -0.25, P < 0.001; low evidence) and shorten the LoH (MD = -2.36, 95%CI = -3.17 to -1.55, P < 0.001; low evidence) compared with standard hydration protocol. Conclusion For patients with MAP, aggressive hydration protocol may be more effective than standard hydration protocol at lowering SIRS and MODS rates, relieving epigastric abdominal pain, and shortening the LoH. Due to the small number of studies that are eligible and poor methodological quality of eligible studies, further studies are required to validate our findings.
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Affiliation(s)
| | - Dong She
- Department of Emergency, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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7
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Zhu F, Yin S, Zhou L, Li Z, Yan H, Zhong Y, Wu X, Luo B, Yang L, Gan D, Deng L, Che D, Li L. Chinese herbal medicine xuebijing injection for acute pancreatitis: An overview of systematic reviews. Front Pharmacol 2022; 13:883729. [PMID: 36034818 PMCID: PMC9399720 DOI: 10.3389/fphar.2022.883729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background: At present, a number of systematic reviews (SRs) on Xuebijing injection (a patent in China) in the treatment of acute pancreatitis (AP) or severe acute pancreatitis (SAP) have been published. However, the quality of evidence is uneven and has not been comprehensively evaluated. Aim: We evaluated the efficacy of Xuebijing injection for AP/SAP through an overview of SR, and to provide a scientific basis for its effectiveness and safety. Methods: We searched Cochrane Library, Embase, PubMed, SinoMed, CNKI, Wanfang, and VIP comprehensively. The retrieval period from inception to 30 November 2021, and the two reviewers independently complete the literature retrieval, data extraction and evaluation. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) were used to evaluate the methodological quality and reporting quality of the SRs, respectively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the quality grading of outcomes and the risk of bias in SRs was evaluated by ROBIS Tool. Finally, the RCTs involved in SRs were synthesized. Stata15.1 was used for quantitative analysis of total effectiveness rate, time until relief of abdominal pain, time until relief of abdominal distension, and serum amylase level. Results: Nine eligible SRs were included, including 92 RCTs and 6,837 participants. The quality of SRs was relatively good, and the manuscript structures were relatively complete. However, the methodological quality of SRs was low or critically low. RoB rated 5 SRs as low risk of bias and 4 SRs as high risk of bias. In GRADE, a total of 47 results were included in the 9 SRs, of which 5 results (10.64%) were moderate quality, 22 results (46.81%) were low quality, and 20 results (42.55%) were very low quality. The results of data synthesis showed that Xuebijing injection combined treatment increased the total effectiveness rate of AP patients (RR = 1.19, 95% CI 1.17–1.23, p < 0.0001), and there was no heterogeneity between studies (I2 = 0.0%, p = 0.589). Compared with the control group, Xuebijing injection group shortened the abdominal pain and distension relief time in AP patients (WMD = −1.69, 95% CI −1.88–−1.50, p < 0.0001; WMD = −1.48, 95% CI −1.74–−1.23, p < 0.0001), with high heterogeneity (I2 = 84.3%, p = 0.000; I2 = 72.2%, p = 0.000). Serum amylase level was also reduced (WMD = −2.06, 95% CI −2.47–−1.64, p < 0.0001), with significant heterogeneity (I2 = 71.6%, p = 0.000). A total of one SR reported adverse drug reaction (ADR), no ADRs were observed in the control group. Conclusion: Although the quality of the evidence is not high, it can still reflect the clinical value of Xuebijing injection as an analgesic and anti-inflammatory traditional Chinese medicine in the treatment of AP/SAP. Therefore, future clinical studies should focus on the long-term efficacy and adverse reactions of drugs. Systematic Review Registration: (website), identifier (registration number).
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Affiliation(s)
- Fengya Zhu
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Shao Yin
- Clinical Medical School, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Zhou
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Zimeng Li
- Acupuncture and Tuina School, The Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Yan
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Yue Zhong
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Xiaohan Wu
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Biao Luo
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Lanying Yang
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Daohui Gan
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Lvyu Deng
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
| | - Deya Che
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
- *Correspondence: Deya Che, ; Liuying Li,
| | - Liuying Li
- Traditional Chinese Medicine Department, Zigong First People’s Hospital, Zigong, China
- *Correspondence: Deya Che, ; Liuying Li,
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8
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A Case Report of Acute Necrotizing Pancreatitis after COVID-19 Infection. Case Rep Med 2022; 2022:3258677. [PMID: 35935668 PMCID: PMC9355785 DOI: 10.1155/2022/3258677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus 2019 (COVID-19), which is associated with many systemic inflammatory reactions and high morbidity and mortality rates, became a serious public health problem and led to a rapid epidemic. Fever, dry cough, and shortness of breath are the most common symptoms of COVID-19. In addition to respiratory symptoms, gastrointestinal manifestations of COVID-19 are increasingly known to progress more rapidly than other symptoms and can occur in cases of mild infection or even after remission of the viral infection. Acute pancreatitis (AP) caused by COVID-19 is one of the rare gastrointestinal symptoms which is an acute inflammatory disease of the pancreas that is associated with high complications. Here, we report acute COVID-19-induced pancreatitis in a 38-year-old man who died.
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9
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Malik A, Amjad W, Farooq U, Saleem SS, Malik MI. Evaluation of the effect of probiotics on septic complications in patients with severe acute pancreatitis. A systematic review and meta-analysis. PRZEGLAD GASTROENTEROLOGICZNY 2022; 18:281-291. [PMID: 37937109 PMCID: PMC10626380 DOI: 10.5114/pg.2022.118164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2023]
Abstract
Introduction Severe acute pancreatitis (SAP) with major complications such as necrosis and multiple organ dysfunction syndrome (MODS) often leads to high mortality rates despite intensive treatment. Aim To evaluate the effect of symbiotics (probiotics) on septic complications in patients with SAP. Material and methods We searched the PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science databases for relevant clinical trials and excluded observational studies. Quality appraisal was evaluated according to GRADE, and we assessed the risk of bias using Cochrane's risk of bias tool. We included the following outcomes: C-reactive protein (CRP), APACHE II score, hospital stay, multiorgan failure (MOF), systemic inflammatory response syndrome, infected pancreatic necrosis, septicaemia, need for operation, and death. We performed the analysis of homogeneous data under a fixed-effects model, while analysis of heterogeneous data were analysed under a random-effects model. We performed the analysis of dichotomous outcomes using the risk ratio (RR) and relative 95% confidence interval (CI). Results We included a total of 7 clinical trials. We found that there was no significant difference between both groups regarding MOF (RR = 0.60 (0.25, 1.44), p = 0.26), septicaemia (RR = 0.66 (0.29, 1.50), p = 0.32), death (RR = 0.66 (0.19, 2.26), p = 0.51), infected pancreatic necrosis (RR = 0.50 (0.18, 1.38), p = 0.18), SIRS (RR = 0.81 (0.29, 2.23), p = 0.68), CRP, APACHE II score, and hospital stay. Conclusions Contrary to some published trials, our meta-analysis concludes that the use of probiotics in patients with SAP is not effective in reducing the mortality rate, septic complications, and need for operation.
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Affiliation(s)
- Adnan Malik
- Mountain Vista Medical Center, Mesa, AZ, United States
| | - Waseem Amjad
- Harvard Medical School, Boston, MA, United States
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10
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Kui B, Pintér J, Molontay R, Nagy M, Farkas N, Gede N, Vincze Á, Bajor J, Gódi S, Czimmer J, Szabó I, Illés A, Sarlós P, Hágendorn R, Pár G, Papp M, Vitális Z, Kovács G, Fehér E, Földi I, Izbéki F, Gajdán L, Fejes R, Németh BC, Török I, Farkas H, Mickevicius A, Sallinen V, Galeev S, Ramírez-Maldonado E, Párniczky A, Erőss B, Hegyi PJ, Márta K, Váncsa S, Sutton R, Szatmary P, Latawiec D, Halloran C, de-Madaria E, Pando E, Alberti P, Gómez-Jurado MJ, Tantau A, Szentesi A, Hegyi P. EASY-APP: An artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis. Clin Transl Med 2022; 12:e842. [PMID: 35653504 PMCID: PMC9162438 DOI: 10.1002/ctm2.842] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 12/17/2022] Open
Abstract
Background Acute pancreatitis (AP) is a potentially severe or even fatal inflammation of the pancreas. Early identification of patients at high risk for developing a severe course of the disease is crucial for preventing organ failure and death. Most of the former predictive scores require many parameters or at least 24 h to predict the severity; therefore, the early therapeutic window is often missed. Methods The early achievable severity index (EASY) is a multicentre, multinational, prospective and observational study (ISRCTN10525246). The predictions were made using machine learning models. We used the scikit‐learn, xgboost and catboost Python packages for modelling. We evaluated our models using fourfold cross‐validation, and the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and accuracy metrics were calculated on the union of the test sets of the cross‐validation. The most critical factors and their contribution to the prediction were identified using a modern tool of explainable artificial intelligence called SHapley Additive exPlanations (SHAP). Results The prediction model was based on an international cohort of 1184 patients and a validation cohort of 3543 patients. The best performing model was an XGBoost classifier with an average AUC score of 0.81 ± 0.033 and an accuracy of 89.1%, and the model improved with experience. The six most influential features were the respiratory rate, body temperature, abdominal muscular reflex, gender, age and glucose level. Using the XGBoost machine learning algorithm for prediction, the SHAP values for the explanation and the bootstrapping method to estimate confidence, we developed a free and easy‐to‐use web application in the Streamlit Python‐based framework (http://easy‐app.org/). Conclusions The EASY prediction score is a practical tool for identifying patients at high risk for severe AP within hours of hospital admission. The web application is available for clinicians and contributes to the improvement of the model.
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Affiliation(s)
- Balázs Kui
- Department of Medicine, University of Szeged, Szeged, Hungary.,Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - József Pintér
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Roland Molontay
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary.,MTA-BME Stochastics Research Group, Budapest, Hungary
| | - Marcell Nagy
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Szilárd Gódi
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - József Czimmer
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Imre Szabó
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Anita Illés
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Roland Hágendorn
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Mária Papp
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Vitális
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - György Kovács
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eszter Fehér
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Földi
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - László Gajdán
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Roland Fejes
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Balázs Csaba Németh
- Department of Medicine, University of Szeged, Szeged, Hungary.,Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Imola Török
- County Emergency Clinical Hospital of Târgu Mures-Gastroenterology Clinic and University of Medicine, Pharmacy, Sciences and Technology 'George Emil Palade', Targu Mures, Romania
| | - Hunor Farkas
- County Emergency Clinical Hospital of Târgu Mures-Gastroenterology Clinic and University of Medicine, Pharmacy, Sciences and Technology 'George Emil Palade', Targu Mures, Romania
| | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Shamil Galeev
- Saint Luke Clinical Hospital, St. Petersburg, Russia
| | | | - Andrea Párniczky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Jenő Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Katalin Márta
- Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Robert Sutton
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Peter Szatmary
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Diane Latawiec
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Chris Halloran
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, England, UK
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Elizabeth Pando
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Piero Alberti
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria José Gómez-Jurado
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alina Tantau
- The 4th Medical Clinic, Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Gastroenterology and Hepatology Medical Center, Cluj-Napoca, Romania
| | - Andrea Szentesi
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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11
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Fauzi A, Suhendro, Simadibrata M, Rani AA, Sajuthi D, Permanawati, Amanda R, Makmun D. Role of glycodeoxycholic acid to induce acute pancreatitis in
Macaca nemestrina. J Med Primatol 2022; 51:134-142. [PMID: 35306662 PMCID: PMC9310849 DOI: 10.1111/jmp.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/04/2022] [Accepted: 02/26/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Achmad Fauzi
- Gastroenterology‐pancreatobiliarry and GI Endoscopy Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta Indonesia
| | - Suhendro
- Tropical medicine Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta Indonesia
| | - Marcellus Simadibrata
- Gastroenterology‐pancreatobiliarry and GI Endoscopy Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta Indonesia
| | - Abdul Azis Rani
- Gastroenterology‐pancreatobiliarry and GI Endoscopy Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta Indonesia
| | - Dondin Sajuthi
- Primate Research Centre Institut Pertanian Bogor Bogor Indonesia
| | - Permanawati
- Primate Research Centre Institut Pertanian Bogor Bogor Indonesia
| | - Rosvitha Amanda
- Gastroenterology‐pancreatobiliarry and GI Endoscopy Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta Indonesia
| | - Dadang Makmun
- Gastroenterology‐pancreatobiliarry and GI Endoscopy Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta Indonesia
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12
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Zhao L, Ma Y, Li Q, Wang Y. Ulinastatin combined with glutamine improves liver function and inflammatory response in patients with severe acute pancreatitis. Am J Transl Res 2022; 14:918-926. [PMID: 35273695 PMCID: PMC8902555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore whether ulinastatin combined with glutamine (Gln) can improve the liver function and inflammation in patients with severe acute pancreatitis (SAP). METHODS Altogether 78 patients with SAP treated in Tangshan Workers' Hospital were retrospectively enrolled and divided into the control group (CG, n=35, conventional treatment plus ulinastatin) and the research group (RG, n=43, additional Gln on the basis of treatment in the CG) according to the treatment regimen. The improvement of clinical symptoms after treatment was observed in both groups. The levels of IgM, IgA and IgG were tested by ELISA. The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were utilized to evaluate the changes of the patients' condition before and after treatment, and the Balthazar CT score was used to assess the changes of the lesions. The changes of inflammatory cytokines were determined via Enzyme linked immunosorbent assay (ELISA). The liver function and amylase indexes of both groups were measured. RESULTS Patients in the RG experienced faster improvement in bloating and abdominal pain, first defecation, and bowel sound recovery than the CG (all P<0.05). After treatment, IgM, IgA and IgG in the RG were higher than those in the CG (all P<0.05). Besides, the RG exhibited markedly lower interleukin-6 (IL6), IL, tumor necrosis factor α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) levels than the CG after treatment (all P<0.05). After treatment, the indexes of liver function and amylase in both groups were decreased, and those in the RG were lower than those in the CG (all P<0.05). CONCLUSION Ulinastatin in combination with glutamine is effective in treating severe pancreatitis, which efficiently reduces inflammation in patients and facilitates the recovery of immune, metabolic, and liver functions, and therefore it has a high clinical application value.
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Affiliation(s)
- Li Zhao
- Department of Gastroenterology and Hepatology, Tangshan Gongren HospitalTangshan 063000, Hebei Province, China
| | - Yanrong Ma
- Department of Oncology, The Central HospitalTangshan 064100, Hebei Province, China
| | - Qiuyue Li
- Nursing Department, Tangshan Gongren HospitalTangshan 063000, Hebei Province, China
| | - Yuhan Wang
- Department of Gastroenterology and Hepatology, Tangshan Gongren HospitalTangshan 063000, Hebei Province, China
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13
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Zheng Q, Cao L, Ma H, Jin Y, Gao Y, Nie J, Guo Q. Evidence-Based Care Can Improve Treatment Compliance and Quality of Life of Patients with Acute Pancreatitis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7621658. [PMID: 35190764 PMCID: PMC8858044 DOI: 10.1155/2022/7621658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/25/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis represents a disease characterized by acute necro-inflammatory changes in the pancreas, which is histologically characterized by destruction of alveolar cells. We aim to explore whether evidence-based care can improve treatment compliance and quality of life of patients with acute pancreatitis. The changes of hemoglobin (HGB), serum pre-albumin (PAB), and serum albumin (ALB) before and after care were observed, as well as the incidence of complications after care, total effective rate after care, disease severity (bedside index for severity in acute pancreatitis, BISAP) before and after care, and psychological scores of the two groups before and after care were observed. Patients' compliance after care, self-management scores after care, and quality of life after care were compared between the two groups. After care, HGB, PAB, and ALB increased significantly in both groups (p < 0.05) and were higher in OG than CG. Compared with CG, OG had significantly lower incidence of complications (p=0.009), significantly higher total effective rate (p=0.011), significantly lower disease severity (p < 0.05), significantly better psychological condition scores (p < 0.05), significantly higher compliance scores (p < 0.05), higher self-management scores (p < 0.05), and significantly higher quality of life (p < 0.001). Evidence-based care can improve treatment compliance of patients with acute pancreatitis and can effectively improve their quality of life.
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Affiliation(s)
- Qiu Zheng
- Department of Gastroenterology, The Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
| | - Li Cao
- Department of Cerebral Surgery, The Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
| | - Huanhuan Ma
- Department of Gastroenterology, The Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
| | - Yangyang Jin
- Medical Oncology, The Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
| | - Yufei Gao
- Heilongjiang University of Traditional Chinese Medicine, Harbin 150040, Heilongjiang, China
| | - Jiating Nie
- The Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
| | - Qingfeng Guo
- Department of Nursing Care, The Fourth Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China
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14
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Demirtürk N, Bilensoy E. Nanocarriers targeting the diseases of the pancreas. Eur J Pharm Biopharm 2022; 170:10-23. [PMID: 34852262 DOI: 10.1016/j.ejpb.2021.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 02/08/2023]
Abstract
Diseases of the pancreas include acute and chronic pancreatitis, exocrine pancreatic insufficiency, diabetes and pancreatic cancer. These pathologies can be difficult to treat due to the innate properties of the pancreas, its structure and localization. The need for effective targeting of the pancreatic tissue by means of nanoparticles delivering therapeutics is a major focus area covered and discussed in this review. Most common diseases of the pancreas do not have specific and direct medical treatment option, and existing treatment options are generally aimed at relieving symptoms. Diabetes has different treatment options for different subtypes based on insulin having stability problems and requiring injections reducing patient compliance. Pancreatic cancer progresses silently and can only be diagnosed in advanced stages. Therefore, survival rate of patients is very low. Gemcitabine and FOLFIRINOX treatment regimens, the most commonly used clinical standard treatments, are generally insufficient due to the chemoresistance that develops in cancer cells and also various side effects. Therefore new treatment options for pancreatic cancer are also under focus. Overcoming drug resistance and pancreatic targeting can be achieved with active and passive targeting methods, and a more effective and safer treatment regimen can be provided at lower drug doses. This review covers the current literature and clinical trials concerning pancreatic drug delivery systems in the nanoscale focusing on the challenges and opportunities provided by these smart delivery systems.
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Affiliation(s)
- Nurbanu Demirtürk
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06100 Ankara, Turkey
| | - Erem Bilensoy
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06100 Ankara, Turkey.
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15
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Ashraf H, Colombo JP, Marcucci V, Rhoton J, Olowoyo O. A Clinical Overview of Acute and Chronic Pancreatitis: The Medical and Surgical Management. Cureus 2021; 13:e19764. [PMID: 34938639 PMCID: PMC8684888 DOI: 10.7759/cureus.19764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/05/2022] Open
Abstract
An inflammatory process involving the pancreas, known as pancreatitis, can be categorized as either acute or chronic and may present in one of many ways. The clinical manifestations of acute pancreatitis are generally limited to epigastric or right upper quadrant pain, while manifestations of chronic pancreatitis are broader and may include abdominal pain in tandem with signs and symptoms of pancreatic endocrine and exocrine insufficiency. An understanding of the initial insult, proper classification, and prognosis are all factors that are of paramount importance as it pertains to managing patients who are afflicted with this disease. Our review delves into the depths of pancreatitis by exploring the embryology and anatomy of the pancreas, the pathophysiology and etiology of acute and chronic pancreatitis, and the medical and surgical management of acute and chronic pancreatitis.
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Affiliation(s)
- Hamza Ashraf
- Medical Education, St. Peter's University Hospital, New Brunswick, USA
| | - John Paul Colombo
- Medical Research, St. Peter's University Hospital, New Brunswick, USA.,Medical Research, St. George's University School of Medicine, True Blue, GRD
| | | | - Jonathan Rhoton
- Surgery, Hackensack University Medical Center, Hackensack, USA
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16
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Acharya R, Dahal P, Parajuli S. Harmless Acute Pancreatitis Negative among Cases of Acute Pancreatitis in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1297-1301. [PMID: 35199790 PMCID: PMC9200029 DOI: 10.31729/jnma.6627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute Pancreatitis is a common disease, diagnosed in about 3% of cases presenting with abdominal pain. Severe disease with multiple systemic complications develops in 10-20% of the cases which require intensive care in specialized centres. Harmless acute pancreatitis score is a simple and economical score predicting the non-severe course of disease within 30 minutes of admission. The aim of our study was to find the prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis in a tertiary care centre. METHODS A descriptive cross-sectional study was conducted after obtaining the ethical approval (Reference no. 344/2076/77). The study was carried out from September 2019 to February 2020 taking 50 patients with the first attack of acute pancreatitis. Convenient sampling was done. Harmless acute pancreatitis score prediction of severe disease and final outcome as severe or non-severe was noted with predefined severity criteria. Data were entered in Microsoft Excel and Statistical Package for the Social Sciences and results represented in tables and charts. Point estimate at 95% was done and frequency and percentage were calculated. RESULTS Out of 50 patients with first attack of acute pancreatitis, using the harmless acute pancreatitis score, the prevalence of harmless acute pancreatitis was 22 (56%) (44.45-67.5 at 90% Confidence Interval). CONCLUSIONS The harmless acute pancreatitis score is an easy, less expensive, quick and promising early scoring system for prediction of non-severe courses of acute pancreatitis. The prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis was found to be similar to other studies.
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Affiliation(s)
- Ravi Acharya
- Department of General Surgery, Rapti Academy of Health Sciences, Dang, Nepal,Correspondence: Dr. Ravi Acharya, Department of General Surgery, Rapti Academy of Health Sciences (RAHS), Dang, Nepal. , Phone: +977-9851167637
| | - Peeyush Dahal
- Burn And Plastic Unit, Bir Hospital, Kathmandu, Nepal
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17
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Tod P, Farkas N, Németh D, Szénási G, Vincze Á, Hágendorn R, Czakó L, Illés D, Izbéki F, Dunás-Varga V, Papp M, Hamvas J, Varga M, Gombos K, Nagy T, Márton Z, Faluhelyi N, Török I, Ince AT, Galeev S, Hegyi PJ, Szentesi A, Párniczky A, Szakács Z, Hegyi P, Hamar P. Initial Renal Function (eGFR) Is a Prognostic Marker of Severe Acute Pancreatitis: A Cohort-Analysis of 1,224 Prospectively Collected Cases. Front Med (Lausanne) 2021; 8:671917. [PMID: 34485326 PMCID: PMC8416275 DOI: 10.3389/fmed.2021.671917] [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: 02/24/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Acute pancreatitis (AP) is a life-threatening disease. We aimed to explore the prognostic relevance of renal function based on estimated glomerular filtration rate (eGFR). Methods: A prospective registry of AP patients was established by the Hungarian Pancreatic Study Group. Data of 1,224 consecutive patients were collected between 2012 and 2017. Patients were divided into 3 groups according to their eGFR measured within 24 h of hospitalization: normal renal function: >90 mL/min, mild to moderate renal functional impairment: 30-90 mL/min and severe renal dysfunction: <30 mL/min. Associations of eGFR with outcome (survival, length of hospitalization, AP severity, blood glucose), inflammatory markers (erythrocyte sedimentation rate, white blood cell count), anemia and organ failure (heart, kidney, liver) were analyzed. Results: Death, longer hospitalization and severe AP, but not the cause of AP, were significantly associated with lower eGFR. The inflammatory markers (CRP, WBC count) but not anemia (Hb, Htk) were closely associated with severe renal dysfunction. Renal function was associated with heart and renal failure but not with other complications of AP such as respiratory failure, local pancreatic complications, diabetes or peptic ulcer. eGFR was not associated with liver damage (ALAT, γ-GT) or liver function (serum bilirubin) although biliary complications, alcohol and metabolic syndrome were the most common etiologies of AP. Conclusions: Our study suggests a useful prognostic value of initial eGFR in AP patients. Even mild eGFR reduction predicted mortality, severity of AP and the length of hospitalization. Thus, precise evaluation of renal function should be considered for assessing AP severity and outcome.
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Affiliation(s)
- Pál Tod
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- School of Medicine, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Nelli Farkas
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Dávid Németh
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Gábor Szénási
- School of Medicine, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Roland Hágendorn
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Czakó
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Illés
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Izbéki
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Veronika Dunás-Varga
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Katalin Gombos
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Nagy
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Márton
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Nándor Faluhelyi
- Department of Radiology, Medical School, University of Pécs, Pécs, Hungary
| | - Imola Török
- County Emergency Clinical Hospital - Gastroenterology and University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureṣ, Romania
| | - Ali Tüzün Ince
- School of Medicine, Hospital of Bezmialem Vakif University, Istanbul, Turkey
| | - Shamil Galeev
- Saint Luke Clinical Hospital, St. Petersburg, Russia
| | - Péter Jenő Hegyi
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Department of Medicine, Centre for Translational Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Párniczky
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Zsolt Szakács
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Department of Medicine, Centre for Translational Medicine, University of Szeged, Szeged, Hungary
- Centre for Translational Medicine, Medical School, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Medical School, Semmelweis University, Budapest, Hungary
| | - Péter Hamar
- Szentágothai Research Centre, Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- School of Medicine, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
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Alkhayyat M, Abou Saleh M, Grewal MK, Abureesh M, Mansoor E, Simons-Linares CR, Abelson A, Chahal P. Pancreatic manifestations in rheumatoid arthritis: a national population-based study. Rheumatology (Oxford) 2021; 60:2366-2374. [PMID: 33244600 DOI: 10.1093/rheumatology/keaa616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES RA is a systemic autoimmune disease characterized by persistent joint inflammation. Extra-articular manifestations of RA can involve different organs including the gastrointestinal (GI) system. Using a large database, we sought to describe the epidemiology of pancreas involvement in RA. METHODS We queried a multicentre database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems in the US from 1999 to 2019. After excluding patients younger than 18, a cohort of individuals with Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) diagnosis of RA was identified. Within this cohort, patients who developed a SNOMED-CT diagnosis of acute pancreatitis (AP), chronic pancreatitis (CP) and primary pancreatic cancer (PaCa) after at least 30 days of RA diagnosis were identified. Statistical analysis for multivariate model was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp) to adjust for several factors. RESULTS Of the 56 183 720 individuals in the database, 518 280 patients had a diagnosis of RA (0.92%). Using a multivariate regression model, patients with RA were more likely to develop AP [odds ratio (OR): 2.51; 95% CI: 2.41, 2.60], CP (OR: 2.97; 95% CI: 2.70, 3.26) and PaC (OR: 1.79; 95% CI: 1.52, 2.10). CONCLUSION In this large database, we found a modest increased risk of AP and CP among patients with RA after adjusting for the common causes of pancreatitis. Further studies are required to better understand this association and the effect of medications used for RA.
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Affiliation(s)
| | - Mohannad Abou Saleh
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY
| | - Emad Mansoor
- Department of Gastroenterology, University Hospitals Cleveland Medical Center
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | - Abby Abelson
- Department of Rheumatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
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High levels of reactive oxygen species in pancreatic necrotic fluid of patients with walled-off pancreatic necrosis. GASTROENTEROLOGY REVIEW 2021; 16:56-61. [PMID: 33986889 PMCID: PMC8112273 DOI: 10.5114/pg.2020.95948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
Introduction Walled-off pancreatic necrosis (WOPN) is a life-threatening, late complication of acute pancreatitis, in which a fluid collection containing necrotic material is formed. Infection of the fluid collection significantly increases the mortality of patients with WOPN. Aim To examine the levels of oxidative stress markers in the pancreatic necrotic fluid (PNF) and serum of patients with sterile and infected WOPN. Material and methods Thirty-three adult patients with sterile WOPN and 14 with infected WOPN, as well as 31 patients with mild AP, were included in this study. Concentrations of oxidative stress markers (8-isoprostane, protein carbonyl groups, and 8-hydroxyguanine) were measured in the PNF and serum of patients with sterile and infected WOPN. Results High concentrations of all measured oxidative stress markers in PNF, but not in serum, were detected in patients with WOPN. Additionally, oxidative stress markers in PNF were significantly increased in patients with infected as compared to sterile WOPN. The serum high sensitive C-reactive protein (hsCRP) concentrations showed the highest correlation with PNF oxidative stress marker levels. Receiver operating characteristics (ROC) curve analysis confirmed that serum hsCRP could be a good predictor of WOPN infection. Conclusions Oxidative stress is associated with WOPN development; infection of PNF worsens the course of WOPN, possibly via increased production of reactive oxygen species; and serum hsCRP concentrations seem to be a good, noninvasive indicator of PNF infection.
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Wang J, Fu J, Xu C, Jia R, Zhang X, Zhao S. Circ_ZFP644 attenuates caerulein-induced inflammatory injury in rat pancreatic acinar cells by modulating miR-106b/Pias3 axis. Exp Mol Pathol 2021; 121:104644. [PMID: 33945806 DOI: 10.1016/j.yexmp.2021.104644] [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: 10/11/2020] [Revised: 03/30/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
(AP) is a kind of inflammatory misorder existing in pancreas. Non-coding RNAs (ncRNAs) have been reported to play important roles in development of AP. The current study was designed to explore the role of circular RNA zinc finger protein 644 (circRNA circ_ZFP644) in caerulein-induced AR42J cells. AP model in vitro was established by exposure of rat pancreatic acinar AR42J cells to caerulein. Amylase activity was measured using a kit. Enzyme-linked immunosorbent assay (ELISA) was performed to examine the levels of several inflammatory factors. The expression of circ_ZFP644, microRNA (miR)-106b and protein inhibitor of activated STAT 3 (Pias3) was detected by quantitative real-time PCR (qRT-PCR) or western blot assay. And flow cytometry was employed to monitor cell apoptosis. Western blot assay was also conducted to analyze the expression of apoptosis-related proteins. The association among circ_ZFP644, miR-106b and Pias3 was validated by dual-luciferase reporter assay. Caerulein treatment activated amylase activity and promoted the secretion of inflammatory cytokines in AR42J cells. Circ_ZFP644 and Pias3 were downregulated, but miR-106b was upregulated in caerulein-induced AR42J cells. Enforced expression of circ_ZFP644 or miR-106b inhibition could reduce amylase activity and inflammatory cytokine secretion, while promote apoptosis in caerulein-induced AR42J cells, which was almost reversed by Pias3 knockdown. Circ_ZFP644 targeted miR-106b to upregulate Pias3 expression. Circ_ZFP644 might exert its anti-inflammation and pro-apoptosis roles in caerulein-induced AR42J cells by regulating miR-106b/Pias3 axis.
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Affiliation(s)
- Jing Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jindong Fu
- Department of Gastroenterology, Rizhao People's Hospital, Rizhao, Shandong, China
| | - Changqin Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ruzhen Jia
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaohua Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shulei Zhao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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21
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Minkov G, Dimitrov E, Yovtchev Y, Enchev E, Lokova R, Halacheva K. Prognostic value of peripheral blood CD14+HLA-DR+ monocytes in patients with acute pancreatitis. J Immunoassay Immunochem 2021; 42:478-492. [PMID: 33818295 DOI: 10.1080/15321819.2021.1903491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acute pancreatitis (AP) is characterized by a potent pro-inflammatory response and concomitant anti-inflammatory response leading to a state of immunosuppression. Decreased HLA (Human Leukocyte Antigen)-DR expression on monocytes is a reliable cellular marker of immune suppression. The main objective of this study was to investigate the clinical value of the percentage of peripheral blood CD14+ HLA-DR+ monocytes (mHLA-DR) for diagnosis and assessment of severity, development of organ failures (OF), local complications (LC), and infected necrosis (IN), and outcome in patients with AP. Flow cytometry was used to measure the percentage of peripheral blood mHLA-DR at different time points in 82 patients with AP enrolled during the period of 2012-2018 admitted to University Hospital Stara Zagora, Bulgaria. The percentages of peripheral blood mHLA-DR in AP patients were significantly associated with severity, development of LC, OF, IN (measured at admission, on the 48th hour and on the 5th day) and with outcome (measured on the 5th day) of AP. The value of peripheral blood mHLA-DR may be used as a biological marker in the diagnosis and assessment of severity, development of OF, LC, IN and to predict outcome in AP.
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Affiliation(s)
- Georgi Minkov
- Department of Surgery, University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora, Bulgaria
| | - Evgeni Dimitrov
- Department of Surgery, University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora, Bulgaria
| | - Yovcho Yovtchev
- Department of Surgery, University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora, Bulgaria
| | - Emil Enchev
- Department of Surgery, University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora, Bulgaria
| | - Rumyana Lokova
- Laboratory of Clinical Immunology, University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora, Bulgaria
| | - Krasimira Halacheva
- Laboratory of Clinical Immunology, University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora, Bulgaria
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Liang G, Yang J, Liu T, Wang S, Wen Y, Han C, Huang Y, Wang R, Wang Y, Hu L, Wang G, Li F, Tyndall JDA, Deng L, Du D, Xia Q. A multi-strategy platform for quality control and Q-markers screen of Chaiqin chengqi decoction. PHYTOMEDICINE 2021; 85:153525. [PMID: 33740732 DOI: 10.1016/j.phymed.2021.153525] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that is associated with substantial morbidity and mortality. Chaiqin chengqi decoction (CQCQD) has been proven clinically to be an effective treatment for AP for decades in West China Hospital. Quality control for CQCQD containing many hundreds of characteristic phytochemicals poses a challenge for developing robust quality assessment metrics. PURPOSE To evaluate quality consistency of CQCQD with a multi-strategy based analytical method, identify potential quality-markers (Q-markers) based on drug properties and effect characteristics, and endeavor to establish CQCQD as a globally-accepted medicine. METHODS A typical analysis of constitutive medicinal plant materials was performed following the Chinese Pharmacopoeia. The extraction process was optimized through an orthogonal array (L9(34)) to evaluate three levels of liquid to solid ratio, soaking time, duration of extraction, and the number of extractions. An ultra-high-performance liquid chromatography (UHPLC) fingerprinting combined with absolute quantitation of multi chemical marker compounds, coupled with similarity, hierarchical clustering analysis (HCA), and principal component analyses (PCA) were performed to evaluate 10 batches of CQCQD. On the basis of systematic analysis of fundamental features of CQCQD in treating AP, the potential Q-marker screen was proposed through detection of quality transfer and efficacy for chemical markers. UHPLC coupled with quadrupole orbitrap mass spectrometry were used to determine compounds in medicinal materials, decoctions and plasma. Network pharmacology and taurolithocholic acid 3-sulfate induced pancreatic acinar cell death were used to evaluate the correlation between chemical markers and anti-pancreatitis activity. A cerulein induced AP murine model was used to validate quality assessed CQCQD batches at clinically-equivalent dose. The effective content of chemical markers was predicted using linear regression analysis on quantitative information between validated batches and the other batches. RESULTS The chemical markers and other physical and chemical indices in the original materials met Chinese Pharmacopoeia standards. A total of 22 co-existing fingerprint peaks were selected and the similarity varied between 0.946 and 0.990. Batch D10 possessed the highest similarity index. HCA classified the 10 batches into 2 main groups: 7 batches represented by D10 and 3 batches represented by D1. During the initial Q-marker screen stage, 22 compounds were detected in both plant materials and decoctions, while 13 compounds were identified in plasma. Network pharmacology predicted the potential targets and pathway of AP related to the 22 compounds. All 10 batches showed reduced necrosis below 60% with the best effect achieved by D10 (~40%). The spectrum-efficacy relationship analyzed by Pearson correlation analysis indicated that emodin, rhein, aloe emodin, geniposide, hesperridin, chrysin, syringin, synephrine, geniposidic acid, magnolol, physcion, sinensetin, and baicalein showed positive correlation with pancreatic acinar cell death protection. Similar to the in vitro evaluation, batch D10 significantly reduced total histopathological scores and biochemical severity indices at a clinically-equivalent dose but batch D1 did not. The content of naringin, narirutin and baicalin in batches D1, D5 and D9 consistently exceeds the upper limit of the predicted value. Eight markers whose lower limit is predicted to be close to 0 contributed less to the material basis for AP protection. CONCLUSION Despite qualified materials used for CQCQD preparation, the clinical effect depends on appropriate content range of Q-markers. Emodin, rhein, aloe emodin, magnolol, hesperidin, synephrine, baicalein, and geniposide are considered as vital Q-markers in the primary screen. This study proposed a feasible platform for producing highly consistent batches of CQCQD in future study.
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Affiliation(s)
- Ge Liang
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China; West China-Washington Mitochondria and Metabolism Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingyu Yang
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tingting Liu
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shisheng Wang
- West China-Washington Mitochondria and Metabolism Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongjian Wen
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenxia Han
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yan Huang
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Rui Wang
- Advanced Mass Spectrometry Center, Research Core Facility, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yiqin Wang
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liqiang Hu
- West China-Washington Mitochondria and Metabolism Centre, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guangzhi Wang
- Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Fei Li
- Laboratory of metabolomics and drug-induced liver injury, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Joel D A Tyndall
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand
| | - Lihui Deng
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Dan Du
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China; West China-Washington Mitochondria and Metabolism Centre, West China Hospital, Sichuan University, Chengdu 610041, China; Advanced Mass Spectrometry Center, Research Core Facility, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Qing Xia
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China.
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CMV Pancreatitis in an Immunocompromised Patient. Case Rep Crit Care 2021; 2021:8811396. [PMID: 33688440 PMCID: PMC7914100 DOI: 10.1155/2021/8811396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Cytomegalovirus (CMV) is a common double-stranded DNA (dsDNA) virus affecting a large majority of the world's population. In immunocompetent patients, CMV infection can range anywhere from an asymptomatic course to mononucleosis. However, in the immunocompromised patient, prognosis can be deadly as CMV can disseminate to the retina, liver, lungs, heart, and GI tract. We present a case of CMV pancreatitis afflicting an immunocompromised patient. Case Summary. A 45-year-old Hispanic female with no past medical history presented to the emergency department (ED) for three days of abdominal pain associated with nausea, vomiting, and diarrhea. ED vitals showed a sepsis picture with fever, tachycardia, low white blood cell (WBC) count with bandemia, and CT scan showing acute pancreatitis, cholelithiasis, gastritis, and colitis. The patient denied alcohol use and MRCP showed no stone impaction. Sepsis protocolled was initiated for biliary pancreatitis, and the patient was admitted to the medicine floors with appropriate consulting services. Over the course of admission, the patient responded poorly to treatment and had a steady decline in respiratory status. She tested positive for HIV with a severely depressed CD4 count (42 cells/McL) and high viral load (1,492,761 copies/ml) and started on appropriate prophylactic antibiotics and HAART therapy. The patient was moved to the Medical Intensive Care Unit (MICU) after acute respiratory failure secondary to ARDS requiring mechanical ventilation with initiation of ARDS protocol. The patient was hemodynamically unstable and required vasopressor support. Hospital course was complicated by melena which prompted an esophagogastroduodenostomy (EGD) with biopsy yielding CMV gastritis. Serum CMV viral load was also found to be positive along with an elevated lipase level, indicative of pancreatitis. Despite initiation of ganciclovir, the patient continued to have refractory hypoxia despite full ventilatory support and proning. Unfortunately, the patient was deemed too unstable for transfer to an ECMO facility. She eventually succumbed to respiratory failure. Discussion. CMV is a Herpesviridae virus that is prevalent among more than half of the world's population. Its effects range from no presenting symptoms to respiratory failure depending on immune status. CMV more commonly affects the retina, lungs, liver, and GI tract; however, in rare cases, it is known to affect the pancreas as well. Other more common causes of pancreatitis were ruled out during the progression of this patient, and an elevated lipase with high CMV viral load points towards CMV pancreatitis. Conclusion This is one of only a few reported cases of CMV pancreatitis and warrants further study due to the massive prevalence of CMV in the entire world's population. Our case demonstrates the extent of dissemination of CMV in a severely immunocompromised patient by showing clear cut pancreatitis secondary to said viral infection with exclusion of other possible causes. Our hope is that clinicians will change their practice to include a more scrutinized study into causes of pancreatitis especially in their immunocompromised patients.
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Tanaka K, Ballard E, Petersen D, Amoako AA, Khalil A, Baartz D. Effect of Retaining the Uterus During Anterior Resection for Rectosigmoid Bowel Endometriosis. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keisuke Tanaka
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Damien Petersen
- Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Akwasi A. Amoako
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Akram Khalil
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - David Baartz
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
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Gameil MA, Elsebaie AH. Mildly symptomatic liraglutide-induced acute pancreatitis in a patient with type 2 diabetes mellitus: a case report. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.1186/s43162-020-00026-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Acute pancreatitis (AP) represents a serious clinical challenge as it can threaten the patient’s life if it is missed or improperly managed. Liraglutide is one of the glucagon-like peptide 1 receptor agonists (GLP1-RA) which represent a novel class of antidiabetic medications in the Egyptian market. Hereby, we report a case of liraglutide-induced acute pancreatitis with atypical presentation.
Case presentation
A 53-year-old Egyptian male patient with diabetes presented to the emergency department with abdominal discomfort and vomiting without significant abdominal pain. Serum lipase and amylase were elevated more than three folds the upper normal limit (NUL 300 and 110 U/L respectively); abdominal ultrasonography was inconclusive, but contrast-enhanced computed tomography was diagnostic. A diagnosis of liraglutide-induced AP was built after exclusion of other causes. After admission, his medications were modified and improved clinically after 1 week.
Conclusion
Mildly symptomatic AP in diabetic patients is a clinical challenge as it can be missed. Therefore, in certain clinical situations, AP should be suspected in patients administrating liraglutide particularly for those with autonomic neuropathy.
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Ferrero-Andrés A, Panisello-Roselló A, Roselló-Catafau J, Folch-Puy E. Polyethylene glycol 35 ameliorates pancreatic inflammatory response in cerulein-induced acute pancreatitis in rats. World J Gastroenterol 2020; 26:5970-5982. [PMID: 33132648 PMCID: PMC7584060 DOI: 10.3748/wjg.v26.i39.5970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/12/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a sudden inflammatory process of the pancreas that may also involve surrounding tissues and/or remote organs. Inflammation and parenchymal cell death are common pathological features of this condition and determinants of disease severity. Polyethylene glycols (PEGs) are non-immunogenic, non-toxic water-soluble polymers widely used in biological, chemical, clinical and pharmaceutical settings.
AIM To evaluate the protective effect of a 35-kDa molecular weight PEG (PEG35) on the pancreatic damage associated to cerulein-induced acute pancreatitis in vivo and in vitro.
METHODS Wistar rats were assigned at random to a control group, a cerulein–induced AP group and a PEG35 treatment group. AP was induced by five hourly intraperitoneal injections of cerulein (50 μg/kg/bw), while the control animals received saline solution. PEG35 was administered intraperitoneally 10 minutes before each cerulein injection in a dose of 10 mg/kg. After AP induction, samples of pancreatic tissue and blood were collected for analysis. AR42J pancreatic acinar cells were treated with increasing concentrations of PEG35 prior to exposure with tumor necrosis factor α (TNFα), staurosporine or cerulein. The severity of AP was determined on the basis of plasma levels of lipase, lactate dehydrogenase activity, pancreatic edema and histological changes. To evaluate the extent of the inflammatory response, the gene expression of inflammation-associated markers was determined in the pancreas and in AR42J-treated cells. Inflammation-induced cell death was also measured in models of in vivo and in vitro pancreatic damage.
RESULTS Administration of PEG35 significantly improved pancreatic damage through reduction on lipase levels and tissue edema in cerulein-induced AP rats. The increased associated inflammatory response caused by cerulein administration was attenuated by a decrease in the gene expression of inflammation-related cytokines and inducible nitric oxide synthase enzyme in the pancreas. In contrast, pancreatic tissue mRNA expression of interleukin 10 was markedly increased. PEG35 treatment also protected against inflammation-induced cell death by attenuating lactate dehydrogenase activity and modulating the pancreatic levels of apoptosis regulator protein BCL-2 in cerulein hyperstimulated rats. Furthermore, the activation of pro-inflammatory markers and inflammation-induced cell death in pancreatic acinar cells treated with TNFα, cerulein or staurosporine was significantly reduced by PEG35 treatment, in a dose-dependent manner.
CONCLUSION PEG35 ameliorates pancreatic damage in cerulein-induced AP and AR42J-treated cells through the attenuation of the inflammatory response and associated cell death. PEG35 may be a valuable option in the management of AP.
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Affiliation(s)
- Ana Ferrero-Andrés
- Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona-Consejo Superior de Investigaciones científicas, Barcelona 08036, Catalonia, Spain
| | - Arnau Panisello-Roselló
- Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona-Consejo Superior de Investigaciones científicas, Barcelona 08036, Catalonia, Spain
| | - Joan Roselló-Catafau
- Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona-Consejo Superior de Investigaciones científicas, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona 08036, Catalonia, Spain
| | - Emma Folch-Puy
- Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona-Consejo Superior de Investigaciones científicas, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona 08036, Catalonia, Spain
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El Halabi M, Bou Daher H, Rustom LBO, Marrache M, Ichkhanian Y, Kahil K, El Sayed M, Sharara AI. Characteristics and outcome of patients presenting with acute Pancreatitis: A one-year descriptive study from a tertiary care center in Lebanon. Arab J Gastroenterol 2020; 21:106-110. [PMID: 32409259 DOI: 10.1016/j.ajg.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 12/16/2022]
Abstract
AIM To determine the aetiology, hospital course, and outcome of patients diagnosed with acute pancreatitis (AP) presenting to the Emergency Department (ED) of a tertiary care center in Lebanon. PATIENTS AND METHODS Using a retrospective cross-sectional study design, records of all patients presenting to the ED with elevated lipase over one calendar year (2016) were reviewed. Patients diagnosed with AP according to the revised Atlanta classification were identified. RESULTS Over one year, a total of 24,133 adult patients visited the ED and 4,976 had serum lipase determination. Of those, 75 patients (mean age 59.4 ± 16.1; range 20-95; M:F 2.1) had confirmed AP accounting for 0.3% of adult ED visits. The most common etiologies were biliary (36%), idiopathic (16%), drugs (13%), and alcohol (11%). Intake of drugs known to be associated with AP was identified in 26% of patients. Alcoholic pancreatitis was more common in males, while biliary pancreatitis was more common in females (p less than 0.05 in both). 63 patients (84%) required regular hospital admission and only 1 (1.3%) required intensive care unit admission and passed away after multiorgan failure. Mean hospital stay was 4.0 ± 4.0 days (range 0-23) with mean hospital charges of $6,637 ± 8,496. CONCLUSION Acute pancreatitis accounts for a relatively small number of emergency visits in Lebanon. Leading etiologies are biliary and drugs, with a low contribution of alcohol compared to the West. The economic burden of AP is important, but outcomes appear largely favorable with an overall mortality of less than 2%.
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Affiliation(s)
- Maan El Halabi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Halim Bou Daher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Luma Basma O Rustom
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Majd Marrache
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yervant Ichkhanian
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karine Kahil
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I Sharara
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
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Sadiq N, Gillani SW, Al Saeedy D, Rahmoun J, Shaban D, Kotait K, Javaheri S. Clinical review of acute, recurrent, and chronic pancreatitis: Recent updates of 2013-2019 literature. J Pharm Bioallied Sci 2020; 12:112-123. [PMID: 32742109 PMCID: PMC7373112 DOI: 10.4103/jpbs.jpbs_313_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/15/2019] [Accepted: 12/21/2019] [Indexed: 11/06/2022] Open
Abstract
The increasing prevalence of pancreatic disorders worldwide has provided challenges in its clinical care and management. This review was aimed to evaluate recent literature on diagnosis, treatment, and management of acute pancreatitis (AP), recurrent acute pancreatitis (RAP), as well as chronic pancreatitis (CP) documented during the past 5–6 years. An extensive literature review was carried out based on studies within the last 6 years (2013–2019). Articles were selected based on updates and therapeutic management. Critical appraisal of literature was performed using the Mixed Methods Appraisal Tool (MMAT), and a PRISMA flowchart was used to avoid bias. The study identified recent updates on the prophylactic treatment in preventing RAP. The risk factors and the therapeutic management options were evaluated and discussed. The findings show that although many lifesaving new protocols are available for implementation in clinical practice, current literature lacks detailed and comprehensive guidelines that cover special populations and comorbidities. The literature evaluated showed that eight genes were involved in pancreatitis, CASR, CFTR, CLDN2, CPA1, CTRC, PRSS1, SBDS, and SPINK1, but the most common gene implicated was found to be CFTR, at 11%. Therefore, it is recommended that a comprehensive guideline should be formulated to facilitate the diagnosis, management, treatment, and prophylactic measures of pancreatic disease. This could in turn reduce disease complications and hospitalization time, and improve clinical practice for management of pancreatitis.
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Affiliation(s)
- Noor Sadiq
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Syed Wasif Gillani
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Dalia Al Saeedy
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Joud Rahmoun
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Durah Shaban
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Kholoud Kotait
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Shahin Javaheri
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, UAE
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Gad MM, Simons-Linares CR. Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies. World J Gastroenterol 2020; 26:1098-1106. [PMID: 32206000 PMCID: PMC7081000 DOI: 10.3748/wjg.v26.i10.1098] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/12/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is conflincting evidence on the intravenous fluid (IVF) strategy for acute pancreatitis (AP). We perform a metaanalysis of the available evidence.
AIM To investigate if aggressive IVF therapy in AP patients is beneficial to decrease mortality and improve outcomes.
METHODS Metaanalysis of available randomized controlled trials and cohort studies comparing aggressive IVF vs non-aggressive IVF resuscitation.
RESULTS There was no significant difference in mortality between the aggressive (n = 1229) and non-aggressive IVF (n = 1397) patients. Patients receiving aggressive IVF therapy had higher risk for acute kidney injury and acute respiratory distress syndrome. There also was no significant difference in the overall incidence of systemic inflammatory response syndrome, persistent organ failure, pancreatic necrosis when comparing both study groups.
CONCLUSION Early aggressive IVF therapy did not improve mortality. Moreover, aggressive IVF therapy could potentially increase the risk for acute kidney injury and pulmonary edema leading to respiratory failure and mechanical ventilation. Studies are needed to investigate which subset of AP patients could benefit from aggressive IVF therapy.
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Affiliation(s)
- Mohamed M Gad
- Internal Medicine Department, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - C. Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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30
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Liu D, Song G, Ma Z, Geng X, Dai Y, Yang T, Meng H, Gong J, Zhou B, Song Z. Resveratrol improves the therapeutic efficacy of bone marrow-derived mesenchymal stem cells in rats with severe acute pancreatitis. Int Immunopharmacol 2020; 80:106128. [PMID: 31978799 DOI: 10.1016/j.intimp.2019.106128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Bone marrow-derived mesenchymal stem cells (BMSCs) are effective in the treatment of severe acute pancreatitis (SAP), but their therapeutic effects could still be improved. In order to optimize the clinical application of BMSCs, we adopted the strategy of resveratrol (Res) pretreatment of BMSCs (Res-BMSCs) and applied it to a rat model of sodium taurocholate (NaT)-induced acute pancreatitis. METHODS SAP was induced by injection of 3% NaT into the pancreatic duct and successful induction of SAP occurred after 12 h. Rats were treated with BMSCs, Res or BMSCs primed with Res at 40 mmol/L, Vandetanib (ZD6474) daily oral dosages of 50 mg/kg vandetanib. RESULTS Res stimulated BMSCs to secrete vascular endothelial growth factor A (VEGFA), activated the downstream phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway, and inhibited pancreatic cell apoptosis. In addition, conditioned medium (CM) from Res-BMSCs enhanced the proliferation of human umbilical vein endothelial cells (HUVECs) in vitro, increased resistance to apoptosis and promoted the expression of angiogenesis-related proteins CD31, VEGF and VEGFR2 in pancreatic tissue, but Vandetanib partly abolished these effects by blocking the VEGFA- mediated pathway. CONCLUSION Resveratrol-preprocessed BMSCs can activate the PI3K/AKT signaling pathway in pancreatic cells and HUVECs through paracrine release of VEGFA; thus, achieving the therapeutic effect of resisting apoptosis of pancreatic cells and promoting regeneration of damaged blood vessels. Res pretreatment may be a new strategy to improve the therapeutic effect of BMSCs on SAP.
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Affiliation(s)
- Dalu Liu
- Shanghai Clinical Medical College of Anhui Medical University, Hefei 230032, China; Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China
| | - Guodong Song
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China
| | - Zhilong Ma
- Department of General Surgery, Tongren Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200072, China
| | - Xiang Geng
- The Affiliated Changzhou NO. 2 People's Hospital of Najing Medical University, Changzhou 213000, China
| | - Yuxiang Dai
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China
| | - Tingsong Yang
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China.
| | - Hongbo Meng
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China
| | - Jian Gong
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China
| | - Bo Zhou
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China
| | - Zhenshun Song
- Shanghai Clinical Medical College of Anhui Medical University, Hefei 230032, China; Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai 200072, China.
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Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 2019; 14:27. [PMID: 31210778 PMCID: PMC6567462 DOI: 10.1186/s13017-019-0247-0] [Citation(s) in RCA: 331] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/27/2019] [Indexed: 02/08/2023] Open
Abstract
Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.
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Affiliation(s)
- Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Haartmaninkatu 4, FI-00029 Helsinki,, Finland
| | - Matti Tolonen
- Abdominal Center, Helsinki University Hospital Meilahti, Haartmaninkatu 4, FI-00029 Helsinki,, Finland
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | | | - Emiliano Gamberini
- Anesthesia and Intensive Care Medicine, Maurizio Bufalini Hospital, Cesena, Italy
| | | | - Chad G. Ball
- Foothills Medical Centre & the University of Calgary, Calgary, AB Canada
| | - Neil Parry
- London Health Sciences Centre, London, ON Canada
| | | | - Daan Wolbrink
- Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Gianluca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini hospital, Cesena, Italy
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps memorial Hospital, La Jolla, CA USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini hospital, Cesena, Italy
| | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ernest Moore
- Trauma Surgery, Denver Health Medical Center, Denver, CO USA
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
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32
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Silva-Vaz P, Abrantes AM, Castelo-Branco M, Gouveia A, Botelho MF, Tralhão JG. Murine Models of Acute Pancreatitis: A Critical Appraisal of Clinical Relevance. Int J Mol Sci 2019; 20:E2794. [PMID: 31181644 PMCID: PMC6600324 DOI: 10.3390/ijms20112794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
Acute pancreatitis (AP) is a severe disease associated with high morbidity and mortality. Clinical studies can provide some data concerning the etiology, pathophysiology, and outcomes of this disease. However, the study of early events and new targeted therapies cannot be performed on humans due to ethical reasons. Experimental murine models can be used in the understanding of the pancreatic inflammation, because they are able to closely mimic the main features of human AP, namely their histologic glandular changes and distant organ failure. These models continue to be important research tools for the reproduction of the etiological, environmental, and genetic factors associated with the pathogenesis of this inflammatory pathology and the exploration of novel therapeutic options. This review provides an overview of several murine models of AP. Furthermore, special focus is made on the most frequently carried out models, the protocols used, and their advantages and limitations. Finally, examples are provided of the use of these models to improve knowledge of the mechanisms involved in the pathogenesis, identify new biomarkers of severity, and develop new targeted therapies.
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Affiliation(s)
- Pedro Silva-Vaz
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
- General Surgery Department, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal.
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal.
| | - Ana Margarida Abrantes
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Miguel Castelo-Branco
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal.
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal.
| | - António Gouveia
- General Surgery Department, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal.
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal.
| | - Maria Filomena Botelho
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-548 Coimbra, Portugal.
| | - José Guilherme Tralhão
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-548 Coimbra, Portugal.
- Surgery Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal.
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33
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Jochheim LS, Odysseos G, Hidalgo-Sastre A, Zhong S, Staufer LM, Kroiss M, Kabacaoglu D, Lange S, Engleitner T, Hartmann D, Hüser N, Steiger K, Schmid RM, Holzmann B, von Figura G. The neuropeptide receptor subunit RAMP1 constrains the innate immune response during acute pancreatitis in mice. Pancreatology 2019; 19:541-547. [PMID: 31109903 DOI: 10.1016/j.pan.2019.05.455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The importance of the Calcitonin-gene-related-peptide-pathway (CGRP) as neuronal modulator of innate immune responses in mice has been previously demonstrated. The CGRP-receptor is composed of two subunits: the receptor-activity-modifying-protein-1 (RAMP1) and the calcitonin-receptor-like-receptor (CLR). CGRP can influence immune cells and their capacity of producing inflammatory cytokines. Using a RAMP1 knockout-mouse (RAMP1-/-) we examined the role of the CGRP-receptor in the acute-phase of cerulein-induced pancreatitis. METHODS Hourly cerulein-injections for a period of 8 h in RAMP1-/- and wild-type mice were performed. To compare severity and extent of inflammation in RAMP1-/- and wild-type mice, histological analyses were done and cytokine levels were assessed using qRT-PCR 8 h, 24 h, 2 days, and 7 days post-cerulein-treatment. Furthermore, serum activities of LDH and lipase were determined. RESULTS After 8 h RAMP1-/- mice showed a higher pancreas-to-body-weight-ratio, increased tissue edema and immune cell infiltration with higher amount of F4/80-positive cells as compared to wild-type mice. Overall infiltration of immune cells at 24 h was increased in RAMP1-/- mice and composed predominantly of MPO-positive neutrophils. In addition, after 24 h RAMP1-/- mice presented a higher pancreas-to-body-weight-ratio, higher expression of Ccl3, Il6, and Il1b and increased number of cleaved caspase 3 positive cells. Serum lipase correlated with the extent of tissue damage in RAMP1-/- compared to wild-type mice 24 h post-cerulein treatment. CONCLUSION Mice lacking RAMP1 showed increased inflammation, tissue edema, and pancreas injury particularly in the early phase of acute pancreatitis. This study highlights the essential role of CGRP for dampening the innate immune response in acute pancreatitis.
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Affiliation(s)
- Leonie S Jochheim
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Georgios Odysseos
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Ana Hidalgo-Sastre
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Suyang Zhong
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Lina M Staufer
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Markus Kroiss
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Derya Kabacaoglu
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Sebastian Lange
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany; Technical University of Munich, School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Thomas Engleitner
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany; Technical University of Munich, School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Daniel Hartmann
- Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Munich, Germany
| | - Norbert Hüser
- Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Munich, Germany
| | - Katja Steiger
- Technical University Munich, School of Medicine, Department of Pathology, Munich, Germany
| | - Roland M Schmid
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Bernhard Holzmann
- Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Munich, Germany
| | - Guido von Figura
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany.
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Qian D, Song G, Ma Z, Wang G, Jin L, Hu M, Song Z, Wang X. MicroRNA-9 modified bone marrow-derived mesenchymal stem cells (BMSCs) repair severe acute pancreatitis (SAP) via inducing angiogenesis in rats. Stem Cell Res Ther 2018; 9:282. [PMID: 30359310 PMCID: PMC6202805 DOI: 10.1186/s13287-018-1022-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/11/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023] Open
Abstract
Background Severe acute pancreatitis (SAP) is an acute abdominal disease characterized by pancreatic necrosis and systemic disease. In a previous study, we showed that bone marrow-derived mesenchymal stem cells (BMSCs) can reduce SAP by secreting microRNA (miR)-9; however, the underlying mechanism remains unclear. The present study investigated the mechanism underlying BMSC-induced pancreatic regeneration. Methods BMSCs were isolated, and miR-9 modified/antagonized BMSCs (pri-miR-9-BMSCs/TuD-BMSCs) were generated and injected into SAP rats. The levels of inflammatory cytokines and histopathologic changes were examined using ELISA and H&E staining. Angiogenesis was analyzed by qRT-PCR, western blotting, and immunohistochemistry. Cell function tests, dual luciferase reporter assays, cell co-culture, western blotting, and cell tracing were used to explore the mechanisms underlying miR-9 induced angiogenesis. Results Pri-miR-9-BMSCs induced angiogenesis in SAP rats (Ang-1↑, TIE-2↑, and CD31↑) and repaired damaged vascular endothelial cells (VECs) in vitro, promoting angiogenesis (Ang-1↑, TIE-2↑, PI3K↑, AKT↑, p-AKT↑, CD31↑, and CD34↑). Pri-miR-9-BMSCs released miR-9 into VECs or injured pancreatic tissue, targeting the VE-cadherin gene and promoting PI3K/AKT signaling to treat SAP (VE-cadherin↓, β-catenin↓, PI3K↑, p-AKT↑), whereas antagonizing miR-9 in BMSCs did not alleviate or aggravated SAP. Conclusions Pri-miR-9-BMSCs can repair injured pancreatic tissue by secreting miR-9 and promoting angiogenesis. Electronic supplementary material The online version of this article (10.1186/s13287-018-1022-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daohai Qian
- Department of General Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, Anhui, China.,Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.,Department of Pharmacology and Pharmaceutical Sciences, USC School of Pharmacy, Los Angeles, California, 90089, USA
| | - Guodong Song
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Zhilong Ma
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Guannan Wang
- Department of General Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Lei Jin
- Department of Gastroenterology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Minghua Hu
- Department of General Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Zhenshun Song
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
| | - Xiaoming Wang
- Department of General Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, 241001, Anhui, China.
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35
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Jones M, Necas M. The performance of ultrasound in determining the cause of biliary dilation. SONOGRAPHY 2018. [DOI: 10.1002/sono.12163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Martin Necas
- The University of Auckland; Auckland New Zealand
- Waikato District Health Board; Hamilton New Zealand
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36
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Waller A, Long B, Koyfman A, Gottlieb M. Acute Pancreatitis: Updates for Emergency Clinicians. J Emerg Med 2018; 55:769-779. [PMID: 30268599 DOI: 10.1016/j.jemermed.2018.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute pancreatitis is a frequent reason for patient presentation to the emergency department (ED) and the most common gastrointestinal disease resulting in admission. Emergency clinicians are often responsible for the diagnosis and initial management of acute pancreatitis. OBJECTIVE This review article provides emergency clinicians with a focused overview of the diagnosis and management of pancreatitis. DISCUSSION Pancreatitis is an inflammatory process within the pancreas. While the disease is often mild, severe forms can have a mortality rate of up to 30%. The diagnosis of pancreatitis requires two of the following three criteria: epigastric abdominal pain, an elevated lipase, and imaging findings of pancreatic inflammation. The most common etiologies include gallbladder disease and alcohol use. After the diagnosis has been made, it is important to identify underlying etiologies requiring specific intervention, as well as obtain a right upper quadrant ultrasound. The initial management of choice is fluid resuscitation and pain control. Recent data have suggested that more cautious fluid resuscitation in the first 24 h might be more appropriate for some patients. Intravenous opiates are generally safe if used judiciously. Appropriate disposition is a multifactorial decision, which can be facilitated by using Ranson criteria or the Bedside Index of Severity in Acute Pancreatitis score. Complications, though rare, can be severe. CONCLUSIONS Pancreatitis is a potentially deadly disease that commonly presents to most emergency departments. It is important for clinicians to be aware of the current evidence regarding the diagnosis, treatment, and disposition of these patients.
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Affiliation(s)
- Anna Waller
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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The concept of severe hypertriglyceridemia and its implications in clinical practice. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2018; 30:193-196. [PMID: 30249422 DOI: 10.1016/j.arteri.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/23/2022]
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Wu C, Wu D, Liu Y, Zhong Y. Genetic polymorphism in cytochrome P450 2E1 and alcoholic pancreatitis sus-ceptibility: a meta-analysis. Hippokratia 2018; 22:60-67. [PMID: 31217677 PMCID: PMC6548521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The association between cytochrome P450 2E1 (CYP2E1) polymorphism and the risk of alcoholic pancreatitis is contentious. This meta-analysis aimed to demonstrate the association between CYP2E1 RsaI/PstI, or DraI polymorphisms and the susceptibility of alcoholic pancreatitis. MATERIALS AND METHODS We searched for sources and background in Pubmed, Medline, Web of science and CNKI (Chinese national knowledge infrastructure), using the following keywords: "cytochrome P450 2E1" or "CYP2E1", "polymorphism" or "genotype", in combination with "alcoholic pancreatitis". All meta-analyses were performed with Stata 12.0. Subgroup analyses on ethnicity and type of alcoholic pancreatitis were conducted as well. Results: Eleven articles, which met the inclusion criteria, included 595 patients with alcoholic pancreatitis, and 1767 controls. For the general population, our analysis suggested no obvious association between CYP2E1 RsaI/PstI or DraI polymorphisms and the risk of alcoholic pancreatitis. However, in the non-Asian subgroup, significant associations were found between the risk for alcoholic pancreatitis and CYP2E1 RsaI/PstI polymorphism [dominant model: odds ratio (OR) =1.92, 95 % confidence interval (CI): 1.25-2.95, p =0.003; allelic contrast model: OR =1.99, 95 % CI: 1.35-2.92, p <0.001. There was not a significant association found within the Asian group. Meanwhile, the susceptibilities of chronic alcoholic pancreatitis were significantly increased for dominant and allelic contrast models of CYP2E1 RsaI/PstI polymorphism [OR =1.62, 95 % CI: 1.12-2.34; p =0.011; OR =1.62, 95 % CI: 1.17-2.24, p = 0.004, respectively] but not for acute alcoholic pancreatitis for all population. CONCLUSIONS CYP2E1 RsaI/PstI polymorphism may increase the risk of alcoholic pancreatitis in the non-Asian population. Additionally, the CYP2E1 RsaI/PstI polymorphism may increase the susceptibility for chronic alcoholic pancreatitis for all population. HIPPOKRATIA 2018, 22(2): 60-67.
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Affiliation(s)
- C Wu
- ICU Center of the Second Xiangya Hospital, Central South University, Changsha, China
| | - D Wu
- ICU Center of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Y Liu
- Hematological department of the Third Xiangya Hospital, Central South University, Changsha, China
| | - Y Zhong
- ICU Center of the Second Xiangya Hospital, Central South University, Changsha, China
- Hematological department of the Third Xiangya Hospital, Central South University, Changsha, China
- Department of Surgery of University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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