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Li C, Wen Y, Tong Q, Peng Y, Yu D, Rao Y, Zeng Y. Gut microbiota-melatonin signaling axis in acute pancreatitis: Revealing the impact of gut health on pancreatic inflammation and disease severity in a case-control study. Medicine (Baltimore) 2024; 103:e38689. [PMID: 38996098 PMCID: PMC11245267 DOI: 10.1097/md.0000000000038689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/03/2024] [Indexed: 07/14/2024] Open
Abstract
Acute pancreatitis (AP), a severe inflammatory condition affecting the pancreas requires investigation into its predictors. Melatonin, a compound with anti-inflammatory and antioxidant properties, has shown promise in managing AP. Additionally, the gut microbiota, a community of microorganisms residing in the intestines has been linked to AP development. This study aims to explore the correlation between melatonin and gut microbiota in predicting AP severity. This study involved 199 participants, with 99 diagnosed with AP and 100 serving as healthy controls. The AP patients were categorized into 2 groups based on the severity of their condition: mild AP (MAP) and severe AP (SAP). Serum melatonin levels were measured on Days 1, 3, and 5 of hospitalization, and gut microbiota composition was examined via 16S rRNA gene sequencing. Other parameters were evaluated, such as the Acute Physiology and Chronic Health Evaluation (APACHE) score, Ranson, and Acute Gastrointestinal Injury (AGI) scores. Melatonin levels were significantly lower in subjects with severe AP compared those with mild AP (18.2 ng/mL vs 32.2 ng/mL, P = .001), and melatonin levels decreased significantly in patients with AP on Days 3 and 5. The study also revealed that individuals with AP exhibited a significantly altered gut microbiota composition compared to control individuals, with a lower Shannon index and higher Simpson index. The AUCs for Simpson index and F/B ratio were significantly higher than those for other biomarkers, indicating that these gut microbiota markers may also be useful for AP prediction. The study proposes that there is a relationship between melatonin levels and the dynamics of gut microbiota profiles in relation to the severity of AP. As a result, the severity of the disease can be assessed by assessing the levels of serum melatonin and gut microbiota profiles.
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Affiliation(s)
- Chao Li
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yangfen Wen
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Qiwen Tong
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yi Peng
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Dan Yu
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yisong Rao
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yuehong Zeng
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
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Abel WF, Soliman YY, Wasserman RD, Reddy S, Sangay ARV, Monkemuller KE, Kesar V, Yeaton P, Kesar V. Endoscopic ultrasound-guided gastrojejunostomy for benign gastric outlet obstruction (GOO): a retrospective analysis of patients and outcomes. Surg Endosc 2024; 38:3849-3857. [PMID: 38831212 DOI: 10.1007/s00464-024-10897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/02/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) has been well utilized in treating malignant gastric outlet obstructions (GOO) given its efficacy and lower risk profile compared to surgery. However, its efficacy and potential for use in patients with benign GOO who are poor surgical candidates is not well documented. The aim of this study was to examine the role of EUS-GJ in treatment of benign GOO in select patients. PATIENTS AND METHODS This is a single-center, open-label, retrospective descriptive study that included all consecutive patients undergoing EUS-GJ to treat benign causes of GOO. Direct antegrade and direct retrograde methods were utilized. RESULTS A total of 18 patients were included, 38.9% female with an average age of 63.3 years. Extrinsic GOO was present in (10 of 18) 55.5% of patients and intrinsic etiology was present in (8 of 18) 45.5% of patients. Technical success was achieved in 100% (18 of 18) patients and clinical success was achieved in 94% (17 of 18) patients. In total, 13 patients had follow-up endoscopy, 2 patients were treated relatively recently in time, 1 patient was lost to follow-up, and 2 patients died of other chronic illnesses. Stents remained in place for a median of 286 days (range 88-1444 days). In patients whose stents were removed, 75% (3 of 4) had extrinsic etiologies of GOO. CONCLUSIONS This study reports a favorable long-term patency with excellent technical and clinical success of EUS-GJ in patients with benign GOO. Despite the limitations of sample size and retrospective nature, it adds to the extremely limited literature of EUS-GJ in management of patients with benign GOO.
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Affiliation(s)
- William F Abel
- Department of Internal Medicine, Virginia Tech Carilion, Roanoke, VA, USA.
- PGY-3 Internal Medicine Resident, Virginia Tech Carilion Internal Medicine Residency, 1906 Belleview Avenue, Roanoke, VA, 24014, USA.
| | - Youssef Y Soliman
- Division of Gastroenterology, Cancer Treatment Centers of America, Phoenix, AZ, USA
| | - Reid D Wasserman
- Department of Internal Medicine, Virginia Tech Carilion, Roanoke, VA, USA
| | - Shravani Reddy
- Division of Gastroenterology, Department of Internal Medicine, Virginia Tech Carilion, Roanoke, VA, USA
| | | | - Klaus E Monkemuller
- Division of Gastroenterology, Department of Internal Medicine, Virginia Tech Carilion, Roanoke, VA, USA
| | - Varun Kesar
- Division of Gastroenterology, Department of Internal Medicine, Virginia Tech Carilion, Roanoke, VA, USA
| | - Paul Yeaton
- Division of Gastroenterology, Department of Internal Medicine, Virginia Tech Carilion, Roanoke, VA, USA
| | - Vivek Kesar
- Division of Gastroenterology, Department of Internal Medicine, Virginia Tech Carilion, Roanoke, VA, USA
- Division of Gastroenterology, Interventional Gastroenterology, Virginia Tech Carilion School of Medicine, 1906 Belleview Avenue, Roanoke, VA, 24014, USA
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Mukherji R, Gopinath M. A Study on the Spectrum of Imaging Findings of Post-ERCP-Specific Complications: A Retrospective Descriptive Study. Indian J Radiol Imaging 2024; 34:422-434. [PMID: 38912237 PMCID: PMC11188732 DOI: 10.1055/s-0044-1779585] [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] [Indexed: 06/25/2024] Open
Abstract
Aim The aim of this study was to examine the imaging manifestations of post-endoscopic retrograde cholangiopancreatography (ERCP) specific complications by computed tomography to aid in its early and successful diagnosis and timely intervention. Method Forty-one cases of imaging having post-ERCP were complications were retrospectively collected and the spectrum of complications and their key imaging features and methods to improve their detection were analyzed. Result The most common complication detected in computed tomography (CT) post-ERCP was the presence of intra-abdominal collections seen in 21 patients (51.2%). Pancreatitis was seen in 20 of 41 patients (48.7%), while bowel perforation was present in 9 patients (21%). Pleural effusion was present in 8 patients (19.5%), liver abscess in 6 patients (14.6%), cholangitis in 4 patients (9.7%), gallbladder perforation in 4 patients (9.7%), displaced common bile duct stent in 3 patients (7.3%), possibility of main pancreatic duct cannulation in 2 patients (4.8%), vascular injury resulting in right hepatic artery pseudoaneurysm in 1 patient (2.4%), thrombosis of portal vein or its branches in 2 patients (4.8%), superior mesenteric vein thrombosis in 1 patient (2.4%), right hepatic vein thrombosis in 1 patient (2.4%), pulmonary thromboembolism in 2 patients (4.8%), duodenal inflammation in 1 patient (2.4%), bowel ileus in 4 patients (9.6%), and bowel obstruction in 1 patient (2.4%). Conclusion Complications after ERCP can cause significant morbidity and mortality if not diagnosed early and treated appropriately. Familiarity with normal findings post-ERCP and knowledge of the imaging appearance of these complications are vital in the early management of these conditions.
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Affiliation(s)
- Ruchira Mukherji
- Department of Radiodiagnosis & Imaging, Army Hospital Research & Referral, Delhi Cantonment, New Delhi, India
| | - Manoj Gopinath
- Department of Radiodiagnosis & Imaging, Army Hospital Research & Referral, Delhi Cantonment, New Delhi, India
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Fu C, Li X, Wang Y, Chen J, Yang Y, Liu K. Association between triglyceride glucose index-related indices with gallstone disease among US adults. Lipids Health Dis 2024; 23:203. [PMID: 38937793 PMCID: PMC11210093 DOI: 10.1186/s12944-024-02194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Triglyceride glucose (TyG) index combined with obesity-related indicators [triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist to height ratio (TyG-WHtR), triglyceride glucose-waist circumference (TyG-WC)], represents emerging methodologies for assessing insulin resistance. The objective of this investigation was to explore the correlation between TyG-related indices and gallstone disease. METHODS The study included 3740 adults from the 2017-2020 period of the National Health and Nutrition Examination Survey. TyG-BMI, TyG-WC, and TyG-WHtR were integrated as both continuous and categorical variables within the multivariate logistic model, respectively to evaluate the connection between various TyG-related indices and gallstone disease. Additionally, restriction cubic splines and subgroup analysis were employed to deepen our understanding of this relationship. RESULTS When analyzed as continuous variables, positive correlations were observed between TyG-BMI, TyG-WC, TyG-WHtR and gallstone disease. The OR(95%CI) were 1.063(1.045,1.082) for TyG-BMI (per 10-unit), 1.026(1.018,1.034) for TyG-WC (per 10-unit) and 1.483(1.314,1.676) for TyG-WHtR (per 1-unit), respectively. When categorized into quartiles, these three TyG-related indices still show statistically significant associations with gallstone disease. Descending in order, the diagnostic capability for gallstone disease is demonstrated as follows: TyG-WHtR (AUC = 0.667), TyG-BMI (AUC = 0.647), and TyG-WC (AUC = 0.640). CONCLUSION There were significantly positive associations between TyG-related indices, including TyG-BMI, TyG-WC, and TyG-WHtR, and gallstone disease. Of these indices, TyG-WHtR demonstrated the most favorable performance in identifying the risk of gallstone disease.
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Affiliation(s)
- Chang Fu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xiaocong Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, 100020, China
| | - Yongxin Wang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Junhong Chen
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yibo Yang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Kai Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China.
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Lee SY, Park SH, Do MY, Lee DK, Jang SI, Cho JH. Increased ERCP-related adverse event from premature urgent ERCP following symptom onset in acute biliary pancreatitis with cholangitis. Sci Rep 2024; 14:13663. [PMID: 38871990 DOI: 10.1038/s41598-024-64644-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 06/11/2024] [Indexed: 06/15/2024] Open
Abstract
Acute biliary pancreatitis (ABP) with cholangitis requires endoscopic retrograde cholangiopancreatography (ERCP) within 24 h to resolve ductal obstruction. However, this recommendation is based on the timing of emergency room (ER) visits. We wanted to determine the optimal timing of ERCP for ABP based on the timing of symptom onset, not the timing of the ER visit. We retrospectively reviewed 162 patients with ABP with cholangitis who underwent urgent ERCP (within 24 h of ER admission). Area under the receiver operating characteristic (ROC) curve (AUC) was analyzed to determine differences in complication rates according to time from symptom onset. A difference in ERCP-related adverse events (AEs) was identified, and Youden's J statistic was used to determine a cutoff time from symptom onset (18 h). We compared mortality and complications based on this cutoff. Based on time to symptom onset, significantly higher rates of aspiration pneumonia (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.15-13.92, P = 0.021) and post-ERCP hypotension (OR 11.9, 95% CI 1.39-101.33, P = 0.005) were observed in the ≤ 18-h group than in the > 18-h group. The study found that patients who underwent ERCP within 18 h of symptom onset is associated with an increased risk of ERCP-related AEs.
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Affiliation(s)
- See Young Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Ho Park
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Min Young Do
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Ill Jang
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea.
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea.
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Hussen MS, Ibrahim AF, Tekle Y, Gebremariam S, Feto AD, Nida T, Mohammed H. Aetiology, clinical profile, management and outcome of acute pancreatitis at public hospitals in Addis Ababa, Ethiopia: a prospective observational study. Ann Med Surg (Lond) 2024; 86:2494-2502. [PMID: 38694301 PMCID: PMC11060299 DOI: 10.1097/ms9.0000000000001967] [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: 11/04/2023] [Accepted: 02/19/2024] [Indexed: 05/04/2024] Open
Abstract
Background Acute pancreatitis (AP) is a rare gastrointestinal pathology that has recently become increasingly common owing to lifestyle changes. Its clinical presentation ranges from mild discomfort to organ failure and death. Previous studies in Ethiopia reported that AP is rare. However, lifestyle changes have recently increased. Therefore, this study aimed to assess the aetiology, clinical profile, management, and outcomes of AP. Methods This prospective observational study included 59 adults diagnosed with AP using the Revised Atlanta Classification between November 2021 and August 2022 at five public hospitals in Addis Ababa. The data were analyzed using SPSS 25. The mean ± standard deviation and adjusted odds ratio (AOR) at 95% CI were used. Results The mean age was 38.2 (SD±11.5 years), mostly aged 30-44, with 67% males and 89.8% patients presenting with new-onset AP. Abdominal pain and nausea were the most common presentations in 93.2% of patients. More than 52.5% of AP cases were caused by alcohol, followed by gallstones (28.8%), and gallstones (47.1%) underwent cholecystectomy during the index admission. One patient (1.7%) died. The length of hospital stay ranges from 1-47 days and increases with the severity of AP. Patients with recurrent AP had a 2.4 folds increase in complications compared to new-onset AP (AOR=2.4, 95% CI=1.38, 15.71). Conclusion Most AP cases were caused by alcohol consumption, followed by gallstones, smoking, and hypertriglyceridemia. One death in a 60-year-old male with an alcohol and smoking history was diagnosed and triaged as severe AP with persistent multiple organ failure; BISAP score 4, his Creatinine=2.55 mg/dl, haematocrit 72.6%; and left shift of WBC, was associated.
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Affiliation(s)
| | | | | | | | | | - Tamrat Nida
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hussen Mohammed
- School of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa
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Xiao M, Di Y, An Y, Cui Y. Acute Necrotizing Pancreatitis Complicated with Paroxysmal Nocturnal Haemoglobinuria: A Case Report. Clin Exp Gastroenterol 2024; 17:141-145. [PMID: 38708059 PMCID: PMC11067917 DOI: 10.2147/ceg.s449594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
This report presents a unique case of acute necrotizing pancreatitis(ANP) concomitant with paroxysmal nocturnal hemoglobinuria(PNH), a combination that has not been documented in existing literature. The impact of PNH on ANP and its treatment remains uncertain due to the lack of consensus. The case described herein involves a patient who exhibited both ANP and PNH, subsequently experiencing splanchnic vein thrombosis (SVT), resulting in substantial intra-abdominal and gastrointestinal hemorrhaging. We attempted to analyze the role of PNH in the formation of SVT in ANP and propose some new insights and hypotheses for the treatment of such patients.
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Affiliation(s)
- Mengbo Xiao
- Tianjin Medical University, Tianjin, People’s Republic of China
| | - Ying Di
- Tianjin Medical University, Tianjin, People’s Republic of China
| | - Yu An
- Tianjin Medical University, Tianjin, People’s Republic of China
| | - Yunfeng Cui
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, People’s Republic of China
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Duhancioglu G, Arif-Tiwari H, Natali S, Reynolds C, Lalwani N, Fulcher A. Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond. Abdom Radiol (NY) 2024; 49:722-737. [PMID: 38044336 DOI: 10.1007/s00261-023-04107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023]
Abstract
Gallstone-related disease comprises a spectrum of conditions resulting from biliary stone formation, leading to obstruction and inflammatory complications. These can significantly impact patient quality of life and carry high morbidity if not accurately detected. Appropriate imaging is essential for evaluating the extent of gallstone disease and assuring appropriate clinical management. Magnetic Resonance Imaging (MRI) techniques (including Magnetic Resonance Cholangiopancreatography (MRCP) are increasingly used for diagnosis of gallstone disease and its complications and provide high contrast resolution and facilitate tissue-level assessment of gallstone disease processes. In this review we seek to delve deep into the spectrum of MR imaging in diagnose of gallstone-related disease within the gallbladder and complications related to migration of the gallstones to the gall bladder neck or cystic duct, common hepatic duct or bile duct (choledocholithiasis) and beyond, including gallstone pancreatitis, gallstone ileus, Bouveret syndrome, and dropped gallstones, by offering key examples from our practice. Furthermore, we will specifically highlight the crucial role of MRI and MRCP for enhancing diagnostic accuracy and improving patient outcomes in gallstone-related disease and showcase relevant surgical pathology specimens of various gallstone related complications.
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Affiliation(s)
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA.
| | - Stefano Natali
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Conner Reynolds
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Neeraj Lalwani
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
| | - Ann Fulcher
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
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Isogai M. Pathophysiology of severe gallstone pancreatitis: A new paradigm. World J Gastroenterol 2024; 30:614-623. [PMID: 38515949 PMCID: PMC10950616 DOI: 10.3748/wjg.v30.i7.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/16/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Severe gallstone pancreatitis (GSP) refractory to maximum conservative therapy has wide clinical variations, and its pathophysiology remains controversial. This Editorial aimed to investigate the pathophysiology of severe disease based on Opie’s theories of obstruction, the common channel, and duodenal reflux and describe its types. Severe GSP might be a hybrid disease with pathology polarized between acute cholangitis with mild pancreatitis (biliary type) and necrotizing pancreatitis uncomplicated with biliary tract disease (pancreatic type), in which hepatobiliary and pancreatic lesion severity is inversely related to the presence or absence of impacted ampullary stones. Severe GSP is caused by stones that are persistently impacted at the ampulla with biliopancreatic obstruction (biliary type), and probably, stones that are either temporarily lodged at the duodenal orifice or passed into the duodenum, thereby permitting reflux of bile or possible duodenal contents into the pancreas (pancreas type). When the status of the stones and the presence or absence of impacted ampullary stones with biliopancreatic obstruction are determined, the clinical course and outcome can be predicted. Gallstones represent the main cause of acute pancreatitis globally, and clinicians are expected to encounter GSP more often. Awareness of the etiology and pathogenesis of severe disease is mandatory.
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Affiliation(s)
- Masatoshi Isogai
- Clinic IB, Ibi 501-0614, Gifu, Japan
- Department of Surgery, Nawa Hospital, Ogaki 503-0893, Gifu, Japan
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Ren D, Lv M, Ye D, Jin D, Ouyang Y. Bedside ultrasound in tigecycline-associated acute pancreatitis: a case description. Quant Imaging Med Surg 2023; 13:8793-8798. [PMID: 38106276 PMCID: PMC10721993 DOI: 10.21037/qims-23-260] [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: 03/02/2023] [Accepted: 09/01/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Dingyuan Ren
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Mingyang Lv
- Department of Rehabilitation, Hospital of Zhejiang Armed Police Corps, Hangzhou, China
| | - Dong Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Dongyun Jin
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Yao Ouyang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
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Cao W, Ni X, Gan M, Xie B, Xie Y, Wang Q, Meng L, He C, Chen J, Wang X. Treatment and diagnosis of hyperlipidemia acute pancreatitis in pregnancy associated with pre‑pregnancy obesity and diabetes: A case report. Exp Ther Med 2023; 26:573. [PMID: 38023361 PMCID: PMC10652241 DOI: 10.3892/etm.2023.12272] [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: 02/13/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Hyperlipidemia acute pancreatitis (HLAP) is a specific type of pancreatitis mainly caused by elevated serum triglyceride (TG) levels. Therefore, knowledge of patients' medical history is crucial to the identification of those at high risk of HLAP. Diabetes and obesity are associated with high levels of triglycerides, a risk factor for the development of HLAP, which should be controlled before pregnancy. Moreover, HLAP is associated with additional diagnostic and management challenges related to hyperlipidemia (HL) and pregnancy. HLAP during pregnancy has a rapid onset and rapid progression, and complications are more likely to damage the function of multiple organs. HLAP is more common after 28 weeks of pregnancy, the cause is mostly high TG and the serum TG of the patient is often >1,000 mg/d1. Clinicians should be alert to the occurrence of server acute pancreatitis (AP). Therefore, clinicians need to identify and implement effective treatment in a timely manner to control the progression of HLAP during pregnancy and improve pregnancy outcomes. The present study reported the case of a 26-year-old pregnant patient who was hospitalized for epigastric pain at 35 weeks and 2 days of gestation. Medical and family history reported previous diagnoses of diabetes and obesity (weight before pregnancy, 103 kg; BMI, 36.40 kg/m2). Laboratory tests demonstrated high levels of lipase and amylase, a notable systemic inflammatory response, HL, coagulopathy, hypoproteinemia and hyperglycemia. Abdominal ultrasonography demonstrated a hypoechoic pancreatic head. A clinical diagnosis of AP was confirmed using CT scanning. Initial interventions for HLAP included aggressive intravenous hydration, bowel rest, pain control and a combination of heparin and insulin. Lipid-lowering agents were administered to reduce serum lipid levels. Hemoperfusion and continuous renal replacement therapy were also used to rapidly counteract the elevated lipid levels. Antibiotics were administered in the present case because inflammatory markers such as leukocytes, neutrophils and C-reactive protein were elevated. The patient and newborn were discharged 11 days after hospitalization, with an improvement in maternal clinical health and the infant was healthy. When evaluating pregnant patients with pre-obesity and diabetes presenting with abdominal pain, obstetricians should consider HLAP. Timely diagnosis and multi-team precision treatment are effective for good outcomes for mother and baby.
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Affiliation(s)
- Weiping Cao
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Xia Ni
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Mengwen Gan
- Department of Nursing, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Bing Xie
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Yurong Xie
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Qin Wang
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Lishi Meng
- Department of Computed Tomography, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Chao He
- Central Laboratory of Medicine, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
| | - Juan Chen
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu 212001, P.R. China
- Department of Obstetrics, Shanghai Changning District Maternal and Children Health Hospital, Shanghai 200050, P.R. China
| | - Xinzhi Wang
- New Drug Screening Center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, Jiangsu 210009, P.R. China
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Bergeron E, Doyon T, Manière T, Désilets É. Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event. Surg Endosc 2023; 37:9546-9555. [PMID: 37726412 PMCID: PMC10709473 DOI: 10.1007/s00464-023-10423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. METHODS The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. RESULTS The study population is composed of 529 patients. Mean age was 58.0 (18-95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. CONCLUSIONS RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles-LeMoyne Hospital, 3120, Boulevard Taschereau, Greenfield Park, QC, J4V 2H1, Canada.
| | - Théo Doyon
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
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13
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Charles JC, Jayarajah U, Subasinghe D. Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review. J Int Med Res 2023; 51:3000605231197461. [PMID: 37776529 PMCID: PMC10542321 DOI: 10.1177/03000605231197461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/08/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVES Acute pancreatitis (AP) is a severe complication of leptospirosis. This review focuses on the current evidence of AP in patients with leptospirosis. METHODS Data on clinical characteristics, biochemical parameters, diagnosis, complications, critical care, fluid management, operative management, and outcomes were analyzed. This study was registered in PROSPERO (CRD42022360802). RESULTS We included 35 individual case reports and 4 case series involving 79 patients. Sex was reported for 48 (60.7%) patients; 38 (48.1%) were male and 10 (12.6%) were female. The patients' mean age was 45.13 (15-83 years). Acute kidney injury, thrombocytopenia, hypotension, and liver injury were the most common complications reported. Complete recovery was reported for 36 (45.5%) patients. Biochemical and radiological recovery was reported for 10 (12.6%) and 9 (11.3%) patients, respectively. Death was reported in 18 (22.7%) patients. CONCLUSION A high degree of clinical suspicion and different modalities of investigations are essential in the diagnosis of AP in leptospirosis. AP can be easily missed in leptospirosis because both conditions share similar clinical presentations and complications. Because of the high prevalence of acute kidney injury, judicious fluid management and close monitoring are mandatory.
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Affiliation(s)
- James C Charles
- Department of Surgery, Teaching Hospital Jaffna, Jaffna, Sri Lanka
| | - Umesh Jayarajah
- Department of Surgery, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Duminda Subasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
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14
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Zhu Q, Luo J, Li HP, Ye W, Pan R, Shi KQ, Yang R, Xu H, Li H, Lee LP, Liu F. Robust Acute Pancreatitis Identification and Diagnosis: RAPIDx. ACS NANO 2023; 17:8564-8574. [PMID: 36988967 DOI: 10.1021/acsnano.3c00922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The occurrence of acute pancreatitis (AP) is increasing significantly worldwide. However, current diagnostic methods of AP do not provide a clear clinical stratification of severity, and the prediction of complications in AP is still limited. Here, we present a robust AP identification and diagnosis (RAPIDx) method by the proteomic fingerprinting of intact nanoscale extracellular vesicles (EVs) from clinical samples. By tracking analysis of circulating biological nanoparticles released by cells (i.e., EVs) via bottom-up proteomics, we obtain close phenotype connections between EVs, cell types, and multiple tissues based on their specific proteomes and identify the serum amyloid A (SAA) proteins on EVs as potential biomarkers that are differentially expressed from AP patients significantly. We accomplish the quantitative analysis of EVs fingerprints using MALDI-TOF MS and find the SAA proteins (SAA1-1, desR-SAA1-2, SAA2, SAA1-2) with areas under the curve (AUCs) from 0.92 to 0.97, which allows us to detect AP within 30 min. We further realize that SAA1-1 and SAA2, combined with two protein peaks (5290.19, 14032.33 m/z), can achieve an AUC of 0.83 for classifying the severity of AP. The RAPIDx platform will facilitate timely diagnosis and treatment of AP before severity development and persistent organ failure and promote precision diagnostics and the early diagnosis of pancreatic cancer.
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Affiliation(s)
- Qingfu Zhu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Jiaxin Luo
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Hui-Ping Li
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Wen Ye
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Reguang Pan
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Ke-Qing Shi
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Rui Yang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Hao Xu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Hengrui Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Luke P Lee
- Harvard Medical School, Department of Medicine, Brigham Women's Hospital, Boston, Massachusetts 02115, United States
- Department of Bioengineering, Department of Electrical Engineering and Computer Science, University of California at Berkeley, Berkeley, California 94720, United States
- Department of Biophysics, Institute of Quantum Biophysics, Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea
| | - Fei Liu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
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15
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Waddell H, Stevenson TJ, Mole DJ. The role of the circadian rhythms in critical illness with a focus on acute pancreatitis. Heliyon 2023; 9:e15335. [PMID: 37089281 PMCID: PMC10119767 DOI: 10.1016/j.heliyon.2023.e15335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/20/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023] Open
Abstract
Circadian rhythms are responsible for governing various physiological processes, including hormone secretion, immune responses, metabolism, and the sleep/wake cycle. In critical illnesses such as acute pancreatitis (AP), circadian rhythms can become dysregulated due to disease. Evidence suggests that time of onset of disease, coupled with peripheral inflammation brought about by AP will impact on the circadian rhythms generated in the central pacemaker and peripheral tissues. Cells of the innate and adaptive immune system are governed by circadian rhythms and the diurnal pattern of expression can be disrupted during disease. Peak circadian immune cell release and gene expression can coincide with AP onset, that may increase pancreatic injury, tissue damage and the potential for systemic inflammation and multiple organ failure to develop. Here, we provide an overview of the role of circadian rhythms in AP and the underpinning inflammatory mechanisms to contextualise ongoing research into the chronobiology and chronotherapeutics of AP.
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Affiliation(s)
- Heather Waddell
- Medical Research Council Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler J. Stevenson
- Institute of Biodiversity and Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Damian J. Mole
- Medical Research Council Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Clinical Surgery, School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, EH16 4SB, UK
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16
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Asim Riaz HM, Islam Z, Rasheed L, Sarfraz Z, Sarfraz A, Robles-Velasco K, Sarfraz M, Cherrez-Ojeda I. The Evaluation of Inflammatory Biomarkers in Predicting Progression of Acute Pancreatitis to Pancreatic Necrosis: A Diagnostic Test Accuracy Review. Healthcare (Basel) 2022; 11:27. [PMID: 36611486 PMCID: PMC9818910 DOI: 10.3390/healthcare11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Acute pancreatitis is the acute inflammation of the pancreas; 30% of cases may progress to pancreatic necrosis. The aim of this study was to assess the diagnostic accuracy of inflammatory biomarkers (C-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH)) in detecting pancreatic necrosis in adults with confirmed acute pancreatitis within 14 days of symptom onset and without organ failure. A systematic search was conducted across the Cumulative Index of Nursing and Allied Health (CINAHL), Cochrane, Embase, PubMed, and Web of Science until May 30, 2022, with the following keywords: acute disease, biomarkers, C-reactive protein, calcitonin, differential, diagnosis, lactate dehydrogenase, pancreatitis, acute necrotizing, necrosis, sensitivity, specificity. Statistical analysis was conducted in RevMan 5.4.1 (Cochrane). Five studies pooling 645 participants were included of which 59.8% were males, with a mean age of 49 years. CRP was the best cutoff at 279 mg/L (χ2 = 47.43, p < 0.001), followed by 200 mg/L (χ2 = 36.54, p < 0.001). LDH was cut off at 290 units/L (χ2 = 51.6, p < 0.001), whereas PCT did not display the most reliable results at 0.05 ng/mL. Inflammatory biomarkers are scalable diagnostic tools that may confer clinical value by decreasing the mortality of acute pancreatitis sequelae.
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Affiliation(s)
| | - Zara Islam
- Department of Research, Sahiwal Medical College, Sahiwal 57040, Pakistan
| | - Lubna Rasheed
- Department of Research, University of Medical and Dental College, Faisalabad 38800, Pakistan
| | - Zouina Sarfraz
- Department of Research and Publications, Fatima Jinnah Medical University, Lahore 54000, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Karla Robles-Velasco
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
| | - Muzna Sarfraz
- Department of Research, King Edward Medical University, Lahore 54000, Pakistan
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
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17
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Wang F, Zhu M, Meng Y, Lin M. Serum soluble T cell immunoglobulin mucin domain-3 as an early predictive marker for severity of acute pancreatitis; a retrospective analysis. BMC Gastroenterol 2022; 22:522. [PMID: 36526975 PMCID: PMC9756921 DOI: 10.1186/s12876-022-02537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early prediction of severe acute pancreatitis (SAP) plays an important role in timely treatment decisions. Soluble T cell immunoglobulin and mucin domain-3 (sTIM-3) has been applied as a potential biomarker for the prediction of many diseases, while its predictive ability for AP severity remains largely unexplored. In this study, we aimed to identify whether serum sTIM-3 could be used as an indicator of AP severity in the early stage of the disease. METHODS A retrospective study was conducted. The enrolled AP patients should meet the 2012 Atlanta guideline and have an onset to admission ≤ 48 h. RESULTS A total of 94 AP patients were enrolled in the current analysis, including 42 (45%), 35 (37%), and 17 (18%) patients were diagnosed as mild AP (MAP), moderately SAP (MSAP), and SAP, respectively. SAP patients had significantly higher the white blood cells (WBCs) count, red blood cells (RBCs) count, C-reactive protein (CRP) level, direct bilirubin level, creatinine and procalcitonin levels compared with MAP and MSAP patients. Among SAP and MSAP patients, significantly higher APACHE II, BISAP, and MCTSI scores were observed compared with MAP patients, and there was significant difference in APACHE II and BISAP scores between SAP and MSAP patients. Stepwise multivariate linear regression analysis showed that the concentrations of serum sTIM-3, as well as the BISAP and MCTSI scores, were significantly associated with the severity of AP. The areas under the ROC curve were 0.914 (95% CI, 0.865-0.963), 0.855 (95%CI, 0.742-0.968) 0.853 (95%CI, 0.768-0.938), and 0.746 (95%CI, 0.633-0.860) for BISAP score, APACHE II score, sTIM-3 level, and MCTSI score, respectively. CONCLUSIONS Serum sTIM-3 might be ultimately incorporated into a predictive system for assessing the severity of AP.
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Affiliation(s)
- Fushuang Wang
- grid.89957.3a0000 0000 9255 8984Department of Gastroenterology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No.188 Gehu Road, Wujin District, Changzhou, Jiangsu Province, China ,grid.411971.b0000 0000 9558 1426Dalian Medical University, No.9 of Lushun South Road, Dalian, Liaoning Province China
| | - Minghui Zhu
- grid.452253.70000 0004 1804 524XDepartment of Gastroenterology, The Third Affiliated Hospital of Soochow University, No.185 Juqian Road, Tianning District, Changzhou, Jiangsu Province China
| | - Yao Meng
- grid.89957.3a0000 0000 9255 8984Department of Gastroenterology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No.188 Gehu Road, Wujin District, Changzhou, Jiangsu Province, China ,grid.411971.b0000 0000 9558 1426Dalian Medical University, No.9 of Lushun South Road, Dalian, Liaoning Province China
| | - Min Lin
- grid.89957.3a0000 0000 9255 8984Department of Gastroenterology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No.188 Gehu Road, Wujin District, Changzhou, Jiangsu Province, China
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18
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González J, Ayala D, Caballero N, Rey Chaves CE, Conde D, Sabogal Olarte JC. Outcomes after Frey's procedure for chronic pancreatitis: a 8-year single-center experience in Colombia. BMC Surg 2022; 22:424. [PMID: 36503674 PMCID: PMC9743672 DOI: 10.1186/s12893-022-01839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic pancreatitis is an inflammatory disease characterized by irreversible morphological changes due to chronic pancreatic fibrosis. The treatment goals are to relieve pain, preserve function, and prevent further pathological consequences. Endoscopic treatment, surgery, or both are options for untreatable pain or suspected malignancy. Frey procedure is a reasonable surgical intervention because of its hybrid character, combining resection and drainage. Unfortunately, there is limited information about the outcomes of this procedure in Latin America, and few cases described in Colombia. This study aims to describe the experience of a pancreatic surgery reference center in the management of patients undergoing Frey's surgery for chronic pancreatitis. METHODS A retrospective review of a prospectively collected database of patients who underwent a Frey procedure due to chronic pancreatitis between January 2014 to February 2022 in a hospital in Bogotá, Colombia, was made. A demographic, clinical, and postoperative outcome description was performed. Mann-Whitney Willcoxon test was performed between operative variables and long-term outcomes. RESULTS Eighteen patients met the inclusion criteria. 55.5% of patients were male. Chronic pancreatitis etiology in most cases (83.3% n = 15) was idiopathic. The median duration of symptoms and chronic pancreatitis diagnosis before surgery was 6.15 months (IQR 5;97). Overall morbidity was 38.88%. One patient died at 30 days of follow-up. The median follow-up time was 42.5 (IQR 19;65 months). The median pain reduction was 3 points according to the visual analog score. Six patients were diagnosed with malignant conditions after surgery (mean 27.8 ± 7.5 months). Wirsung's duct size was statistically related with malignancy presentation after Frey's procedure (Z = 2.54; P = 0.01). CONCLUSION According to our data, Frey's procedure remains safe and feasible, with acceptable outcomes in terms of pain relief and pancreatic function. The study confirms the importance of a longstanding follow-up due to an inherent risk of pancreatic malignancy. Our data suggest that pancreatic duct size could be related with the malignancy diagnosis after Frey's procedure; however, further prospective studies with a larger sample size would be helpful to confirm these results.
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Affiliation(s)
- Juliana González
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Daniela Ayala
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Nicolás Caballero
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Eduardo Rey Chaves
- grid.41312.350000 0001 1033 6040School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia ,111011 Bogotá D.C, Colombia
| | - Danny Conde
- grid.412191.e0000 0001 2205 5940School of Medicine, Universidad del Rosario, Bogotá, Colombia ,Hospital Universitario Mayor Méderi, Bogotá, Colombia
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19
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Chen X, Ning J, Li Q, Kuang W, Jiang H, Qin S. Prediction of acute pancreatitis complications using routine blood parameters during early admission. Immun Inflamm Dis 2022; 10:e747. [PMID: 36444624 PMCID: PMC9695081 DOI: 10.1002/iid3.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/16/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There have been many reports on biomarkers for predicting the severity of acute pancreatitis (AP), but few studies on biomarkers for predicting complications; some simple and inexpensive indicators, in particular, are worth exploring. METHODS We retrospectively collected clinical data of 809 AP patients, including medical history and results of routine blood tests, and grouped them according to the occurrence of complications. Differences in clinical characteristics between groups with and without complications were compared using t-test or χ2 test. Receiver operating curve (ROC) and area under the curve were calculated to evaluate the ability of predicting the occurrence of complications for the routine blood parameters with statistical differences. Then, through univariate and multivariate analyses, independent risk factors closely associated with complications were identified. Finally, we built a three-parameter prediction system and evaluated its ability to predict AP complications. RESULTS Compared with the group without complications, the patients in the complication group had higher white blood cells, neutrophils, C-reactive protein, and erythrocyte sedimentation rate (ESR), and lower red blood cells and hemoglobin (Hb) (all p < .05), and most of them had severe pancreatitis. In addition, pseudocysts were more common in patients with alcoholic etiology, recurrence, low BMI, and high platelet (PLT) and plateletocrit. Acute respiratory failure was more common in patients with first onset and high mean PLT volume (MPV). Sepsis was more common in patients with lipogenic etiology, high MPV, and low lymphocytes. Infectious pancreatic necrosis was more common in patients with alcoholic etiology. Acute renal failure was more common in patients with monocytes and high MPV and low PLT. Multivariate analysis showed that PLT and ESR were risk factors for pseudocyst development. The ROC showed that the combination of Hb, PLT and ESR had a significantly higher predictive ability for pseudocyst than the single parameter. CONCLUSION Routine blood parameters can be used to predict the complications of AP. A predictive model combining ESR, PLT, and Hb may be an effective tool for identifying pseudocysts in AP patients.
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Affiliation(s)
- Xiubing Chen
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Jing Ning
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Qing Li
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Wenxi Kuang
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Haixing Jiang
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Shanyu Qin
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
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20
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Sardana O, Kumari P, Singh R, Chopra H, Emran TB. Health-related quality of life among acute pancreatitis patients correlates with metabolic variables and associated factors. Ann Med Surg (Lond) 2022; 82:104504. [PMID: 36268403 PMCID: PMC9577452 DOI: 10.1016/j.amsu.2022.104504] [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: 07/06/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Acute pancreatitis (AP) and associated metabolic abnormalities constitute prevalent medical disorders that have disastrous implications and expensive cost of care. However, the connection with metabolic abnormalities and their influence on wellbeing i.e., health-related quality of life (HRQoL) remains unclear. As a result, we investigated the influence of MetS components on HRQoL in AP patients. Methods In a tertiary care hospital in North India, comprehensive observational research was undertaken with enrollment of subjects having AP along metabolic syndrome (MetS) or without was included. MetS was diagnosed for subjects using the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) guidelines. Various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P ≤ 0.05) in AP patients. Student's t-test and Short Form-36 (SF-36) along with the association between AP and MetS, as well as their impact on HRQoL, was investigated finally with, Pearson Correlation Analysis Factor. Results The study comprised 100 subjects or patients diseased of AP associated with MetS and 100 patients with AP associated without MetS. Gender, Age, Educational Status, Tobacco uses along with the metabolic variables were found to be statistically significant (P ≤ 0.05) and comparatively increased in patients with AP with MetSthan AP without MetS except HDL levels. Finally, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in Health compartment scores. Conclusion AP with MetS patients had a worse aggregate HRQOL than AP without MetS patients. Acute pancreatitis (AP) and associated metabolic abnormalities constitute prevalent medical disorders. We investigated the influence of MetS components on HRQoL in AP patients. The focus of this study is to figure out the relationship between MetS with quality of life among AP patients. AP with MetS patients had a worse aggregate HRQOL than AP without MetS patients.
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Affiliation(s)
- Ojus Sardana
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Pratima Kumari
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Ravinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
- Corresponding author. Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Patiala, 140401, Punjab, India.
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh
- Corresponding author. Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
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21
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Carneiro TJ, Pinto J, Serrao EM, Barros AS, Brindle KM, Gil AM. Metabolic profiling of induced acute pancreatitis and pancreatic cancer progression in a mutant Kras mouse model. Front Mol Biosci 2022; 9:937865. [PMID: 36090050 PMCID: PMC9452780 DOI: 10.3389/fmolb.2022.937865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Untargeted Nuclear Magnetic Resonance (NMR) metabolomics of polar extracts from the pancreata of a caerulin-induced mouse model of pancreatitis (Pt) and of a transgenic mouse model of pancreatic cancer (PCa) were used to find metabolic markers of Pt and to characterize the metabolic changes accompanying PCa progression. Using multivariate analysis a 10-metabolite metabolic signature specific to Pt tissue was found to distinguish the benign condition from both normal tissue and precancerous tissue (low grade pancreatic intraepithelial neoplasia, PanIN, lesions). The mice pancreata showed significant changes in the progression from normal tissue, through low-grade and high-grade PanIN lesions to pancreatic ductal adenocarcinoma (PDA). These included increased lactate production, amino acid changes consistent with enhanced anaplerosis, decreased concentrations of intermediates in membrane biosynthesis (phosphocholine and phosphoethanolamine) and decreased glycosylated uridine phosphates, reflecting activation of the hexosamine biosynthesis pathway and protein glycosylation.
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Affiliation(s)
- Tatiana J. Carneiro
- CICECO - Aveiro Institute of Materials (CICECO/UA), Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Joana Pinto
- CICECO - Aveiro Institute of Materials (CICECO/UA), Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Eva M. Serrao
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - António S. Barros
- CICECO - Aveiro Institute of Materials (CICECO/UA), Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Kevin M. Brindle
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Ana M. Gil
- CICECO - Aveiro Institute of Materials (CICECO/UA), Department of Chemistry, University of Aveiro, Aveiro, Portugal
- *Correspondence: Ana M. Gil,
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Abdellatif W, Vasan V, Kay FU, Kohli A, Abbara S, Brewington C. Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists. Emerg Radiol 2022; 29:1019-1031. [PMID: 35945464 PMCID: PMC9363271 DOI: 10.1007/s10140-022-02085-7] [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: 06/12/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Due to a contrast shortage crisis resulting from the decreased supply of iodinated contrast agents, the American College of Radiology (ACR) has issued a guidance statement followed by memoranda from various hospitals to preserve and prioritize the limited supply of contrast. The vast majority of iodinated contrast is used by CT, with a minority used by vascular and intervention radiology, fluoroscopy, and other services. A direct consequence is a paradigm shift to large volume unenhanced CT scans being utilized for acute and post traumatic patients in EDs, an uncharted territory for most radiologists and trainees. This article provides radiological diagnostic guidance and a pictorial example through systematic review of common unenhanced CT findings in the acute setting.
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Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA.
| | - Vasantha Vasan
- Abdominal Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Fernando U Kay
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Ajay Kohli
- Departments of Radiology and Orthopedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Cecelia Brewington
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
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23
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Froes CD, Gosal K, Singh P, Collier V. The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis. Cureus 2022; 14:e27752. [PMID: 36106274 PMCID: PMC9445414 DOI: 10.7759/cureus.27752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/21/2022] Open
Abstract
Aim Acute pancreatitis is a diagnosis established by fulfillment of at least two out of three clinical features, including epigastric pain, elevated lipase, and/or radiographic evidence of acute pancreatitis. Computed tomography of the abdomen and pelvis (CTAP) is the gold standard imaging modality for evaluating acute pancreatitis. Although abdominal ultrasound (AUS) is increasingly utilized given the widespread availability and high sensitivity and specificity for detecting gallstone-related complications, including gallstone pancreatitis, the leading cause of acute pancreatitis in the US. However, recent literature has concluded that performing AUS following a negative CTAP rarely led to changes in management and imparted an increased length of service (LOS) in the ED. Our study investigated whether a similar relationship was observed when managing acute pancreatitis in the inpatient setting. We aimed to quantify how performing AUS influenced inpatient LOS for patients admitted for acute pancreatitis without radiographic evidence of acute pancreatitis on CTAP. We also aimed to quantify how AUS influenced the likelihood of subsequent intervention via endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy, including the relative impact of certain demographic or clinical features. Methods A retrospective analysis was performed using a cohort of 6069 patient encounters extracted via the HCA Healthcare enterprise data warehouse (EDW) database. Inclusion criteria were all adult patients with an index admission for acute pancreatitis between January 1 and December 31, 2019, who underwent CTAP during admission. Patients younger than 18 years, with prior cholecystectomy, or without documentation of demographic or clinical data of interest were excluded. The primary outcome was to quantify how performing AUS within 48 hours impacted LOS for patients admitted for acute pancreatitis following negative CTAP. Secondary outcomes examined whether AUS changed management (i.e., per likelihood of subsequent ERCP or cholecystectomy). This included determining the influence of various demographic or clinical characteristics on the likelihood of intervention via ERCP or cholecystectomy. Linear regression was used to determine the effect of performing AUS on the duration of LOS. Logistic regression was used for covariate analysis based on demographic (BMI, sex, race, age) and clinical data (comorbid conditions, abnormal labs, and vital signs). Results Patients with acute pancreatitis who underwent AUS within 48 hours had a reduced LOS of 1.099 days. Patients who underwent AUS were 1.126 times more likely to undergo subsequent ERCP than those who received CTAP alone. Patients who received AUS following CTAP were also 2.711 times more likely to undergo subsequent cholecystectomy. Increasing age and BMI were correlated with an increased likelihood of ERCP and cholecystectomy. Males were less likely to undergo cholecystectomy (OR = 0.753) and ERCP (OR = 0.815) compared to females. Conclusion Performing AUS within 48 hours following negative CTAP in this cohort of patients admitted for acute pancreatitis was associated with a decreased LOS. Furthermore, patients who underwent AUS were more likely to undergo ERCP and even more likely to undergo cholecystectomy. The likelihood of ERCP and cholecystectomy increased proportionally to both age and BMI. Females were more likely than males to undergo subsequent ERCP or cholecystectomy.
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24
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Li M, Wang A, Ren S, Wang Z, Wang Q, Gou C, Zhao W, Zhang L, Li N. Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study. Scand J Gastroenterol 2022; 57:896-903. [PMID: 35297730 DOI: 10.1080/00365521.2022.2050294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Impaction of a stone at the duodenal papilla can obstruct biliopancreatic outflow and thereby lead to acute pancreatitis. But not all patients with an impacted papillary stone (IPS) had the clinical features of pancreatitis. This study aimed to identify factors associated with acute pancreatitis in patients with IPS. METHODS We retrospectively analyzed patients with IPS who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Tianjin Nankai Hospital. Clinical factors were compared between patients with/without acute pancreatitis before ERCP. Factors associated with acute pancreatitis were identified by univariable and multivariable binary logistic regression. RESULTS The final analysis included 174 patients with acute pancreatitis (pancreatitis group, PG) and 130 patients without acute pancreatitis (non-pancreatitis group, NPG). Preoperative incidences of jaundice (85.6 vs. 72.3%), acute cholangitis (54.6 vs. 33.8%), and hyperlipidemia (39.1 vs. 22.3%) were higher in the PG than in the NPG (p < .05). High tension in the duodenal papilla (83.3 vs. 71.5%), circular papillary orifice (82.8 vs. 70.0%), and distal stone impaction (90.8 vs. 82.3%) were more common in the PG than in the NPG (p < .05), whereas stone diameter and common bile duct diameter did not differ significantly between groups. Multivariable logistic regression revealed that jaundice, acute cholangitis, hyperlipidemia, and dot/circular papillary orifice were independently associated with acute pancreatitis (p < .05). CONCLUSIONS Jaundice, acute cholangitis, and hyperlipidemia are independent risk factors for acute pancreatitis in patients with IPS. Prompt ERCP in patients with these features might reduce acute pancreatitis risk. Dot/circular papillary orifice may be an anatomical factor of acute pancreatitis, which needs more evidence.
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Affiliation(s)
- Ming Li
- Department of Hepatopancreatobiliary Surgery, Tianjin Medical University NanKai Hospital, Tianjin, China
| | - Ao Wang
- Tianjin Medical University, Tianjin, China
| | | | - Zhenyu Wang
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Qing Wang
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Chengyue Gou
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Weichuan Zhao
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Li Zhang
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
| | - Ning Li
- Endoscopy Center, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.,Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China
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25
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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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26
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Liengswangwong W, Preechakul P, Yuksen C, Jenpanitpong C, Tienpratarn W, Watcharakitpaisan S. Clinical Prediction Score for Early Diagnosis of Acute Pancreatitis in Emergency Departments. OPEN ACCESS EMERGENCY MEDICINE 2022; 14:355-366. [PMID: 35924030 PMCID: PMC9342661 DOI: 10.2147/oaem.s371237] [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: 04/29/2022] [Accepted: 07/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background In Thailand, most primary care hospitals cannot measure serum lipase and amylase; no 24 hours computed tomography and magnetic resonance imaging available, and no on-call gastroenterologists. Thus, acute pancreatitis cannot be diagnosed based on the established diagnostic criteria that require this information. The resultant delayed management increases morbidity and mortality. This study was performed to create a clinical prediction score for early diagnosis of acute pancreatitis in emergency departments without requiring a computed tomography scan or laboratory measurement to assist in the initial diagnosis, treatment, or referral. Methods Patients with suspected acute pancreatitis who had available data regarding lipase and amylase measurements and visited the emergency department from June 2019 to August 2020 were retrospectively analyzed. The baseline predictive factors were compared between patients with and without acute pancreatitis according to the 2012 revised Atlanta classification. Multivariable logistic regression was used to explore potential predictive factors and develop a clinical prediction score for the diagnosis of acute pancreatitis. Results A total of 506 eligible patients, 84 (16%) had acute pancreatitis. The PRE-PAN score [area under the receiver operating characteristics curve, 0.88; 95% confidence interval (CI), 0.84–0.93] included six factors: alcohol drinking, epigastric pain, pain radiating to the back, persistent pain, nausea or vomiting, and the pain score. A score of >7.5 points suggested a high probability of acute pancreatitis [positive likelihood ratio, 6.80 (95% CI, 4.75–9.34; p < 0.001); sensitivity, 66.7% (95% CI, 54.6–77.3); specificity, 90.2% (95% CI, 86.6–93.1); positive predictive value, 58.5% (95% CI, 47.1–69.3);, 92.9% (95% CI, 89.6–95.4)]. Conclusion A PRE-PAN risk score is a screening tool for predicting acute pancreatitis without using the lipase concentration or radiological findings. A high predictive score, especially >7.5, suggests a high probability of acute pancreatitis.
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Affiliation(s)
- Wijittra Liengswangwong
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pacharaporn Preechakul
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Chaiyaporn Yuksen, Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand, Email
| | - Chetsadakon Jenpanitpong
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Welawat Tienpratarn
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sorawich Watcharakitpaisan
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Effect of TRAF6 in acute pancreatitis-induced intestinal barrier injury via TLR4/NF-κB signal pathway. Tissue Cell 2022; 76:101792. [DOI: 10.1016/j.tice.2022.101792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/28/2022]
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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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Nair A, Tiwary MK, Seelam S, Kothapalli KK, Pulipaka K. Efficacy and Safety of Thoracic Epidural Analgesia in Patients With Acute Pancreatitis: A Narrative Review. Cureus 2022; 14:e23234. [PMID: 35449658 PMCID: PMC9012692 DOI: 10.7759/cureus.23234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/09/2022] Open
Abstract
Patients admitted to the intensive care unit with moderate to severe acute pancreatitis carry significant morbidity and mortality. A few unfortunate patients in whom the initial line of treatment fails to show clinical improvement develop multiorgan dysfunction involving lungs (adult respiratory distress syndrome), renal failure, intra-abdominal infections, sepsis, and septic shock, which ultimately leads to prolonged hospitalization and a substantial cost of treatment. The acute abdominal pain experienced by these patients is excruciating and requires multimodal analgesia. Continuous epidural analgesia has been found to provide good quality, opioid-sparing analgesia in these patients. A few studies have also demonstrated that segmental sympathectomy resulting from epidural blockade could lead to lowering of serum amylase and lipase levels improve paralytic ileus, and thus hastens the process of recovery. The present paper aims to discuss the advantages of continuous epidural analgesia in patients with acute pancreatitis of varying severity and to review the existing literature using specific keywords.
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30
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Oliveira SRBD, Franco ÁX, Quaresma MP, de Carvalho CMM, da Cunha Jácome Marques F, da Silva Pantoja P, Mendonça VA, da Silva Osterne VJ, Correia JLA, Assreuy AMS, de Souza MHLP, do Nascimento KS, Cavada BS, Criddle DN, Soares PMG. Anti-inflammatory and anti-necrotic effects of lectins from Canavalia ensiformis and Canavalia brasiliensis in experimental acute pancreatitis. Glycoconj J 2022; 39:599-608. [PMID: 35239112 DOI: 10.1007/s10719-022-10048-w] [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: 11/09/2021] [Revised: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 11/04/2022]
Abstract
Lectins isolated from Canavalia ensiformis (ConA) and Canavalia brasiliensis (ConBr) are promising molecules to prevent cell death. Acute pancreatitis, characterized by acinar cell necrosis and inflammation, presents significant morbidity and mortality. This study has investigated the effects of ConA and ConBr in experimental acute pancreatitis and pancreatic acinar cell death induced by bile acid. Pancreatitis was induced by retrograde pancreatic ductal injection of 3% sodium taurocholate (Na-TC) in male Swiss mice. ConA or ConBr (0.1, 1 or 10 mg/kg) were intravenously applied to mice 1 h and 12 h after induction. After 24 h, the severity of pancreatitis was evaluated by serum amylase and lipase, histopathological changes and myeloperoxidase assay. Pancreatic acinar cells were incubated with ConA (200 µg/ml) or ConBr (200 µg/ml) and taurolithocholic acid 3-sulfate (TLCS; 500 µM). Necrosis and changes in mitochondrial membrane potential (ΔѰm) were detected by fluorescence confocal microscopy. Treatment (post-insult) with ConA and ConBr decreased pancreatic damage caused by retrograde injection of Na-TC in mice, reducing pancreatic neutrophil infiltration, edema and necrosis. In addition, ConA and ConBr decreased pancreatic acinar cell necrosis and depolarization of ΔѰm caused by TLCS. The inhibition of necrosis was prevented by the lectin domain blockade. In conclusion, ConA and ConBr markedly inhibited in vitro and in vivo damage, effects partly dependent on the interaction with mannose residues on acinar cells. These data support the potential application of these proteins for treatment of acute pancreatitis.
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Affiliation(s)
| | - Álvaro Xavier Franco
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Marielle Pires Quaresma
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | | | - Vanessa Azevedo Mendonça
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | | | | | | | - Benildo Sousa Cavada
- Department of Biochemistry and Molecular Biology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - David Neil Criddle
- Department of Molecular Physiology & Cell Signalling, ISMIB, University of Liverpool, Liverpool, UK
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Akdur G, Bardakcı O, Das M, Akdur O, Beyazit Y. Diagnostic utility of hematological indices in predicting adverse outcomes and severity of acute pancreatitis based on BISAP and modified Glasgow score. ULUS TRAVMA ACIL CER 2022; 28:268-275. [PMID: 35485556 PMCID: PMC10493544 DOI: 10.14744/tjtes.2020.26348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), and red blood cell distribution width (RDW) are simple indicators of inflammatory status previously established as a severity indicator in distinct disease states. This study aimed to determine the impact of these simple hematologic indices with conventional inflammation markers such as C-reactive pro-tein (CRP) and white blood cells in acute pancreatitis (AP) patients and their relationship with AP risk stratification scores including Bedside Index for Severity of Acute Pancreatitis (BISAP) and modified Glaskow Prognostic score (mGPS) scores. METHODS This retrospective study was performed in the emergency department of Canakkale Onsekiz Mart University. A total of 171 patients (male/female: 68 [39.8%]/103 [60.3%]) with AP and 59 age and gender matched healthy subjects (male/female: 23 [39%]/36[61%]) as controls were enrolled in the present study. The patients were grouped according to severity and adverse outcomes according to BISAP and mGPS and a comparative analysis was performed to compare the NLR, PLR, and RDW between groups. RESULTS The mean NLR values of AP patients and control group were 9.62±6.34 and 2.04±1.08, respectively (p<0.001), while the mean PLR values of AP patients and control group were 221.83±122.43 and 83.30±38.89, respectively (p<0.001). Except from RDW, all the other hematologic indices were found to be elevated (p<0.05 for WBC; NLR, PLR, and CRP) on both mild and severe disease at disease onset. NLR and PLR showed significant predictive ability for estimating serious complications associated with AP. CONCLUSION The present study showed that NLR and PLR is increased in AP. Moreover, peripheral blood NLR and PLR values can predict disease severity and adverse outcomes associated with AP and can be used as an adjunctive marker for estimating disease severity.
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Affiliation(s)
- Gökhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Okan Bardakcı
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Murat Das
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Okhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Yavuz Beyazit
- Department of Internal Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
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Walter FR, Harazin A, Tóth AE, Veszelka S, Santa-Maria AR, Barna L, Kincses A, Biczó G, Balla Z, Kui B, Maléth J, Cervenak L, Tubak V, Kittel Á, Rakonczay Z, Deli MA. Blood-brain barrier dysfunction in L-ornithine induced acute pancreatitis in rats and the direct effect of L-ornithine on cultured brain endothelial cells. Fluids Barriers CNS 2022; 19:16. [PMID: 35177109 PMCID: PMC8851707 DOI: 10.1186/s12987-022-00308-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In severe acute pancreatitis (AP) the CNS is affected manifesting in neurological symptoms. Earlier research from our laboratory showed blood-brain barrier (BBB) permeability elevation in a taurocholate-induced AP model. Here we aimed to further explore BBB changes in AP using a different, non-invasive in vivo model induced by L-ornithine. Our goal was also to identify whether L-ornithine, a cationic amino acid, has a direct effect on brain endothelial cells in vitro contributing to the observed BBB changes. METHODS AP was induced in rats by the intraperitoneal administration of L-ornithine-HCl. Vessel permeability and the gene expression of the primary transporter of L-ornithine, cationic amino acid transporter-1 (Cat-1) in the brain cortex, pancreas, liver and lung were determined. Ultrastructural changes were followed by transmission electron microscopy. The direct effect of L-ornithine was tested on primary rat brain endothelial cells and a triple co-culture model of the BBB. Viability and barrier integrity, including permeability and TEER, nitrogen monoxide (NO) and reactive oxygen species (ROS) production and NF-κB translocation were measured. Fluorescent staining for claudin-5, occludin, ZO-1, β-catenin, cell adhesion molecules Icam-1 and Vcam-1 and mitochondria was performed. Cell surface charge was measured by laser Doppler velocimetry. RESULTS In the L-ornithine-induced AP model vessel permeability for fluorescein and Cat-1 expression levels were elevated in the brain cortex and pancreas. On the ultrastructural level surface glycocalyx and mitochondrial damage, tight junction and basal membrane alterations, and glial edema were observed. L-ornithine decreased cell impedance and elevated the BBB model permeability in vitro. Discontinuity in the surface glycocalyx labeling and immunostaining of junctional proteins, cytoplasmic redistribution of ZO-1 and β-catenin, and elevation of Vcam-1 expression were measured. ROS production was increased and mitochondrial network was damaged without NF-κB, NO production or mitochondrial membrane potential alterations. Similar ultrastructural changes were seen in L-ornithine treated brain endothelial cells as in vivo. The basal negative zeta potential of brain endothelial cells became more positive after L-ornithine treatment. CONCLUSION We demonstrated BBB damage in the L-ornithine-induced rat AP model suggesting a general, AP model independent effect. L-ornithine induced oxidative stress, decreased barrier integrity and altered BBB morphology in a culture BBB model. These data suggest a direct effect of the cationic L-ornithine on brain endothelium. Endothelial surface glycocalyx injury was revealed both in vivo and in vitro, as an additional novel component of the BBB-related pathological changes in AP.
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Affiliation(s)
- Fruzsina R Walter
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary
| | - András Harazin
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary
- Department of Biomedicine, Faculty of Health, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
| | - Andrea E Tóth
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary
- Department of Biomedicine, Faculty of Health, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus C, Denmark
| | - Szilvia Veszelka
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary
| | - Ana R Santa-Maria
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary
- Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Lilla Barna
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary
| | - András Kincses
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary
| | - György Biczó
- Department of Medicine, University of Szeged, Kálvária sgt 57, Szeged, 6725, Hungary
| | - Zsolt Balla
- Department of Medicine, University of Szeged, Kálvária sgt 57, Szeged, 6725, Hungary
- Institute of Applied Sciences, Department of Environmental Biology and Education, Juhász Gyula Faculty of Education, University of Szeged, Boldogasszony sgt. 6, Szeged, 6725, Hungary
| | - Balázs Kui
- Department of Medicine, University of Szeged, Kálvária sgt 57, Szeged, 6725, Hungary
| | - József Maléth
- Department of Medicine, University of Szeged, Kálvária sgt 57, Szeged, 6725, Hungary
- HAS-USZ Momentum Epithelial Cell Signaling and Secretion Research Group, University of Szeged, Dóm sqr. 10, Szeged, 6720, Hungary
- HCEMM-SZTE Molecular Gastroenterology Research Group, University of Szeged, Dóm sqr. 10, Szeged, 6720, Hungary
| | - László Cervenak
- Department of Internal Medicine and Hematology, Research Laboratory, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Vilmos Tubak
- Creative Laboratory Ltd, Temesvári krt. 62, Szeged, 6726, Hungary
| | - Ágnes Kittel
- Institute of Experimental Medicine, Eötvös Loránd Research Network, Szigony u. 43, Budapest, 1083, Hungary
| | - Zoltán Rakonczay
- Department of Medicine, University of Szeged, Kálvária sgt 57, Szeged, 6725, Hungary
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, Szeged, 6701, Hungary
| | - Mária A Deli
- Institute of Biophysics, Biological Research Centre, Temesvári krt. 62, Szeged, 6726, Hungary.
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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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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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Mohamed MZ, Mohammed HH, Khalaf HM. Therapeutic effect of rupatadine against l-arginine-induced acute pancreatitis in rats: role of inflammation. Can J Physiol Pharmacol 2022; 100:176-183. [PMID: 35050802 DOI: 10.1139/cjpp-2021-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute pancreatitis (AP) is an abrupt inflammatory disorder causing high morbidity and mortality. As AP is an insidious medical emergency, a curative modality is required instead of a preventive measure. Thus, we investigated the possible curative effect of rupatadine on a rat model of AP. Rupatadine is a potent histamine receptor 1 (H1R) and platelet-activating factor (PAF) blocker. We used four groups of six Wistar rats as follows: the control group received vehicle; the rupatadine control group received rupatadine as 6 mg/kg orally; the AP group received l-arginine intraperitoneally, and the treatment group received rupatadine at 1, 6, and 24 h after l-arginine injection. The levels of serum amylase, pancreatic oxidative parameters, and pancreatic cytokines were measured. PAF, histamine, and myeloperoxidase levels were determined in the pancreas. Histopathological and immunohistochemical examinations were performed to determine nuclear factor kappa-B (NF-κB) and caspase 3 expressions. Oxidative damage and severe inflammation were detected in the pancreas of the AP group. Rupatadine reduced the oxidative damage and the levels of proinflammatory cytokines, PAF, histamine, myeloperoxidase, NF-κB, and caspase 3 expressions. It restored the pancreatic acini to almost normal condition. Rupatadine induced important anti-inflammatory and antiapoptotic effects against l-arginine-induced AP.
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Affiliation(s)
- Mervat Z Mohamed
- Department of Pharmacology, Faculty of Medicine, Minia University, 61511 Minia, Egypt
| | - Hanaa H Mohammed
- Department of Histology, Faculty of Medicine, Minia University, 61511 Minia, Egypt
| | - Hanaa M Khalaf
- Department of Pharmacology, Faculty of Medicine, Minia University, 61511 Minia, Egypt
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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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Filip SS, Slyvka RM, Skrypinets YP, Bratasyuk AM, Shitev AI. EXPERIENCE OF THE TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2462-2466. [PMID: 36472280 DOI: 10.36740/wlek202210127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: To improve the results of treatment of patients diagnosed with acute pancreatitis. PATIENTS AND METHODS Materials and methods: The materials of the work are based on the clinical examination and treatment of 301 patients with acute pancreatitis, in the treatment of which, along with classical treatment, a therapeutic and diagnostic complex was used, which allows predicting and preventing the development of abdominal compartment syndrome (ACS). RESULTS Results: Managed to reduce the number of cases of infected pancreatic necrosis, effectively predict and prevent the development of abdominal compartment syndrome (ACS), reduce the average length of stay of patients in the hospital. CONCLUSION Conclusions: The use of the proposed management algorithm for patients with acute pancreatitis allows to shorten the treatment period by effectively predicting and preventing the development of pancreatic necrosis, its septic complications and abdominal compartment syndrome.
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Birda CL, Agarwal A. Role of ERCP in acute biliary pancreatitis: yet unanswered. Endosc Int Open 2021; 9:E1917. [PMID: 34917462 PMCID: PMC8670989 DOI: 10.1055/a-1591-0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chhagan Lal Birda
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ashish Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Iqbal K, Rathore SS, Hanyalu Shankar V, Deepika K, Pattan V, Koritala T, Jain N, Adhikari R. A Case of Acute Pancreatitis in a Patient Receiving High-Dose Steroids for Optic Neuritis. Cureus 2021; 13:e19132. [PMID: 34858765 PMCID: PMC8614170 DOI: 10.7759/cureus.19132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/19/2022] Open
Abstract
Although rare, drug-induced pancreatitis is an important cause of acute pancreatitis. The diagnosis of drug-induced pancreatitis remains a challenge for clinicians. Steroids are one of the frequently used drugs in hospitals for many acute illnesses. Patients presenting with signs and symptoms of acute pancreatitis, with a recent history of steroid use, in the absence of other potential causes, should be approached with a high suspicion for steroid-induced pancreatitis to ensure a timely diagnosis. We describe a case of a 57-year-old female treated for optic neuritis of the left eye with high doses of Methylprednisolone for five days, who presented to the emergency room with acute abdominal pain within 24 hours of discharge. A detailed evaluation of the patient's medical history and exclusion of other probable etiologies confirmed the diagnosis of steroid-induced pancreatitis. Withdrawal of the offending agent and supportive care resolved the underlying acute pancreatitis.
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Affiliation(s)
- Kinza Iqbal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Keerti Deepika
- Pediatrics/Translational Research, Thomas Jefferson University, Philadelphia, USA
| | | | | | - Nitesh Jain
- Pulmonary and Critical Care Medicine, Mayo Clinic, Mankato, USA
| | - Ramesh Adhikari
- Hospital Medicine, Franciscan Health, Lafayette, USA.,Geriatrics, Brown University, Providence, USA
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Hudson-Phillips S, Mayo K, Cox K, Sharif Z, Burns J. Anorexia nervosa and pancreatitis. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34983221 DOI: 10.12968/hmed.2021.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute pancreatitis is a condition whereby erroneous activation of trypsin and zymogen results in pancreatic autodigestion. There are many aetiologies, with alcohol intake and gallstones being the most common. Anorexia nervosa is an eating disorder in which patients' reduced food intake and psychological aversion of weight gain can result in low body weight and malnourishment. The link between pancreatitis and anorexia nervosa is not well understood; this article explores the theorised pathophysiology connecting the two conditions, as well as the optimal management of patients when the conditions co-exist based on current literature. A literature search was performed using MEDLINE, EMBASE and CINAHL databases for all journal articles on the topic of presentations of acute or chronic pancreatitis in adults with anorexia nervosa. The literature proposes various links between anorexia nervosa and pancreatitis. It is theorised that pancreatitis may arise as a result of malnourishment itself or secondary to the refeeding process. Some explanations focus on the histopathological changes to the pancreas that malnourishment induces, while others focus on the enzymatic changes and oxidative damage that arise in the malnourished state. More mechanical mechanisms such as gastric dilatation, gastrointestinal ileus and compartmental fluid shift during refeeding have also been proposed as explanations for the link between the conditions. Some medications used in the management of anorexia nervosa have also been linked to pancreatitis.
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Affiliation(s)
| | - Kate Mayo
- Department of General Surgery, St George's Hospital, London, UK
| | - Kofi Cox
- St George's University, London, UK
| | | | - Joshua Burns
- Department of General Surgery, St George's Hospital, London, UK
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Tran A, Hoff C, Polireddy K, Neymotin A, Maddu K. Beyond acute cholecystitis-gallstone-related complications and what the emergency radiologist should know. Emerg Radiol 2021; 29:173-186. [PMID: 34787758 DOI: 10.1007/s10140-021-01999-y] [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] [Received: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
The purpose of this study is to emphasize the imaging features of complications of gallstones beyond the cystic duct on ultrasound (US), enhanced and nonenhanced computed tomography (CECT and NECT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). This article includes a brief overview of gallstone imaging and emerging trends in the detection of gallstones. This review article will highlight complications of gallstones, including choledocholithiasis, gallstone pancreatitis, acute cholangitis, Mirizzi syndrome, cholecystobiliary and cholecystoenteric fistulas, and gallstone ileus. Imaging findings and limitations of US, CT, MRI, and ERCP will be discussed. The review article will also briefly discuss the management of each disease. The presence of gallstones beyond the level of the cystic duct can lead to a spectrum of diseases, and emergency radiologists play a critical role in disease management by providing a timely diagnosis. Documenting the location of a gallstone within the common bile duct (CBD) in symptomatic cholelithiasis and the presence of acute interstitial edematous pancreatitis and/or ascending cholangitis plays a pivotal role in disease management. Establishing the presence of ectopic gallstones and biliary-enteric fistulae has a significant role in directing patient management.
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Affiliation(s)
- Andrew Tran
- Emory University School of Medicine, Atlanta, GA, USA.
| | - Carrie Hoff
- Div. Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Atlanta, USA
| | | | - Arie Neymotin
- Department of Radiology, MedStar Health, Washington, DC, USA
| | - Kiran Maddu
- Div. Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Atlanta, USA
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Wei B, Gong Y, Yang H, Zhou J, Su Z, Liang Z. Role of tumor necrosis factor receptor‑associated factor 6 in pyroptosis during acute pancreatitis. Mol Med Rep 2021; 24:848. [PMID: 34643253 PMCID: PMC8524430 DOI: 10.3892/mmr.2021.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/17/2021] [Indexed: 01/09/2023] Open
Abstract
Acute pancreatitis (AP) is hypothesized to be related to the activation of an inflammatory response induced by pyroptosis. The aim of the present study was to investigate the potential role of tumor necrosis factor receptor-associated factor 6 (TRAF6) in pyroptosis in an AP rat model and the human pancreatic ductal epithelial HPDE6C7 cell line. In vivo, AP was induced by intraperitoneal injection of caerulein (CAE) in rats. The rats were sacrificed at 24 or 48 h after the final CAE injection. In vitro, HPDE6C7 cells were treated with CAE for 12, 24 and 48 h. Moreover, TRAF6 was overexpressed and treated with CAE for 48 h. Histopathological changes of pancreatic, serum and supernatant inflammatory cytokines and pyroptosis-related mRNA and protein expression levels were determined by histopathological scores, ELISA, reverse transcription-quantitative PCR and western blotting. In addition, pyroptosis morphological changes were also determined by Hoechst/PI staining in HPDE6C7 cells. Results showed that AP was observed in the CAE-induced rat model, and that serum IL-1β and IL-18 levels, and TRAF6, NLR pyrin domain containing 3 (NLRP3), caspase-1 and caspase-3 mRNA and protein expression levels were increased. Similar in HPDE6C7 cells, CAE treatment caused supernatant IL-1β level, NLRP3 and caspase-1 mRNA expression levels to significantly increase. After TRAF6 overexpression and CAE treatment, supernatant IL-1β level, caspase-1 protein expression level, and NLRP3 and caspase-3 mRNA and protein expression levels were also significantly increased. Furthermore, cells exhibited red fluorescence in Hoechst/PI staining, which can be used as a method of detecting pyroptosis activation. The results also showed that the red fluorescence was stronger after CAE treatment or TRAF6 overexpression plus CAE treatment. In conclusion, TRAF6 and caspase-1/3 signaling pathways were involved in the pathogenesis of CAE-induced AP in rats. Pyroptosis was activated by CAE and TRAF6 overexpression via the caspase-1/3 signaling pathways in HPDE6C7 cells.
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Affiliation(s)
- Biwei Wei
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Yahui Gong
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Huiying Yang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Jie Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Zhou Su
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Zhihai Liang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
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Zhang J, Wang S, Cai H, Feng T, Liu Z, Xu Y, Li J. Hydrophobic ion-pairing assembled liposomal Rhein with efficient loading for acute pancreatitis treatment. J Microencapsul 2021; 38:559-571. [PMID: 34637365 DOI: 10.1080/02652048.2021.1993363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The present study aimed to develop liposomal Rhein by employing a hydrophobic ion-pairing technique (HIP) for improved pancreatitis therapy. METHODS F127 modified liposomal Rhein (F127-RPC-Lip) was prepared using a two-step process consisting of complexation first, followed by a film-ultrasonic dispersion step. The drug-phospholipid interaction was characterised by FT-IR and P-XRD. Particle size and morphology were investigated using DLS and TEM, respectively. Biodistribution and therapeutic efficacy of F127-RPC-Lip were evaluated in a rat model of acute pancreatitis. RESULTS F127-RPC-Lip achieved efficient drug encapsulation after complexation with lipids through non-covalent interactions and had an average hydrodynamic diameter of about 141 nm. F127-RPC-Lip demonstrated slower drug release (55.90 ± 3.60%, w/w) than Rhein solution (90.27 ± 5.11%) within 24 h. Compared with Rhein, F127-RPC-Lip exhibited prolonged systemic circulation time, superior drug distribution, and attenuated injury in the pancreas of rats post-injection. CONCLUSIONS HIP-assembled liposomes are a promising strategy for Rhein in treating pancreatitis.
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Affiliation(s)
- Jinjie Zhang
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Targeting Therapy and Diagnosis of Critical Diseases, Zhengzhou, Henan Province, China.,Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, China
| | - Shuaishuai Wang
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Targeting Therapy and Diagnosis of Critical Diseases, Zhengzhou, Henan Province, China.,Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, China
| | - Huijie Cai
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Targeting Therapy and Diagnosis of Critical Diseases, Zhengzhou, Henan Province, China.,Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, China
| | - Tiange Feng
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Targeting Therapy and Diagnosis of Critical Diseases, Zhengzhou, Henan Province, China.,Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, China
| | - Zhilei Liu
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China.,BGI College, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yaru Xu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Targeting Therapy and Diagnosis of Critical Diseases, Zhengzhou, Henan Province, China.,Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, China
| | - Jianbo Li
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China.,BGI College, Zhengzhou University, Zhengzhou, Henan Province, China
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Porozan S, Alavinejad P, Mozafari J, Kazem Mousavi H, Delirrooyfard A. Serum Level of Galectin-3 in Early Detection of Acute Pancreatitis. Middle East J Dig Dis 2021; 13:350-355. [PMID: 36606007 PMCID: PMC9489453 DOI: 10.34172/mejdd.2021.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/19/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a common cause of hospital admissions. Diagnosing AP in patients presenting to emergency departments remains a challenge for physicians. Thus, we aimed to evaluate the diagnostic accuracy of galectin-3 to find a new and effective method for detecting AP. METHODS In this prospective cross-sectional study, 43 patients with a manifestation of AP were enrolled. The serum levels of galectin-3 were measured at admission and 48 hours later and compared between the groups of patients with and without AP. RESULTS Serum levels of galectin-3 at admission and after 48 hours were significantly higher in AP cases compared with non-AP individuals. The area under the curve (AUC) for galectin-3 was 73.1%, which revealed a good accuracy in predicting the AP diagnosis. CONCLUSION Serum levels of galectin-3 at admission and after 48 hours were significantly higher in AP cases, and their diagnostic value was acceptable in the detection of AP.
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Affiliation(s)
- Samaneh Porozan
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pezhman Alavinejad
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Mozafari
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hosein Kazem Mousavi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Delirrooyfard
- Imam Khomeini Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
,Corresponding Author: Ali Delirrooyfard, MD Address : Ahvaz,Azadegan St. Imam Khomeini Medical Center of Ahvaz, Ahvaz,Iran Tel : + 989173159418 Fax : + 986132225763
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Wang M, Jiang Z, Liang H. Glucocorticoids in acute pancreatitis: a propensity score matching analysis. BMC Gastroenterol 2021; 21:331. [PMID: 34433425 PMCID: PMC8386156 DOI: 10.1186/s12876-021-01907-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background There are few reports about the effect of glucocorticoids in the treatment of acute pancreatitis in humans. This study aims to evaluate the effect of glucocorticoids in the treatment of acute pancreatitis by propensity score matching analysis. Results Acute pancreatitis patients admitted between 2014 and 2019 were collected from the database and analyzed. Included patients were divided into the glucocorticoids-used group (GC group) and the non-glucocorticoids-used group (NGC group) according to whether glucocorticoids were used. A total of 818 eligible patients were included in the final analysis. Seventy-six patients were treated with glucocorticoids, and 742 patients were treated without glucocorticoids. Before propensity score matching, the triglyceride levels (38.2 ± 18.5 vs. 20.2 ± 16.8, P < 0.05) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (7.1 ± 2.5 vs. 4.5 ± 2.1, P < 0.05) at admission were significantly higher in the GC group than in the NGC group. The incidence of multi-organ failure (33.3% vs. 11.9%, P < 0.05) was significantly higher in the GC group than in the NGC group. Patients in the GC group showed a positive balance of fluid intake and output over 72 h. After 1:1 propensity score matching, 59 patients from each group (GC and NGC) were included in the analysis. There were no significant differences in age, sex, body mass index, triglycerides, or APACHE II scores between the two groups (P > 0.05), and the patients’ clinical outcomes were reversed. The proportion of patients with organ failure (40.7% vs. 52.5%, p < 0.05) and multi-organ failure (35.0% vs. 67.7%, P < 0.05) was significantly lower in the GC group than in the NGC group. Furthermore, patients in the GC group had significantly shorter lengths of hospital stay (12.9 ± 5.5 vs. 16.3 ± 7.7, P < 0.05) and costs (25,348.4 ± 2512.6vs. 32,421.7 ± 2813.3, P < 0.05) than those in the NGC group. Conclusions This study presents preliminary confirmation of the beneficial effect of glucocorticoids in the treatment of acute pancreatitis. More high-quality prospective studies are needed in the future.
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Affiliation(s)
- Meng Wang
- Department of Traditional Chinese Medicine, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, China
| | - Zongxing Jiang
- Department of General Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, 613000, China
| | - Hongyin Liang
- Department of General Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, 613000, China.
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Zheng CB, Zheng ZH, Zheng YP. Therapeutic plasma exchange for hyperlipidemic pancreatitis: Current evidence and unmet needs. World J Clin Cases 2021; 9:5794-5803. [PMID: 34368298 PMCID: PMC8316951 DOI: 10.12998/wjcc.v9.i21.5794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
With changes in lifestyle and diet worldwide, the prevalence of hyperlipidemic acute pancreatitis (HLAP) has greatly increased, and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol. There are many available therapies for HLAP, including oral lipid-lowering agents, intravenous insulin, heparin, and therapeutic plasmapheresis (TPE). It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides (TG), thus a rapid decrease in serum TG level is the key to the successful management of HLAP. TPE has emerged as an effective modality in rapidly reducing serum TG levels. However, due to its cost and accessibility, TPE remains poorly evaluated until now. Some studies revealed its efficacy in helping to treat and prevent the recurrence, while some studies suggested that TG levels were not correlated with disease severity, mortality, or length of hospital stay. Thus TPE might have no beneficial effect for the outcome. This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors, adverse effects of the procedure, and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis. Future direction of TPE research for HLAP is also discussed in this review.
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Affiliation(s)
- Can-Bin Zheng
- Department of Endocrine and Metabolic Disease, Shantou Central Hospital, Shantou 515031, Guangdong Province, China
| | - Zi-Hui Zheng
- Nursing College, Guangdong Pharmaceutical University, Guangzhou 510000, Guangdong Province, China
| | - Yong-Ping Zheng
- Department of Gastroenterology, Shantou Central Hospital, Shantou 515031, Guangdong Province, China
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Pijl JP, Nienhuis PH, Kwee TC, Glaudemans AWJM, Slart RHJA, Gormsen LC. Limitations and Pitfalls of FDG-PET/CT in Infection and Inflammation. Semin Nucl Med 2021; 51:633-645. [PMID: 34246448 DOI: 10.1053/j.semnuclmed.2021.06.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
White blood cells activated by either a pathogen or as part of a systemic inflammatory disease are characterized by high energy consumption and are therefore taking up the glucose analogue PET tracer FDG avidly. It is therefore not surprising that a steadily growing body of research and clinical reports now supports the use of FDG PET/CT to diagnose a wide range of patients with non-oncological diseases. However, using FDG PET/CT in patients with infectious or inflammatory diseases has some limitations and potential pitfalls that are not necessarily as pronounced in oncology FDG PET/CT. Some of these limitations are of a general nature and related to the laborious acquisition of PET images in patients that are often acutely ill, whereas others are more disease-specific and related to the particular metabolism in some of the organs most commonly affected by infections or inflammatory disease. Both inflammatory and infectious diseases are characterized by a more diffuse and less pathognomonic pattern of FDG uptake than oncology FDG PET/CT and the affected organs also typically have some physiological FDG uptake. In addition, patients referred to PET/CT with suspected infection or inflammation are rarely treatment naïve and may have received varying doses of antibiotics, corticosteroids or other immune-modulating drugs at the time of their examination. Combined, this results in a higher rate of false positive FDG findings and also in some cases a lower sensitivity to detect active disease. In this review, we therefore discuss the limitations and pitfalls of FDG PET/CT to diagnose infections and inflammation taking these issues into consideration. Our review encompasses the most commonly encountered inflammatory and infectious diseases in head and neck, in the cardiovascular system, in the abdominal organs and in the musculoskeletal system. Finally, new developments in the field of PET/CT that may help overcome some of these limitations are briefly highlighted.
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Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Pieter H Nienhuis
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Andor W J M Glaudemans
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen; Faculty of Science and Technology, Department of Biomedical Photonic Imaging, University of Twente, Enschede
| | - Lars C Gormsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus N.
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Shipley LC, Steele DT, Wilcox CM, Burski CM. A Rare Cause of Acute Pancreatitis in a Transgender Female. J Investig Med High Impact Case Rep 2021; 8:2324709620921333. [PMID: 32406257 PMCID: PMC7238772 DOI: 10.1177/2324709620921333] [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] [Indexed: 12/26/2022] Open
Abstract
Acute pancreatitis is defined as an acute inflammation of the pancreas and is most commonly caused by gallstones and alcohol followed by elevated triglycerides and medications. Estrogen as a cause of secondary hypertriglyceridemic pancreatitis is a rare but known phenomenon in females on hormonal therapy; however, it is not well described in the transgender female population. In this article, we present a case of a 31-year-old transgender female who developed acute, severe pancreatitis after a few months of using estrogen as transition therapy. To our knowledge, this is the third case report of a transgender female presenting with acute pancreatitis secondary to estrogen. Long-term supraphysiologic doses of sex hormones are required to maintain secondary sex characteristics placing this population at a higher risk of developing acute pancreatitis. Further research is needed to determine risk and screening methods to prevent this side effect.
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Sun C, Li Z, Shi Z, Li G. Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study. BMC Gastroenterol 2021; 21:210. [PMID: 33964868 PMCID: PMC8105912 DOI: 10.1186/s12876-021-01799-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Efficacy of pancreatic enzyme inhibitors in acute pancreatitis (AP) is unclear in China. AIMS We aimed to present the current status of AP and evaluate the efficacy of pancreatic enzyme inhibitors in a larger population in China. METHOD A retrospective, cross-sectional, real-world, multicenter analysis of a large dataset of patients presenting with AP from four hospitals of China over a two-year period was performed. Data were collected from the existing clinical records and the patients were grouped into medication group (somatostatin or octreotide or somatostatin and octreotide) and no medication group. Pair wise propensity score matching was performed for comparing somatostatin, octreotide and somatostatin/octreotide. The end points were incidence of disease complications, organ failure, hospitalization duration, and recovery time taken (hours) for serum amylase/serum lipase to normalcy. RESULTS A total of 3900 patients were recruited and 2775 patients were included for analysis. A total of 1100, 661, 676 and 338 patients received either somatostatin or octreotide or somatostatin and octreotide or no medication, respectively. The incidence of complications (7.6% vs 13.6%), organ failure (4.5% vs 7.4%), and the instances of entering ICU (9.3% vs 13.3%) were higher in unmedicated group. Complications at discharge (2.91 times), organ failure (2.53 times), and hospitalization stay were higher in octreotide-treated patients compared with somatostatin-treated patients. In comparison to the octreotide group, the serum amylase/lipase recovery time was shorter in the somatostatin group. CONCLUSION This real-world study suggested that the use of pancreatic enzyme inhibitors was positively associated with greater clinical efficacy in AP patients and somatostatin might be more effective than octreotide in real-world settings in China.
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Affiliation(s)
- Chuandong Sun
- Department of Surgery, The Affiliated Hospital of Qingdao University, Shandong, People's Republic of China
| | - Zhu Li
- Department of Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, People's Republic of China
| | - Zheng Shi
- Department of Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Guichen Li
- Department of Surgery, The First Hospital of China Medical University, No. 155 Najing North Street, Heping District, Shenyang, Liaoning Province, People's Republic of China.
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Yin J, Chen Z, Niu W, Feng L, Fan B, Zhou L, Zeng B, Zhang J, Chen H, Tong B, Tong L, Chen X. Using a multidisciplinary team for the staged management and optimally minimally invasive treatment of severe acute pancreatitis. Biosci Trends 2021; 15:180-187. [PMID: 33840680 DOI: 10.5582/bst.2021.01075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Severe acute pancreatitis (SAP) is a common critical disease with a high mortality rate that involves a complex, rapid change in condition and multiple organ systems. Therefore, a multidisciplinary team (MDT), including staff from the emergency department, intensive care unit, pancreatic surgery, gastroenterology , and imaging, is necessary for the early diagnosis, evaluation, and treatment of patients with SAP. This involves managing the systemic inflammatory response and maintaining organ function in the early stage and managing systemic infection and treatment of peripancreatic complications in the middle-to-late stages. The MDT should be led by departments corresponding to the clinical characteristics of each stage, and those departments should be responsible for the coordination and implementation of treatment by other relevant departments. In the late stage, pancreatic surgery and gastroenterology are the main departments that should manage peripancreatic complications. In line with the principle of minimally invasive treatment, the timely and reasonable selection of endoscopic or minimally invasive surgical debridement can achieve good therapeutic outcomes. Open surgery is also an effective method for treating an intractable massive hemorrhage in the abdominal cavity or necrotic cavity, intractable abdominal compartment syndrome, visceral perforation, and fistulae.
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Affiliation(s)
- Junxiang Yin
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Zhi Chen
- Critical Care Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Wei Niu
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Lili Feng
- Medical Imaging Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Bing Fan
- Medical Imaging Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Longfei Zhou
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Bingliang Zeng
- Medical Imaging Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Jun Zhang
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Hui Chen
- Microbiology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Bo Tong
- Pulmonary and Critical Care Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Lingfei Tong
- Clinical Pharmacy Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Xiaoliang Chen
- Hepatobiliary Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
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