1
|
Zhang Q, Xu Q, Zhu Q, Zhu L, Pan C, Chen J, Liu J, Deng D, Chen W, Chen C. Association between serum triglyceride level and severity of acute biliary pancreatitis. Pancreatology 2024; 24:343-349. [PMID: 38350790 DOI: 10.1016/j.pan.2024.02.001] [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: 06/13/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Acute biliary pancreatitis (ABP) is the most common type of acute pancreatitis. However, the effect of serum triglyceride (TG) levels on the severity of ABP remains unclear. The aim of this study was to assess the correlation between serum TG levels and the severity of ABP. METHODS Data from 526 ABP patients was analyzed in this study. The patients were divided into normal and elevated groups according to the TG level measured within 24 h after admission, and the elevated group was further divided into mild, moderate, and severe elevated groups. The demographic data and clinical outcomes of each group were compared. RESULTS Of the 526 ABP patients, 394 were in the normal TG group and 132 were in the elevated TG group (36 mild, 57 moderate, and 39 severe). The elevated group was younger (51.5 ± 12.9 vs. 58.9 ± 13.9), predominantly male (66.7% vs. 45.2%), had more history of diabetes (22.7% vs. 12.4%) and hyperlipidemia (19.7% vs. 0.8%), and developed systemic inflammatory response syndrome (SIRS) (25.8% vs. 15.5%), persistent organ failure (POF) (11.4% vs. 2.8%), and local complications (62.9% vs. 42.1%) more frequently compared to the normal group (P < 0.05). The incidence of SIRS, POF, acute peripancreatic fluid collection (APFC), and acute necrotic collection (ANC) increased with increasing TG levels (Ptrend < 0.05). In multivariate analysis, TG was independently associated with POF, APFC, and ANC in increments of 100 mg/dl (P < 0.05), and there was a linear relationship between TG levels and POF, APFC, and ANC (non-linear P > 0.05, P overall <0.05). In addition, nonalcoholic fatty liver disease is not a risk factor for POF, ANC, and APFC in ABP patients. CONCLUSIONS Elevated serum TG levels were independently associated with more severe ABP. The incidence of POF, APFC, and ANC in ABP patients increased with the increase of TG levels, with a linear relationship.
Collapse
Affiliation(s)
- Qian Zhang
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Qingcheng Xu
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Quping Zhu
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Lei Zhu
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Changbao Pan
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Juan Chen
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Jun Liu
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Denghao Deng
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China
| | - Weiwei Chen
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China.
| | - Chaowu Chen
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu Province, China.
| |
Collapse
|
2
|
Chen Y, Huang S, Luo B, Jiang J, Ren W, Zou K, Zhong X, Lü M, Tang X. Prediction and evaluation of a nomogram model for recurrent acute pancreatitis. Eur J Gastroenterol Hepatol 2024; 36:554-562. [PMID: 38407842 DOI: 10.1097/meg.0000000000002732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the influencing factors for recurrent acute pancreatitis and construct the nomogram model to predict the risk of recurrent acute pancreatitis. METHODS Patients diagnosed with acute pancreatitis in the Affiliated Hospital of Southwest Medical University were enrolled. We collected these patients' basic information, laboratory data, imaging information. Using Logistic regression and least absolute shrinkage and selection operator regression to select risk factor for Cross-Validation Criterion. To create nomogram and validated by receiver operator characteristic curve, calibration curves and decision curve analysis. RESULTS A total of 533 patients with acute pancreatitis were included, including 99 recurrent acute pancreatitis patients. The average age of recurrent acute pancreatitis patients was 49.69 years old, and 67.7% of them were male. At the same time, in all recurrent acute pancreatitis patients, hypertriglyceridemic pancreatitis is the most important reason (54.5%). Regression analysis and least absolute shrinkage and selection operator regression showed that smoking history, acute necrotic collection, triglyceride, and alcohol etiology for acute pancreatitis were identified and entered into the nomogram. The area under the receiver operator characteristic curve of the training set was 0.747. The calibration curve showed the consistency between the nomogram model and the actual probability. CONCLUSION In conclusion, some high-risk factors like smoking history, acute necrotic collection, triglyceride, and alcohol etiology for acute pancreatitis may predict recurrent pancreatitis and their incorporation into a nomogram has high accuracy in predicting recurrence.
Collapse
Affiliation(s)
- Yuan Chen
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Shu Huang
- Department of Gastroenterology, Lianshui County People' Hospital
- Department of Gastroenterology, Lianshui People' Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian, China
| | - Bei Luo
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Jiao Jiang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Wensen Ren
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Kang Zou
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Xiaolin Zhong
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Muhan Lü
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| |
Collapse
|
3
|
Inayat F, Afzal A, Anwar MS, Saeed A, Chaudhry A, Haider M, Zulfiqar L, Afzal MS, Arslan HM, Saif MW. Acute pancreatitis associated with pembrolizumab-induced hypertriglyceridemia. J Oncol Pharm Pract 2024:10781552241245332. [PMID: 38576329 DOI: 10.1177/10781552241245332] [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: 04/06/2024]
Abstract
INTRODUCTION Acute pancreatitis (AP) following drug-induced hypertriglyceridemia is a rare clinical phenomenon. Immune checkpoint inhibitors have revolutionized treatment for a variety of solid organ and hematological malignancies. Pembrolizumab is a programmed cell death receptor-1 (PD-1) inhibitor that has shown promising responses in many advanced cancers. However, a constellation of immune-related adverse events has also been described. There are reports of pembrolizumab-induced hypertriglyceridemia, but AP as a result of this side effect remains an exceedingly rare clinical sequela. CASE REPORT We delineate a case of a patient with stage IVB non-small-cell lung cancer who developed progressive abdominal pain and nausea following administration of pembrolizumab for four months. Laboratory studies revealed increased serum lipase and triglyceride levels at 12,562 IU/L and 16,901 mg/dL, respectively. The diagnosis of AP was made based on the revised Atlanta classification criteria. After ruling out alternative causes, pembrolizumab-induced hypertriglyceridemia was considered the likely etiology of AP. MANAGEMENT AND OUTCOME The patient was transferred to the medical intensive care unit for close monitoring. Treatment was initiated with intravenous fluids, pain medications, and an insulin infusion. However, her hypertriglyceridemia levels remained persistently elevated, necessitating therapeutic apheresis. She recovered well with no complications after triglyceride apheresis. DISCUSSION AP following pembrolizumab-associated hypertriglyceridemia remains a rare clinicopathologic entity. Given the widespread clinical use of immune checkpoint inhibitors, knowledge of such rare adverse events is crucial. Evaluation of serum triglyceride levels before and after initiating pembrolizumab therapy may be mandated, especially in patients with metabolic comorbidities.
Collapse
Affiliation(s)
- Faisal Inayat
- Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Arslan Afzal
- Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | | | | | | | | | | | | | | | - Muhammad Wasif Saif
- St. Dominic's Hospital, Jackson, MS, USA
- Karmanos Cancer Center, Wayne State University, Detroit, MI, USA
| |
Collapse
|
4
|
Ni YH, Song LJ, Xiao B. Magnetic resonance imaging for acute pancreatitis in type 2 diabetes patients. World J Clin Cases 2023; 11:7268-7276. [PMID: 37969447 PMCID: PMC10643067 DOI: 10.12998/wjcc.v11.i30.7268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/13/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and its complications have significantly increased the burden of mortality and disability globally, making diabetes one of the most dangerous and prevalent chronic diseases. Acute pancreatitis (AP) is one of the most frequent gastrointestinal causes for hospital admission, which is a common exocrine pancreatic inflammatory disease that can cause severe abdominal pain and multiple organ dysfunction. There is an inseparable relationship between AP and diabetes. Diabetes is a high risk factor of AP, and patients with AP can develop pancreatogenic diabetes. In T2DM patients, the incidence rate of AP is significantly higher than that of the general population, and the clinical symptoms are more severe, with the majority of cases being moderate to severe AP. This review briefly introduces the pathogenesis and clinical features of AP in T2DM patients, focusing on the magnetic resonance imaging (MRI) manifestations of AP in T2DM patients. Our aim is to evaluate the severity of AP in patients with T2DM by MRI, so as to help clinicians assess the patient's condition and prognosis.
Collapse
Affiliation(s)
- Yan-Hui Ni
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Ling-Ji Song
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Bo Xiao
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing 402760, China
| |
Collapse
|
5
|
Regasa T, Dinku Y, Gezahegn B, Feleke Z, Regassa Z, Mamo A, Assefa T, Gezahegn H, Solomon D, Atlaw D, Dessie M. The Elevation of Pancreatic Enzymes in Serum and Their Distribution at Different Stages of Renal Insufficiency Among Diabetic Patients Attending Goba Referral Hospital. Diabetes Metab Syndr Obes 2022; 15:2087-2093. [PMID: 35880135 PMCID: PMC9307908 DOI: 10.2147/dmso.s363714] [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: 03/16/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Acute pancreatitis is auto-cell destruction that is manifested by increased leakage of amylase and lipase into circulation. During pancreatitis, the activity of serum amylase and lipase is elevated three times above the upper limit of the normal range. This elevation was observed in both prediabetic and diabetic patients. Severe acute pancreatitis can result in acute kidney injury and other multi-organ dysfunction, which is one of the reasons for death. OBJECTIVE This study aimed to evaluate the elevation of serum amylase and lipase and their distribution at different stages of renal insufficiency among diabetic patients. METHODS This study included 286 diabetic patients (36 type 1 and 250 type 2), and data were collected from May 1 to June 30, 2019. The study design used was an institution-based cross-sectional study. A face-to-face interview was used to collect data, and serum creatinine, amylase, and lipase levels were measured using a chemistry analyzer. For data entry and statistical analysis, respectively, Epidata software version 3.02 and SPSS version 21 were used. RESULTS The mean serum amylase among diabetic patients suffering from G3b and G4 was 106.79 IU/L ± 118.18 IU/L and 104.85 ± 90.42 IU/L, respectively. Their mean serum lipase activity was 105.07 IU/L ± 127.54 IU/L and 106.98 IU/L ± 88.35 IU/L, respectively. Serum lipase activity was elevated above the normal range and three times above the upper limit of the normal range with a magnitude of 11.2% and 4.2%, respectively. Similarly, 9.1% and 0.7% of diabetic patients had increased serum amylase above the normal range and three-fold above the normal range, respectively. CONCLUSION As glomerular filtration decreases, particularly in moderate-to-severe chronic kidney disease, serum amylase and lipase activity rise above the upper limit.
Collapse
Affiliation(s)
- Tadele Regasa
- School of medicine, Madda Walabu University, Goba, Ethiopia
- Correspondence: Tadele Regasa, Tel +251922311812, Email
| | - Yohannes Dinku
- School of medicine, Madda Walabu University, Goba, Ethiopia
| | | | - Zegeye Feleke
- School of Health Science, Madda Walabu University, Goba, Ethiopia
| | - Zegeye Regassa
- School of Health Science, Madda Walabu University, Goba, Ethiopia
| | - Ayele Mamo
- School of medicine, Madda Walabu University, Goba, Ethiopia
| | - Tesfaye Assefa
- School of Health Science, Madda Walabu University, Goba, Ethiopia
| | | | - Damtew Solomon
- School of medicine, Madda Walabu University, Goba, Ethiopia
| | - Daniel Atlaw
- School of medicine, Madda Walabu University, Goba, Ethiopia
| | - Mengistu Dessie
- School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| |
Collapse
|
6
|
Nagy A, Juhász MF, Görbe A, Váradi A, Izbéki F, Vincze Á, Sarlós P, Czimmer J, Szepes Z, Takács T, Papp M, Fehér E, Hamvas J, Kárász K, Török I, Stimac D, Poropat G, Ince AT, Erőss B, Márta K, Pécsi D, Illés D, Váncsa S, Földi M, Faluhelyi N, Farkas O, Nagy T, Kanizsai P, Márton Z, Szentesi A, Hegyi P, Párniczky A. Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: Post-hoc analysis of a prospective, international cohort of 2250 acute pancreatitis cases. Pancreatology 2021; 21:1237-1246. [PMID: 34332908 DOI: 10.1016/j.pan.2021.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/31/2021] [Accepted: 06/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Metabolic risk factors, such as obesity, hypertension, and hyperlipidemia are independent risk factors for the development of various complications in acute pancreatitis (AP). Hypertriglyceridemia dose-dependently elicits pancreatotoxicity and worsens the outcomes of AP. The role of hyperglycemia, as a toxic metabolic factor in the clinical course of AP, has not been examined yet. METHODS We analyzed a prospective, international cohort of 2250 AP patients, examining associations between (1) glycosylated hemoglobin (HbA1c), (2) on-admission glucose, (3) peak in-hospital glucose and clinically important outcomes (mortality, severity, complications, length of hospitalization (LOH), maximal C-reactive protein (CRP)). We conducted a binary logistic regression accounting for age, gender, etiology, diabetes, and our examined variables. Receiver Operating Characteristic Curve (ROC) was applied to detect the diagnostic accuracy of the three variables. RESULTS Both on-admission and peak serum glucose are independently associated with AP severity and mortality, accounting for age, gender, known diabetes and AP etiology. They show a dose-dependent association with severity (p < 0.001 in both), mortality (p < 0.001), LOH (p < 0.001), maximal CRP (p < 0.001), systemic (p < 0.001) and local complications (p < 0.001). Patients with peak glucose >7 mmol/l had a 15 times higher odds for severe AP and a five times higher odds for mortality. We found a trend of increasing HbA1c with increasing LOH (p < 0.001), severity and local complications. CONCLUSIONS On-admission and peak in-hospital glucose are independently and dose-dependently associated with increasing AP severity and mortality. In-hospital laboratory control of glucose and adequate treatment of hyperglycemia are crucial in the management of AP.
Collapse
Affiliation(s)
- Anikó Nagy
- Heim Pál National Pediatric Institute, Budapest, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Márk Félix Juhász
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Anikó Görbe
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Alex Váradi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Ferenc Izbéki
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - József Czimmer
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Szepes
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Takács
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Debrecen, Hungary
| | - Eszter Fehér
- Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Debrecen, Hungary
| | | | | | - Imola Török
- County Emergency Clinical Hospital - Gastroenterology and University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Davor Stimac
- Clinical Hospital Center Rijeka, Rijeka, Croatia
| | | | - Ali Tüzün Ince
- Hospital of Bezmialem Vakif University, School of Medicine, Istanbul, Turkey
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Katalin Márta
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Pécsi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Dóra Illés
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Mária Földi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Nándor Faluhelyi
- Department of Medical Imaging, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Orsolya Farkas
- Department of Medical Imaging, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Nagy
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Kanizsai
- Department of Emergency Medicine, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Márton
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Párniczky
- Heim Pál National Pediatric Institute, Budapest, Hungary; Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.
| |
Collapse
|
7
|
Bergantin LB. A Link Between Brain Insulin Resistance and Cognitive Dysfunctions: Targeting Ca2+/cAMP Signalling. Cent Nerv Syst Agents Med Chem 2021; 20:103-109. [PMID: 31995022 DOI: 10.2174/1871524920666200129121232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND A correlation between cognitive dysfunctions and brain insulin resistance has been established by several clinical and experimental studies. Consistent data support that people diagnosed with brain insulin resistance, resulted from diabetes, have shown an increased risk of presenting cognitive dysfunctions, clinical signs of dementia and depression, then speculating a role of dysregulations related to insulin signalling in these diseases. Furthermore, it is currently discussed that Ca2+ signalling, and its dysregulations, may be a factor which could correlate with brain insulin resistance and cognitive dysfunctions. OBJECTIVE Following this, revealing this interplay between these diseases may provide novel insights into the pathogenesis of such diseases. METHODS Publications covering topics such as Ca2+ signalling, diabetes, depression and dementia (alone or combined) were collected by searching PubMed and EMBASE. RESULTS The controlling of both neurotransmitters/hormones release and neuronal death could be achieved through modulating Ca2+ and cAMP signalling pathways (Ca2+/cAMP signalling). CONCLUSION Taking into account our previous reports on Ca2+/cAMP signalling, and considering a limited discussion in the literature on the role of Ca2+/cAMP signalling in the link between cognitive dysfunctions and brain insulin resistance, this article has comprehensively discussed the role of these signalling pathways in this link (between cognitive dysfunctions and brain insulin resistance).
Collapse
Affiliation(s)
- Leandro B Bergantin
- Department of Pharmacology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
8
|
Acute Pancreatitis in Patients With a Medical History of Type 2 Diabetes Mellitus: Clinical Findings and Magnetic Resonance Imaging Characteristics. Pancreas 2020; 49:591-597. [PMID: 32282775 DOI: 10.1097/mpa.0000000000001530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To determine the characteristics of type 2 diabetes mellitus (T2DM)-related acute pancreatitis (AP) on magnetic resonance imaging (MRI). METHODS Retrospectively studied 262 patients with AP were admitted to our institution and underwent MRI. Diagnosis of T2DM-related AP was based on clinical manifestations, laboratory tests, and MRI. Pancreatic/peripancreatic changes were assessed on MRI. RESULTS Fifty-three (20.2%) patients with T2DM-related AP and 209 (79.8%) with nondiabetic AP were enrolled. On MRI, a higher prevalence of necrotizing pancreatitis (P < 0.001), pancreatic necrosis >30% (57.5% vs 29.2%; P = 0.006), hemorrhage (35.8% vs 19.1%; P = 0.009), abdominal wall edema (67.9% vs 46.8%; P = 0.006), walled-off necrosis (43.2% vs 14.6%; P < 0.001), and infected collections (P < 0.001) were registered in T2DM with AP. T2DM-related AP sustained greater magnetic resonance severity index (mean, 5.1 [range, 2-10] vs 3.4 [range, 1-10]; P < 0.001), higher incidence of moderate and severe pancreatitis (69.8% vs 40.2%; P < 0.001), higher organ failure (45.3% vs 22%; P = 0.001), and prolonged hospitalization (mean, 25.2 [range, 10-63] vs 16 [range, 5-48] days; P < 0.001). CONCLUSIONS Type 2 diabetes mellitus-related AP is more moderate-to-severe pancreatitis, and it correlates with MRI characteristics of the pancreas itself, hemorrhage, abdominal wall, and infected collections.
Collapse
|
9
|
Tabone R, Burstow MJ, Vardesh DL, Yuide PJ, Gundara J, Chua TC. Anti-lipid therapy and risk factor management for triglyceridaemia-induced acute pancreatitis. ANZ J Surg 2020; 90:1997-2003. [PMID: 32190973 DOI: 10.1111/ans.15829] [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: 12/19/2019] [Revised: 02/08/2020] [Accepted: 03/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatitis secondary to hypertriglyceridaemia is rare, accounting for less than 5% of pancreatitis presentations. We reviewed our institutional experience with triglyceridaemia induced acute pancreatitis to report the clinical presentation, patient demographics and clinical management. METHODS The Acute Surgical Unit database at a high-volume general surgical referral centre was queried to identify cases of acute pancreatitis secondary to hypertriglyceridaemia between 2016 and 2019. Patient demographics, clinical manifestations, biochemical derangements and treatment regimens were analysed. Current related literature was reviewed. RESULTS There were 496 presentations for acute pancreatitis of which 14 presentations (2.8%), amongst 12 patients were due to hypertriglyceridaemia. The mean triglyceride level at presentation was 92.46 (standard deviation 46.9) mmol/L. Ten patients (83%) had poorly controlled type 2 diabetes. All patients were managed using conservative therapy combined with a restricted fat diet and commenced on long-term anti-lipid therapy to manage associated risk factors. In addition, 10 patients received an insulin infusion and one patient received insulin infusion, plasmapheresis and heparin infusion in combination. The median length of hospital stay was 5.5 (range 3-13) days. Two patients (16%) developed a recurrent episode related to non-compliance to medical therapy. CONCLUSION Hypertriglyceridaemia is a rare cause of acute pancreatitis. Successful management involves the treatment of acute pancreatitis in conjunction with long-term anti-lipid therapy and optimisation of associated risk factors.
Collapse
Affiliation(s)
- Renee Tabone
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Matthew J Burstow
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Deepak L Vardesh
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Peter J Yuide
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Justin Gundara
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Logan Hospital, Metro South Health, Logan City, Queensland, Australia.,Division of Medicine, Logan Hospital, Metro South Health, Logan City, Queensland, Australia
| |
Collapse
|
10
|
Zhang Q, Qin M, Liang Z, Huang H, Tang Y, Qin L, Wei Z, Xu M, Tang G. The relationship between serum triglyceride levels and acute pancreatitis in an animal model and a 14-year retrospective clinical study. Lipids Health Dis 2019; 18:183. [PMID: 31647014 PMCID: PMC6813107 DOI: 10.1186/s12944-019-1126-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives The aim of the current study was to evaluate influence of serum triglyceride levels on the course of acute pancreatitis (AP). Methods Rats models of hypertriglyceridemic were used in animal experiments. Following induction of acute pancreatitis, amylase, and pancreas histological scores were all compared. In addition, in a clinical study, clinical data were collected from 1681 AP patients admitted from 2003 to 2016 who were divided into 4 groups based on their serum triglyceride (TG) levels. The clinical features among these 4 groups were compared, and a receiver operating characteristic (ROC) curve analysis was also performed on TG values to estimate their relationship with severity. Results In animal experiments, the hypertriglyceridemic pancreatitis (HTGP) group had markedly higher serum amylase, and histological scores relative to the other animal groups. In the clinical study, we identified significant differences in gender, age, body mass index (BMI), cost, and incidence of partial complications among the 4 TG-based groups. Importantly, the TG levels on day 3–4 after admission could be used to accurately predict disease severity. Conclusions Hypertriglyceridemia (HTG) can aggravate pancreatic injury, and hypertriglyceridemia patients are more likely to suffer from severe pancreatic injury with a higher possibility of complications. In addition, triglyceride levels are correlated with the severity of AP positively.
Collapse
Affiliation(s)
- Qiyue Zhang
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Mengbin Qin
- Department of Gastroenterology, Second Affiliated Hospital, Guangxi Medical University, Nanning, 530007, Guangxi, China
| | - Zhihai Liang
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Huali Huang
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yongfeng Tang
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Lingyan Qin
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Zhenping Wei
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Mengtao Xu
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Guodu Tang
- Department of Gastroenterology, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi, China.
| |
Collapse
|
11
|
Jo SI, Chang JH, Kim TH, Kim CW, Kim JK, Han SW. Subsets associated with developing acute pancreatitis in patients with severe hypertriglyceridemia and the severity of pancreatitis. Pancreatology 2019; 19:795-800. [PMID: 31421975 DOI: 10.1016/j.pan.2019.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/25/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypertriglyceridemia (HTG) is a rare but well-recognized cause for acute pancreatitis (AP). This study aimed to determine subsets related to development of AP in patients with severe HTG and the severity of HTG-induced AP (HTG-AP). METHODS Patients who had severe HTG (serum triglyceride level >1,000 mg/dL) more than once between Jan. 2010 and Dec. 2017 in a single institute were evaluated retrospectively. Patients were divided into two groups, with AP or without AP, and were compared. HTG-APs in patients with severe HTG were compared to APs due to other causes during the same period. RESULTS Sixty-three patients (19.3%) presented with AP of a total 326 patients with severe HTG. The AP group displayed younger age, more alcohol consumption and diabetes mellitus, and higher initial/maximum serum levels of triglyceride, glucose, HbA1c, total cholesterol, and calculated non-high-density lipoprotein cholesterol (p < 0.05). HTG-APs were clinically more severe compared with 277 APs due to other causes in terms of CRP (p < 0.001), CT severity index (p = 0.002), revised Atlanta classification (p < 0.001), and hospital stay (p = 0.011). In logistic regression analysis, maximum serum triglyceride level (OR 2.706, p = 0.015), alcohol consumption amount (OR 5.292, p < 0.001), and age (OR 0.358, p = 0.017) were independently associated with development of AP in patients with severe HTG. CONCLUSIONS Development of AP in patient with severe HTG was independently associated with younger age, higher serum TG level, and more alcohol consumption. HTG-APs are clinically more severe than APs due to other causes.
Collapse
Affiliation(s)
- Seong Il Jo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Tae Ho Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Whan Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kwang Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sok Won Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
12
|
Li L, Liu M, Zhang T, Jia Y, Zhang Y, Yuan H, Zhang G, He C. Indomethacin down-regulating HMGB1 and TNF-α to prevent pancreatitis after endoscopic retrograde cholangiopancreatography. Scand J Gastroenterol 2019; 54:793-799. [PMID: 31177924 DOI: 10.1080/00365521.2019.1623306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background and aims: Several articles demonstrated that non-steroidal anti-inflammation drugs (NSAIDs) were effective in reducing the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). However, studies revealed inconsistent results. The mechanism of NSAIDs in preventing PEP is still little known. Therefore, the aim of our study was to evaluate the efficacy of NSAIDs for PEP prophylaxis and further to explore the mechanism of NSAIDs for prevention of PEP. Methods: Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to receive 100 mg rectal indomethacin or glycerin suppository 15-20 min before ERCP. The primary outcome was the rate of PEP. And the levels of serum HMGB1 and TNF-α were also measured before ERCP and 3 and 24 h after ERCP. Univariate analysis and multivariate analysis were carried out to estimate the independent risk factors for PEP. Results: Totally, 100 patients were enrolled, 50 received indomethacin and 50 with placebo (glycerin suppository). PEP developed in six patients in indomethacin group and 16 in the control group, the difference was significant (p = .016). The levels of HMGB1 and TNF-α were significantly decreased in indomethacin group at 3 (p < .0001) and 24 h (p < .0001) after ERCP, compared to the control group. Multivariate analysis revealed that duration of ERCP (OR, 0.221; 95% CI, 0.072-0.680; p = .008) and usage of NSAIDs (OR, 0.278; 95% CI, 0.090-0.861; p = .026) were independent predictors of PEP. Conclusions: Rectal indomethacin could significantly reduce the risk of PEP by down-regulating the levels of HMGB1 and TNF-α.
Collapse
Affiliation(s)
- Lin Li
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Miaomiao Liu
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Tingting Zhang
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Yuliang Jia
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Yan Zhang
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Heming Yuan
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Guozheng Zhang
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| | - Chiyi He
- Departments of Gastroenterology, Yijishan Hospital of Wannan Medical College , Wuhu , PR China
| |
Collapse
|
13
|
Syrén E, Eriksson S, Enochsson L, Eklund A, Sandblom G. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography. BJS Open 2019; 3:485-489. [PMID: 31406957 PMCID: PMC6681151 DOI: 10.1002/bjs5.50162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/25/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to assess whether sex, age, ASA grade, previous history of acute pancreatitis, diabetes, hyperlipidaemia, hypercalcaemia, kidney disease and liver cirrhosis influence the risk for developing post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). A total of 15 800 ERCP procedures retrieved from the Swedish National Quality Register for Gallstone Surgery and ERCP (GallRiks) for 2006–2014 were identified and cross‐checked with the National Patient Register. Women, patients aged less than 65 years, patients with hyperlipidaemia and those with a previous history of acute pancreatitis had a significantly increased risk of PEP, whereas patients with diabetes had a significantly decreased risk.
![]() Risk of pancreatitis following ERCP
Collapse
Affiliation(s)
- E Syrén
- Department of Surgical Sciences Uppsala University Uppsala Sweden.,Department of Surgery, Centre for Clinical Research Västmanland Regional Hospital Västerås Sweden
| | - S Eriksson
- Department of Surgical Sciences Uppsala University Uppsala Sweden.,Department of Surgery, Centre for Clinical Research Västmanland Regional Hospital Västerås Sweden
| | - L Enochsson
- Department of Surgical and Perioperative Sciences, Sunderby Research Unit Umeå University Umeå Sweden
| | - A Eklund
- Department of Surgery Uppsala University Hospital Uppsala Sweden
| | - G Sandblom
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden.,Department of Surgery Södersjukhuset Stockholm Sweden
| |
Collapse
|
14
|
Bai W, Kou C, Zhang L, You Y, Yu W, Hua W, Li Y, Yu Y, Zhao T, Wu Y. Functional polymorphisms of the APOA1/C3/A4/A5-ZPR1-BUD13 gene cluster are associated with dyslipidemia in a sex-specific pattern. PeerJ 2019; 6:e6175. [PMID: 30631647 PMCID: PMC6322487 DOI: 10.7717/peerj.6175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/26/2018] [Indexed: 12/14/2022] Open
Abstract
Background Dyslipidemia contributes to the risk of many diseases, including stroke, cardiovascular disease and metabolic-related diseases. Previous studies have indicated that single nucleotide polymorphisms (SNPs) are associated with different levels of serum lipid. Therefore, this study explored the relationship between the APOA1/C3/A4/A5-ZPR1-BUD13 gene cluster gene polymorphisms and dyslipidemia in the total sample population and stratified by genders in a northeast Chinese population. Methods A total of 3,850 participants from Jilin Province, China, were enrolled in our study, and their serum lipid levels were measured. Six functional SNPs (APOA1 rs5072, APOC3 rs5128, APOA4 rs5104, APOA5 rs651821, ZPR1 rs2075294 and BUD13 rs10488698) were genotyped using polymerase chain reaction and MALDI-TOF-MS. Logistic regression analysis was performed to explore the relationship of APOA1/C3/A4/A5-ZPR1-BUD13 gene cluster gene polymorphisms with dyslipidemia. Linkage disequilibrium and haplotype analyses were performed with the SNPStats program and Haploview software. Results All SNPs conformed to Hardy-Weinberg equilibrium. Logistic regression analysis revealed that rs5072, rs5128 and rs651821 were associated with hypertriglyceridemia, rs5104 and rs651821 were associated with low-HDL cholesterolemia in overall group. rs651821 was associated with hypertriglyceridemia and low-HDL cholesterolemia in both the male and female group. However, among females, rs5072 was observed to be associated with hypertriglyceridemia. Haplotype analysis showed that haplotypes TGCCGC and CAGCGC were associated with dyslipidemia in the overall, male and female groups. Conclusion SNPs in the APOA1/C3/A4/A5-ZPR1-BUD13 gene cluster were associated with dyslipidemia. Furthermore, the association of APOA1 rs5072 in this gene cluster with dyslipidemia differed between genders; thus, additional studies are needed to confirm this conclusion, and the mechanisms underlying these results warrant further exploration.
Collapse
Affiliation(s)
- Wei Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Lili Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yueyue You
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Weiying Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Wanqing Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yuanyuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yaqin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Tiancheng Zhao
- Department of Endoscopy Center, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yanhua Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China.,Division of Clinical Research, First Hospital of Jilin University, Changchun, Jilin Province, China
| |
Collapse
|
15
|
Albai O, Frandes M, Timar R, Roman D, Timar B. Risk factors for developing dementia in type 2 diabetes mellitus patients with mild cognitive impairment. Neuropsychiatr Dis Treat 2019; 15:167-175. [PMID: 30655669 PMCID: PMC6322491 DOI: 10.2147/ndt.s189905] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Dementia and cognitive dysfunction have many causes. There is strong evidence that diabetes mellitus (DM) increases the risk of cognitive impairment and dementia. Optimal glycemic control, identification of diabetic risk factors, and prophylactic approach are essential in the prevention of cognitive complications. AIMS The main purpose of this study was to establish the cognitive impairment in DM patients, cared for in the Diabetes Center from Timisoara. Also, we investigated the prevalence of dementia in our group as well as the risk factors involved in the progression of mild cognitive impairment (MCI) to dementia. PATIENTS AND METHODS We considered a sample of 207 type 2 DM (T2DM) patients, aged between 33 and 81 years, mean 57.49 (±11.37) years. We established the diagnosis of dementia based on the Mini-Mental State Examination (MMSE) test, as well as on the psychological testing, psychiatric and neurological investigations, and imaging tests (computerized tomography and MRI). RESULTS A percentage of 42.03% of patients presented MCI, mean age 63 (57.00-71.00) years, being older than patients without MCI, mean age 52.00 (45.00-61.00) years, P<0.001. We observed that diabetes duration was a significant risk factor for developing dementia. Also, patients with MCI presented higher values of body fat than patients without MCI. Moreover, we found that glucose levels, low-density lipoprotein cholesterol levels, the presence of stroke events, and the presence of cardiovascular disease were significant risk factors for MCI conversion to dementia. CONCLUSION Patients with T2DM at early to severe stages of MCI are more likely to develop dementia and should be regularly evaluated for their cognitive status. Regular administrations of the MMSE test can be done to detect early stages of MCI development. Also, to reduce the progression of cognitive impairment to dementia, it is worthwhile to give greater importance to glycemic control and overall DM management.
Collapse
Affiliation(s)
- Oana Albai
- Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mirela Frandes
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| | - Romulus Timar
- Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Deiana Roman
- Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Bogdan Timar
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| |
Collapse
|
16
|
Mesenchymal Stem Cells as New Therapeutic Approach for Diabetes and Pancreatic Disorders. Int J Mol Sci 2018; 19:ijms19092783. [PMID: 30223606 PMCID: PMC6163453 DOI: 10.3390/ijms19092783] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023] Open
Abstract
Diabetes is a worldwide disease which actually includes different disorders related to glucose metabolism. According to different epidemiological studies, patients affected by diabetes present a higher risk to develop both acute and chronic pancreatitis, clinical situations which, in turn, increase the risk to develop pancreatic cancer. Current therapies are able to adjust insulin levels according to blood glucose peak, but they only partly reach the goal to abrogate the consequent inflammatory milieu responsible for diabetes-related diseases. In recent years, many studies have investigated the possible use of adult mesenchymal stem cells (MSCs) as alternative therapeutic treatment for diabetes, with promising results due to the manifold properties of these cells. In this review we will critically analyze the many different uses of MSCs for both diabetes treatment and for the reduction of diabetes-related disease development, focusing on their putative molecular mechanisms.
Collapse
|
17
|
Richardson T, Aslibekyan S, Ashraf AP. Clinical Characteristics and Sequelae of Severe Hypertriglyceridemia in Pediatrics. Endocr Pract 2018; 24:789-795. [PMID: 30084679 DOI: 10.4158/ep-2018-0106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Severe hypertriglyceridemia (HTG) (i.e., plasma triglycerides [TGs] >1,000 mg/dL) in children is a rare but pernicious and understudied condition. Our objective was to evaluate the etiology, characteristics, and sequelae of severe pediatric HTG. METHODS This was a retrospective electronic medical record review of pediatric patients with severe HTG at a tertiary referral Children's hospital over a 17-year period. RESULTS There were a total of 124 patients with severe HTG. The etiology varied: hemato-oncologic (n = 48), diabetes and insulin resistance-related (n = 46), total parenteral nutrition (TPN)-related (n = 6), renal (n = 12), and miscellaneous (n = 12). There was considerable variability in the number of days for the plasma TGs to decrease to <1,000 mg/dL (147.7 ± 567.3 days) and to further decrease to <500 mg/dL (136.84 ± 230.9 days). Patients with diabetes required the longest time to improve their plasma TGs (165.8 ± 305.7 days) compared to other groups. There were 11 cases of pancreatitis, comorbid with diabetes (n = 5), hemato-oncologic conditions (n = 3), and TPN (n = 3). Sixty-seven patients (54%) had persistent HTG. CONCLUSION Severe HTG in pediatrics is commonly due to secondary causes. Patients with diabetes tend to have a longer course of dyslipidemia. A substantial number of patients had persistent dyslipidemia, indicating underlying genetic susceptibility to HTG that is phenotypically expressed consequent to a secondary metabolic insult. ABBREVIATIONS DKA = diabetic ketoacidosis; EMR = electronic medical record; GSD = glycogen storage disorder; HbA1c = hemoglobin A1c; HIV = human immunodeficiency virus; HTG = hypertriglyceridemia; ICD-9 = International Classification of Diseases-Ninth Revision; IV = intravenous; LCHAD = long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency; LPL = lipoprotein lipase; NPO = nothing by mouth; PCOS = polycystic ovary syndrome; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus; TG = triglyceride; TPN = total parenteral nutrition; VLDL = very-low-density lipoprotein.
Collapse
|
18
|
Ding CZ, Guo XF, Wang GL, Wang HT, Xu GH, Liu YY, Wu ZJ, Chen YH, Wang J, Wang WG. High glucose contributes to the proliferation and migration of non-small cell lung cancer cells via GAS5-TRIB3 axis. Biosci Rep 2018; 38:BSR20171014. [PMID: 29367413 PMCID: PMC5857909 DOI: 10.1042/bsr20171014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/29/2017] [Accepted: 01/23/2018] [Indexed: 01/01/2023] Open
Abstract
Despite the growing number of studies exhibited an association of diabetes mellitus (DM) and lung cancer progression, the concrete mechanism of DM aggravating lung cancer has not been elucidated. This study was to investigate whether and how high glucose (HG) contribute to the proliferation and migration of non-small cell lung cancer (NSCLC) cells in vitro. In the present study, we confirmed that HG promoted the proliferation and migration of NSCLC cells, and also induced an anti-apoptosis effect on NSCLC cells. Moreover, HG inhibited the expression of GAS5 in NSCLC cells but elevated the protein level of TRIB3. GAS5 overexpression promoted the degradation of TRIB3 protein by ubiquitination and inhibited the HG induced-proliferation, anti-apoptosis and migration of NSCLC cells. Importantly, TRIB3 overexpression reversed the effects of GAS5 on the HG-treated NSCLC cells. Taken together, down-regulated GAS5 by HG significantly enhanced the proliferation, anti-apoptosis and migration in NSCLC cells through TRIB3, thus promoting the carcinogenesis of NSCLC.
Collapse
Affiliation(s)
- Cheng-Zhi Ding
- Department of Thoracic Oncology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Xu-Feng Guo
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guo-Lei Wang
- Department of Thoracic Oncology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Hong-Tao Wang
- Department of Thoracic Oncology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Guang-Hui Xu
- Department of Thoracic Oncology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yuan-Yuan Liu
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Zhen-Jiang Wu
- Department of Thoracic Oncology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yu-Hang Chen
- Department of Thoracic Oncology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jiao Wang
- Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wen-Guang Wang
- Department of Thoracic Oncology, Henan Provincial Chest Hospital, Zhengzhou, China
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW The obesity pandemic poses a unique set of problems for acute pancreatitis - both by increasing acute pancreatitis incidence, and worsening acute pancreatitis severity. This review explores these associations, underlying mechanisms, and potential therapies. RECENT FINDINGS We review how the obesity associated increase in gallstones, surgical, and endoscopic interventions for obesity management, diabetes, and related medications such as incretin-based therapies and hypertriglyceridemia may increase the incidence of acute pancreatitis. The mechanism of how obesity may increase acute pancreatitis severity are discussed with a focus on cytokines, adipokines, damage-associated molecular patterns and unsaturated fatty acid-mediated lipotoxicity. The role of obesity in exacerbating pancreatic necrosis is discussed; focusing on obesity-associated pancreatic steatosis. We also discuss how peripancreatic fat necrosis worsens organ failure independent of pancreatic necrosis. Last, we discuss emerging therapies including choice of intravenous fluids and the use of lipase inhibitors which have shown promise during severe acute pancreatitis. SUMMARY We discuss how obesity may contribute to increasing acute pancreatitis incidence, the role of lipolytic unsaturated fatty acid release in worsening acute pancreatitis, and potential approaches, including appropriate fluid management and lipase inhibition in improving acute pancreatitis outcomes.
Collapse
|
20
|
Liu W, Yuan Q, Guo S, Fu Z. Emodin in Severe Acute Pancreatitis Treatment. Chin Med 2017. [DOI: 10.4236/cm.2017.84008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|