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Ayoub M, Tomanguillo J, Faris C, Anwar N, Chela H, Daglilar E. Use of proton pump inhibitors improves outcomes in mild acute pancreatitis: A nationwide cohort study. Medicine (Baltimore) 2024; 103:e37694. [PMID: 38579028 PMCID: PMC10994513 DOI: 10.1097/md.0000000000037694] [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] [Received: 01/07/2024] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
Previous studies showed a potential anti-inflammatory effect of proton pump inhibitors (PPI) as well as possible inhibition of pancreatic secretion. This presents the question of their possible use in acute pancreatitis (AP). Current clinical evidence does not address the role of PPI and the present review for possible therapeutic use and safety is lacking. Therefore, our study aims to address the role of PPI in the management of AP and their association with the different outcomes of AP. We queried the Diamond Network through TriNetX-Research Network. This network included 92 healthcare organizations. Patients with mild AP with Bedside Index of Severity in Acute Pancreatitis (BISAP) score of Zero regardless of etiology were divided into 2 cohorts; 1st cohort included patients on PPI, and 2nd cohort included patients not on any PPI. Patients with BISAP score equal to or more than 1 or on PPI prior to the study date were excluded. Two well-matched cohorts were created using 1:1 propensity-scored matching model between cohorts. We compared the incidence of intensive care unit admission, mortality, and other associated complications. A total of 431,571 patients met the inclusion criteria. Of those, 32.9% (n = 142,062) were on PPI, and 67% (n = 289,509) were not on any PPI. After propensity matching, the sample included 115,630 patients on PPI vs 115,630 patients not on PPI. The PPI group had a lower rate of mortality (3.7% vs 4.4%, P < .001), a lower rate of intensive care unit admission (3.9% vs 5.5%, P < .001), a lower rate of necrotizing pancreatitis (1.1% vs 1.9%, P < .001), a lower rate of Hospital-Acquired Pneumonia (3.6% vs 4.9%, P < .001), a lower rate of respiratory failure (2.8% vs 4.2%, P < .001), and a lower rate of acute kidney injury (6.9% vs 10.1%, P < .001). There was no statistical difference in the rate of Clostridium difficile infection between the 2 cohorts (0.9% vs 0.8%, P = .5). The use of PPI in mild AP with a BISAP-score of zero is associated with reduced pancreatitis-related complications and improved mortality. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Mark Ayoub
- Internal Medicine Department, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Julton Tomanguillo
- Internal Medicine Department, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Carol Faris
- Department of General Surgery, Marshall University School of Medicine, Huntington, WV, USA
| | - Nadeem Anwar
- West Virginia University School of Medicine, Charleston Division, Gastroenterology, Charleston, WV, USA
| | - Harleen Chela
- West Virginia University School of Medicine, Charleston Division, Gastroenterology, Charleston, WV, USA
| | - Ebubekir Daglilar
- West Virginia University School of Medicine, Charleston Division, Gastroenterology, Charleston, WV, USA
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Patil AR, Lalwani L. A Comprehensive Physiotherapeutic Approach in a Young Patient With Necrotizing Pancreatitis With Bilateral Pleural Effusion: A Case Report. Cureus 2024; 16:e54524. [PMID: 38516494 PMCID: PMC10955800 DOI: 10.7759/cureus.54524] [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: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Necrotizing pancreatitis represents a severe variant of acute pancreatitis characterized by the death of pancreatic tissue (necrosis). This condition commonly stems from inflammation and damage to the pancreas, leading to the development of areas of dead tissue within the organ. Pleural effusion, on the other hand, involves the accumulation of fluid within the pleural cavity. Typically, these effusions are of mild to moderate severity and tend to occur on the left side. In the following case report, we present a 25-year-old male who was diagnosed with necrotizing pancreatitis and bilateral pleural effusion. It is important to emphasize that cardiopulmonary physiotherapy plays a crucial role in managing pleural effusion. Such interventions, which encompass breathing exercises and thoracic expansion exercises, are pivotal for optimizing lung ventilation, enhancing oxygen levels, and preventing complications such as atelectasis and pneumonia. By boosting oxygenation and improving lung compliance, physiotherapy helps reduce the risk of respiratory problems and expedites the recovery process. This approach enables young individuals to regain their lung function and overall quality of life. In this particular case, the patient received medical management and pulmonary rehabilitation, resulting in a decrease in the Modified Medical Research Council Scale score and an improvement in the six-minute walk test (6 MWT), which subsequently enhanced their quality of life.
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Affiliation(s)
- Anushri R Patil
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lajwanti Lalwani
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Zeng T, An J, Wu Y, Hu X, An N, Gao L, Wan C, Liu L, Shen Y. Incidence and prognostic role of pleural effusion in patients with acute pancreatitis: a meta-analysis. Ann Med 2023; 55:2285909. [PMID: 38010411 PMCID: PMC10880572 DOI: 10.1080/07853890.2023.2285909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Pleural effusion (PE) is reported as a common complication in acute pancreatitis (AP), while the incidence of PE in AP varies widely among studies, and the association between PE and mortality is not clear. This study aimed to comprehensively analyze the pooled incidence of PE in patients with AP and to evaluate the influence of PE on mortality through a meta-analysis. METHOD Six databases (PubMed, Web of Science, EMBASE, Cochrane, Scopus, and OVID) were searched thoroughly for relevant studies. Data were extracted, and Stata SE 16.0 software was applied to compute the pooled incidence of PE and assess the association between PE and mortality, taking the risk ratio (RR) as the effect size. RESULTS Thirty-five articles involving 7,675 patients with AP were eventually included in this meta-analysis. The pooled incidence of PE was 34% (95% CI: 28%-39%), with significant heterogeneity among studies (I2=96.7%). Further analysis revealed that the pooled incidence of unilateral and small PE occupied 49% (95% CI: 21%-77%) and 59% (95% CI: 38%-81%) of AP patients complicated by PE, respectively. The subgroup analysis revealed that "region" and "examination method" may contribute to heterogeneity. PE may be associated with increased mortality in AP patients (RR 3.99, 95% CI: 1.73-9.2). CONCLUSION This study suggested that PE is a common complication with high pooled incidence and that PE may be associated with increased mortality in AP patients. More studies should be performed to validate our findings.
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Affiliation(s)
- Tingting Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Jing An
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Xueru Hu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Naer An
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Lijuan Gao
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Lian Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
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Hu JX, Zhao CF, Wang SL, Tu XY, Huang WB, Chen JN, Xie Y, Chen CR. Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence. World J Gastroenterol 2023; 29:5268-5291. [PMID: 37899784 PMCID: PMC10600804 DOI: 10.3748/wjg.v29.i37.5268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications. Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild, moderate, or severe categories, guiding treatment decisions, such as intensive care unit admission, early enteral feeding, and antibiotic use. Despite the central role of imaging technologies and scoring systems in AP management, these methods have limitations in terms of accuracy, reproducibility, practicality and economics. Recent advancements of artificial intelligence (AI) provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data. AI algorithms can analyze large amounts of clinical and imaging data, identify scoring system patterns, and predict the clinical course of disease. AI-based models have shown promising results in predicting the severity and mortality of AP, but further validation and standardization are required before widespread clinical application. In addition, understanding the correlation between these three technologies will aid in developing new methods that can accurately, sensitively, and specifically be used in the diagnosis, severity prediction, and prognosis assessment of AP through complementary advantages.
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Affiliation(s)
- Jian-Xiong Hu
- Intensive Care Unit, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - Cheng-Fei Zhao
- School of Pharmacy and Medical Technology, Putian University, Putian 351100, Fujian Province, China
- Key Laboratory of Pharmaceutical Analysis and Laboratory Medicine, Putian University, Putian 351100, Fujian Province, China
| | - Shu-Ling Wang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Xiao-Yan Tu
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Wei-Bin Huang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jun-Nian Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ying Xie
- School of Mechanical, Electrical and Information Engineering, Putian University, Putian 351100, Fujian Province, China
| | - Cun-Rong Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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Aljiffry MM, Alhazmi MF, Abu Alqam R, Takieddin SZ, Abulfaraj M. Epidemiological Features of Acute Pancreatitis (AP): Largest Single-Center, Cohort Study in the Western Region of Saudi Arabia. Cureus 2023; 15:e38445. [PMID: 37273380 PMCID: PMC10234453 DOI: 10.7759/cureus.38445] [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] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a medical emergency which can range in severity from a mild, self-limiting condition to a catastrophic event that results in multiorgan failure. This study aimed to evaluate the epidemiological characteristics of AP. METHODS This study included all patients diagnosed with AP at King Abdulaziz University Hospital, a tertiary care hospital in Jeddah, Saudi Arabia, between 2017 and 2021. The main aim of this study was to investigate the frequency of AP in patients who present to the hospital with abdominal pain. Secondary objectives included analyzing the causes, complications, severity, and outcomes of the patients. RESULTS A total of 67 patients were included. AP constituted 11.6% of all cases of patients presenting to the hospital with abdominal pain. Only seven patients presented with severe AP, which was significantly associated with advanced age (over 60 years old). The primary causes of AP were biliary and idiopathic pancreatitis, accounting for 80.6% of the cases. The most frequent complications observed were peripancreatic fluid collection and atelectasis, which occurred in 40.3% of cases. CONCLUSION AP is a prevalent condition in patients with abdominal pain, with biliary pancreatitis being the leading cause of the disease. The majority of patients exhibited mild to moderate severity of symptoms and experienced positive outcomes when treated appropriately.
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Affiliation(s)
| | - Mohammed F Alhazmi
- Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Rakan Abu Alqam
- Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Siba Z Takieddin
- Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Moaz Abulfaraj
- Surgery, King Abdulaziz University Hospital, Jeddah, SAU
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Komolafe K, Pacurari M. CXC Chemokines in the Pathogenesis of Pulmonary Disease and Pharmacological Relevance. Int J Inflam 2022; 2022:4558159. [PMID: 36164329 PMCID: PMC9509283 DOI: 10.1155/2022/4558159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Chemokines and their receptors play important roles in the pathophysiology of many diseases by regulating the cellular migration of major inflammatory and immune players. The CXC motif chemokine subfamily is the second largest family, and it is further subdivided into ELR motif CXC (ELR+) and non-ELR motif (ELR-) CXC chemokines, which are effective chemoattractants for neutrophils and lymphocytes/monocytes, respectively. These chemokines and their receptors are expected to have a significant impact on a wide range of lung diseases, many of which have inflammatory or immunological underpinnings. As a result, manipulations of this subfamily of chemokines and their receptors using small molecular agents and other means have been explored for potential therapeutic benefit in the setting of several lung pathologies. Furthermore, encouraging preclinical data has necessitated the progression of a few of these drugs into clinical trials in order to make the most effective use of interventions in the development of viable targeted therapeutics. The current review presents the understanding of the roles of CXC ligands (CXCLs) and their cognate receptors (CXCRs) in the pathogenesis of several lung diseases such as allergic rhinitis, COPD, lung fibrosis, lung cancer, pneumonia, and tuberculosis. The potential therapeutic benefits of pharmacological or other CXCL/CXCR axis manipulations are also discussed.
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Affiliation(s)
- Kayode Komolafe
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Maricica Pacurari
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, Jackson, MS 39217, USA
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7
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Liao Y, Chiu N, Chen C, Su K. Acute-on-chronic pancreatitis complicated with mediastinal pseudocysts and cardiac tamponade: A case report and literature review. Respirol Case Rep 2022; 10:e0929. [PMID: 35309959 PMCID: PMC8907752 DOI: 10.1002/rcr2.929] [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: 01/23/2022] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/08/2022] Open
Abstract
The clinical course and severity of pancreatitis might vary largely. Pancreatitis-related thoracic complications might be life-threatening but frequently ignored. We report an alcoholic patient who initially presented to the emergency department with community-acquired pneumonia, acute respiratory failure and acute-on-chronic pancreatitis with massive pancreatic pleural effusion. Subsequently, he developed insidiously pancreatitis-related intra-abdominal, mediastinal pseudocysts, and unexpectedly sudden onset of cardiac tamponade. Although tamponade-related haemodynamic instability improved soon after timely diagnosis and emergent pericardial drainage, his recovery period was prolonged. His serum amylase and lipase were persistently elevated until definitive treatment with endoscopic retrograde cholangiopancreatography-assisted removal of pancreatic duct stones. Pancreatitis-related cardiac tamponade is rare but lethal without prompt diagnosis and management. We reviewed pancreatitis-related thoracic complications, particularly for cardiac tamponade, and discussed about the pathophysiology and management options.
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Affiliation(s)
- Ying‐Ting Liao
- Department of Chest MedicineTaipei Veterans General HospitalTaipei CityTaiwan, Republic of China
| | - Nai‐Chi Chiu
- Department of RadiologyTaipei Veterans General HospitalTaipei CityTaiwan, Republic of China
- School of MedicineNational Yang Ming Chiao Tung University, Yangming CampusTaipei CityTaiwan, Republic of China
| | - Chun‐Ku Chen
- Department of RadiologyTaipei Veterans General HospitalTaipei CityTaiwan, Republic of China
- School of MedicineNational Yang Ming Chiao Tung University, Yangming CampusTaipei CityTaiwan, Republic of China
| | - Kang‐Cheng Su
- Department of Chest MedicineTaipei Veterans General HospitalTaipei CityTaiwan, Republic of China
- School of MedicineNational Yang Ming Chiao Tung University, Yangming CampusTaipei CityTaiwan, Republic of China
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Luiken I, Eisenmann S, Garbe J, Sternby H, Verdonk RC, Dimova A, Ignatavicius P, Ilzarbe L, Koiva P, Penttilä AK, Regnér S, Dober J, Wohlgemuth WA, Brill R, Michl P, Rosendahl J, Damm M. Pleuropulmonary pathologies in the early phase of acute pancreatitis correlate with disease severity. PLoS One 2022; 17:e0263739. [PMID: 35130290 PMCID: PMC8820650 DOI: 10.1371/journal.pone.0263739] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background
Respiratory failure worsens the outcome of acute pancreatitis (AP) and underlying factors might be early detectable.
Aims
To evaluate the prevalence and prognostic relevance of early pleuropulmonary pathologies and pre-existing chronic lung diseases (CLD) in AP patients.
Methods
Multicentre retrospective cohort study. Caudal sections of the thorax derived from abdominal contrast enhanced computed tomography (CECT) performed in the early phase of AP were assessed. Independent predictors of severe AP were identified by binary logistic regression analysis. A one-year survival analysis using Kaplan-Meier curves and log rank test was performed.
Results
358 patients were analysed, finding pleuropulmonary pathologies in 81%. CECTs were performed with a median of 2 days (IQR 1–3) after admission. Multivariable analysis identified moderate to severe or bilateral pleural effusions (PEs) (OR = 4.16, 95%CI 2.05–8.45, p<0.001) and pre-existing CLD (OR = 2.93, 95%CI 1.17–7.32, p = 0.022) as independent predictors of severe AP. Log rank test showed a significantly worse one-year survival in patients with bilateral compared to unilateral PEs in a subgroup.
Conclusions
Increasing awareness of the prognostic impact of large and bilateral PEs and pre-existing CLD could facilitate the identification of patients at high risk for severe AP in the early phase and thus improve their prognosis.
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Affiliation(s)
- Ina Luiken
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jakob Garbe
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Hanna Sternby
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Robert C. Verdonk
- Department of Gastroenterology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Alexandra Dimova
- Department of Surgery, University Hospital for Emergency Medicine “Pirogov”, Sofia, Bulgaria
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lucas Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Peeter Koiva
- Department of Gastroenterology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Anne K. Penttilä
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sara Regnér
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Johannes Dober
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A. Wohlgemuth
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Richard Brill
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Patrick Michl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marko Damm
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
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Cesta MC, Zippoli M, Marsiglia C, Gavioli EM, Mantelli F, Allegretti M, Balk RA. The Role of Interleukin-8 in Lung Inflammation and Injury: Implications for the Management of COVID-19 and Hyperinflammatory Acute Respiratory Distress Syndrome. Front Pharmacol 2022; 12:808797. [PMID: 35095519 PMCID: PMC8790527 DOI: 10.3389/fphar.2021.808797] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus—2 (SARS CoV-2) has resulted in the global spread of Coronavirus Disease 2019 (COVID-19) and an increase in complications including Acute Respiratory Distress Syndrome (ARDS). Due to the lack of therapeutic options for Acute Respiratory Distress Syndrome, recent attention has focused on differentiating hyper- and hypo-inflammatory phenotypes of ARDS to help define effective therapeutic strategies. Interleukin 8 (IL-8) is a pro-inflammatory cytokine that has a role in neutrophil activation and has been identified within the pathogenesis and progression of this disease. The aim of this review is to highlight the role of IL-8 as a biomarker and prognostic factor in modulating the hyperinflammatory response in ARDS. The crucial role of IL-8 in lung inflammation and disease pathogenesis might suggest IL-8 as a possible new therapeutic target to efficiently modulate the hyperinflammatory response in ARDS.
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Affiliation(s)
| | - Mara Zippoli
- Dompé Farmaceutici SpA, Via Tommaso De Amicis, Napoli, Italy
| | | | | | | | | | - Robert A Balk
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rush Medical College and Rush University Medical Center, Chicago, IL, United States
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Wang G, Shang D, Zhang G, Zhang S, Jiang N, Liu H, Chen H. Effects of QingYi decoction on inflammatory markers in patients with acute pancreatitis: A meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 95:153738. [PMID: 34544631 DOI: 10.1016/j.phymed.2021.153738] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/08/2021] [Accepted: 09/05/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION It is widely accepted that inflammatory responses play a key role in acute pancreatitis (AP). We conducted a systematic review and meta-analysis to determine the effect of QingYi decoction on inflammatory markers. METHODS The PubMed, EMBASE, Cochrane, CNKI, CBM, and WANFGANG databases were searched for randomized controlled trials published before December 2019. Thirty-nine eligible studies were included in the meta-analysis. The quality of the included studies was assessed using the Cochrane Collaboration risk of bias tool. The standardized mean differences (SMDs) with corresponding 95% CIs were examined for inflammatory markers. The chi-square test and I2 statistic were used to assess heterogeneity. We assessed publication bias by Begg's test, Egger's test, and the trim and fill method. In addition, a meta-regression, sensitivity analysis, subgroup analysis, and cumulative meta-analysis were performed to assess the effects of confounding factors. The quality of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS The pooled effect estimate indicated that QingYi decoction treatment significantly reduced the levels of pro-inflammatory IL-6 (SMD = -3.33; 95% CI, -4.17, -2.50; p < 0.001; I2: 97.9%), IL-8 (SMD = -1.55; 95% CI, -2.03, -1.07; p < 0.001; I2: 96.1%), TNF-α (SMD = -1.04; 95% CI, -1.37, -0.72; p < 0.001; I2: 93.9%), IL-1 (SMD = -2.05; 95% CI, -3.21, -0.90; p < 0.001; I2: 93.4%), and IL-1β (SMD = -1.31; 95% CI, -2.42, -0.21; p < 0.001; I2: 89.8%) and elevated the levels of anti-inflammatory IL-10 (SMD = 0.99; 95% CI, 0.60, 1.38; p < 0.001; I2: 91.1%) among patients with AP. CONCLUSION The current review and meta-analysis suggest that the therapeutic effect of QingYi decoction may be related to its anti-inflammatory properties. Due to the high heterogeneity across the included studies, additional large-scale and rigorously designed studies are needed to confirm the conclusions of this study.
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Affiliation(s)
- Guanyu Wang
- General Surgery Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China; Institute of Integrative Medicine of Dalian Medical University, Dalian, China
| | - Dong Shang
- General Surgery Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China; Institute of Integrative Medicine of Dalian Medical University, Dalian, China
| | - Guixin Zhang
- General Surgery Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China; Institute of Integrative Medicine of Dalian Medical University, Dalian, China
| | - Shenglin Zhang
- General Surgery Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China; Institute of Integrative Medicine of Dalian Medical University, Dalian, China
| | - Nan Jiang
- Institute of Integrative Medicine of Dalian Medical University, Dalian, China; Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huanhuan Liu
- Institute of Integrative Medicine of Dalian Medical University, Dalian, China
| | - Hailong Chen
- General Surgery Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China; Institute of Integrative Medicine of Dalian Medical University, Dalian, China.
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11
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Thapa R, Iqbal Z, Garikipati A, Siefkas A, Hoffman J, Mao Q, Das R. Early prediction of severe acute pancreatitis using machine learning. Pancreatology 2022; 22:43-50. [PMID: 34690046 DOI: 10.1016/j.pan.2021.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) is one of the most common causes of gastrointestinal-related hospitalizations in the United States. Severe AP (SAP) is associated with a mortality rate of nearly 30% and is distinguished from milder forms of AP. Risk stratification to identify SAP cases needing inpatient treatment is an important aspect of AP diagnosis. METHODS We developed machine learning algorithms to predict which patients presenting with AP would require treatment for SAP. Three models were developed using logistic regression, neural networks, and XGBoost. Models were assessed in terms of area under the receiver operating characteristic (AUROC) and compared to the Harmless Acute Pancreatitis Score (HAPS) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores for AP risk stratification. RESULTS 61,894 patients were used to train and test the machine learning models. With an AUROC value of 0.921, the model developed using XGBoost outperformed the logistic regression and neural network-based models. The XGBoost model also achieved a higher AUROC than both HAPS and BISAP for identifying patients who would be diagnosed with SAP. CONCLUSIONS Machine learning may be able to improve the accuracy of AP risk stratification methods and allow for more timely treatment and initiation of interventions.
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12
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Batcioglu K, Dogan T, Kustepe E, Uyumlu A, Yilmaztekin Y. Protective effect of Lycium barbarum on renal injury induced by acute pancreatitis in rats. Pharmacogn Mag 2022. [DOI: 10.4103/pm.pm_516_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Cammarano CA, Sandhu NS, Villaluz JE. Localizing the Pain: Continuous Paravertebral Nerve Blockade in a Patient with Acute Pancreatitis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934189. [PMID: 34958656 PMCID: PMC8721992 DOI: 10.12659/ajcr.934189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Female, 41-year-old
Final Diagnosis: Pancreatitis
Symptoms: Abdominal pain • nausea • vomiting
Medication: —
Clinical Procedure: —
Specialty: Anesthesiology
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14
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Gori E, Pierini A, Lippi I, Citi S, Mannucci T, Marchetti V. Evaluation of diagnostic and prognostic usefulness of abdominal ultrasonography in dogs with clinical signs of acute pancreatitis. J Am Vet Med Assoc 2021; 259:631-636. [PMID: 34448616 DOI: 10.2460/javma.259.6.631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report abdominal ultrasonography (AUS) findings in dogs with clinical signs of acute pancreatitis (AP) during the first 2 days of hospitalization and to compare AUS findings with severity of disease and mortality rate. ANIMALS 37 client-owned dogs with clinical signs of AP. PROCEDURES Dogs suspected of having AP with complete medical records, AUS examinations performed throughout the first 2 days of hospitalization, and available frozen surplus serum samples for quantitative measurement of canine pancreatic lipase (cPL) concentrations at hospital admission met the criteria for study inclusion. Dogs were grouped as AUS+ or AUS- on the basis of positive or negative findings for AP on AUS, respectively. Abdominal ultrasonography findings of AP were stratified (as mild, moderate, or severe) by use of an AUS severity index, and a canine acute pancreatitis severity score was calculated. RESULTS 24 of 37 (64.8%) dogs had AUS findings of AP at hospital admission, whereas 10 had positive findings for AP on AUS within 2 days of hospitalization. Three (8%) dogs were AUS- but had serum cPL concentrations > 400 μg/L (ie, values considered diagnostic for AP). On the AUS severity index, 5 of 34 (14.7%) AUS+ dogs had mild findings, 18 (52.9%) AUS+ dogs had moderate findings, and 11 (32.4%) AUS+ dogs had severe findings. Severe findings were associated with a higher risk of death than mild and moderate findings. A significant association was found between canine acute pancreatitis severity scores and mortality rates. CONCLUSIONS AND CLINICAL RELEVANCE For dogs with clinical signs of AP, repeated AUS examinations during hospitalization should be performed, severe findings on the AUS severity index may indicate an increased risk of death, and serum cPL concentrations may increase earlier than findings on AUS of AP.
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15
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Murteira F, Costa T, Pinto SB, Francisco E, Gomes AC. Pancreaticopleural fistula: An insidious cause of pleural effusion –case report. J Cardiovasc Thorac Res 2021; 14:67-70. [PMID: 35620754 PMCID: PMC9106946 DOI: 10.34172/jcvtr.2021.37] [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: 12/07/2020] [Accepted: 06/12/2021] [Indexed: 12/03/2022] Open
Abstract
Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.
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Affiliation(s)
- Fábio Murteira
- Internal Medicine Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Corresponding Author: Fábio Murteira,
| | - Tiago Costa
- Internal Medicine Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sara Barbosa Pinto
- Internal Medicine Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Elsa Francisco
- General Surgery Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Catarina Gomes
- Gastroenterology Departement, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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16
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Zhang Q, Zhou J, Zhou J, Fang RH, Gao W, Zhang L. Lure-and-kill macrophage nanoparticles alleviate the severity of experimental acute pancreatitis. Nat Commun 2021; 12:4136. [PMID: 34230486 PMCID: PMC8260623 DOI: 10.1038/s41467-021-24447-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023] Open
Abstract
Acute pancreatitis is a disease associated with suffering and high lethality. Although the disease mechanism is unclear, phospholipase A2 (PLA2) produced by pancreatic acinar cells is a known pathogenic trigger. Here, we show macrophage membrane-coated nanoparticles with a built-in 'lure and kill' mechanism (denoted 'MΦ-NP(L&K)') for the treatment of acute pancreatitis. MΦ-NP(L&K) are made with polymeric cores wrapped with natural macrophage membrane doped with melittin and MJ-33. The membrane incorporated melittin and MJ-33 function as a PLA2 attractant and a PLA2 inhibitor, respectively. These molecules, together with membrane lipids, work synergistically to lure and kill PLA2 enzymes. These nanoparticles can neutralize PLA2 activity in the sera of mice and human patients with acute pancreatitis in a dose-dependent manner and suppress PLA2-induced inflammatory response accordingly. In mouse models of both mild and severe acute pancreatitis, MΦ-NP(L&K) confer effective protection against disease-associated inflammation, tissue damage and lethality. Overall, this biomimetic nanotherapeutic strategy offers an anti-PLA2 treatment option that might be applicable to a wide range of PLA2-mediated inflammatory disorders.
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Affiliation(s)
- Qiangzhe Zhang
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Julia Zhou
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jiarong Zhou
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Ronnie H Fang
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Weiwei Gao
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Liangfang Zhang
- Department of Nanoengineering, Chemical Engineering Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
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17
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Khiatah B, Huynh T, Frugoli A, Lyche KD. Acute Pancreatitis with an Ongoing Pancreatic Duct Leak Complicated by Refractory Pleural Effusion: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931330. [PMID: 34112749 PMCID: PMC8207542 DOI: 10.12659/ajcr.931330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 52-year-old Final Diagnosis: Pancreatic duct leak Symptoms: Epigastric pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Bashar Khiatah
- Department of Internal Medicine, Community Memorial Health Systems, Ventura, CA, USA
| | - Thatcher Huynh
- Department of Internal Medicine, Community Memorial Health Systems, Ventura, CA, USA
| | - Amanda Frugoli
- Department of Internal Medicine, Community Memorial Health Systems, Ventura, CA, USA.,Department of Graduate Medical Education, Community Memorial Hospital, Ventura, CA, USA
| | - Kip D Lyche
- Department of Gastroenterology, Community Memorial Health Systems, Ventura, CA, USA
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18
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Jiang N, Li Z, Luo Y, Jiang L, Zhang G, Yang Q, Chen H. Emodin ameliorates acute pancreatitis-induced lung injury by suppressing NLRP3 inflammasome-mediated neutrophil recruitment. Exp Ther Med 2021; 22:857. [PMID: 34178130 PMCID: PMC8220649 DOI: 10.3892/etm.2021.10289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
Severe acute pancreatitis (SAP) activates the systemic inflammatory response and is potentially lethal. The aim of the present study was to determine the effects of emodin on acute lung injury (ALI) in rats with SAP and investigate the role of the Nod-like receptor protein 3 (NLRP3) inflammasome and its association with neutrophil recruitment. Sodium taurocholate (5.0%) was used to establish the SAP model. All animals were randomly assigned into four groups: Sham, SAP, emodin and dexamethasone (positive control drug) groups (n=10 mice per group). Histopathology observation of pancreatic and lung tissues was detected by hematoxylin and eosin staining. The levels of serum amylase, IL-1β and IL-18 were measured by ELISA. Single-cell suspensions were obtained from enzymatically digested lung tissues, followed by flow cytometric analysis for apoptosis. In addition, the expression levels of NLRP3 inflammasome-associated and apoptosis-associated proteins in lung tissues were measured by western blotting. Moreover, lymphocyte antigen 6 complex locus G6D+ (Ly6G+) cell recruitment was detected using immunohistochemical analysis. The results revealed that emodin markedly improved pancreatic histological injury and decreased the levels of serum amylase, IL-1β and IL-18. Pulmonary edema and apoptosis were significantly alleviated by emodin. Additionally, the protein expression levels of intercellular adhesion molecule 1, NLRP3, apoptosis-associated speck-like protein containing a CARD and cleaved caspase-1 were downregulated following emodin treatment. Moreover, emodin inhibited Ly6G+ cell recruitment in lung tissues. The present study demonstrated that emodin may offer protection against ALI induced by SAP via inhibiting and suppressing NLRP3 inflammasome-mediated neutrophil recruitment and may be a novel therapeutic strategy for the clinical treatment of ALI.
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Affiliation(s)
- Nan Jiang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Institute (College) of Integrative Medicine and College of Pharmacy, Dalian Medical University, Dalian, Liaoning 116044, P.R. China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Zhaoxia Li
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Institute (College) of Integrative Medicine and College of Pharmacy, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Yalan Luo
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Institute (College) of Integrative Medicine and College of Pharmacy, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Liu Jiang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Institute (College) of Integrative Medicine and College of Pharmacy, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Guixin Zhang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Institute (College) of Integrative Medicine and College of Pharmacy, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Qi Yang
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Hailong Chen
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
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19
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Bruen C, Miller J, Wilburn J, Mackey C, Bollen TL, Stauderman K, Hebbar S. Auxora for the Treatment of Patients With Acute Pancreatitis and Accompanying Systemic Inflammatory Response Syndrome: Clinical Development of a Calcium Release-Activated Calcium Channel Inhibitor. Pancreas 2021; 50:537-543. [PMID: 33939666 PMCID: PMC8104014 DOI: 10.1097/mpa.0000000000001793] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/26/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the safety of Auxora in patients with acute pancreatitis (AP), systemic inflammatory response syndrome (SIRS), and hypoxemia, and identify efficacy endpoints to prospectively test in future studies. METHODS This phase 2, open-label, dose-response study randomized patients with AP, accompanying SIRS, and hypoxemia (n = 21) to receive low-dose or high-dose Auxora plus standard of care (SOC) or SOC alone. All patients received pancreatic contrast-enhanced computed tomography scans at screenings, day 5/discharge, and as clinically required 90 days postrandomization; scans were blinded and centrally read to determine AP severity using computed tomography severity index. Solid food tolerance was assessed at every meal and SIRS every 12 hours. RESULTS The number of patients experiencing serious adverse events was not increased with Auxora versus SOC alone. Three (36.5%) patients with moderate AP receiving low-dose Auxora improved to mild AP; no computed tomography severity index improvements were observed with SOC. By study end, patients receiving Auxora better tolerated solid foods, had less persistent SIRS, and had reduced hospitalization versus SOC. CONCLUSIONS The favorable safety profile and patient outcomes suggest Auxora may be an appropriate early treatment for patients with AP and SIRS. Clinical development will continue in a randomized, controlled, blinded, dose-ranging study.
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Affiliation(s)
- Charles Bruen
- From the Departments of Critical Care Medicine
- Emergency Medicine, Regions Hospital, HealthPartners, St. Paul, MN
| | - Joseph Miller
- Departments of Emergency Medicine
- Internal Medicine, Henry Ford Hospital System
| | - John Wilburn
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Caleb Mackey
- Departments ofPulmonary Medicine
- Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH
| | - Thomas L. Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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20
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Sandhu H, Mallik D, Lokavarapu MJ, Huda F, Basu S. Acute Recurrent Pancreatitis and COVID-19 Infection: A Case Report with Literature Review. Cureus 2021; 13:e13490. [PMID: 33777577 PMCID: PMC7990082 DOI: 10.7759/cureus.13490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/19/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection typically presents with respiratory symptoms, although presentation with gastrointestinal symptoms is not uncommon. Coronavirus disease 2019 (COVID-19) presenting as acute pancreatitis is rare. There are several etiological factors for acute recurrent pancreatitis, but its association with COVID-19 disease is not yet known. We present an unusual case of recurrent attacks of acute pancreatitis in a young woman with SARS-CoV-2 infection, which was diagnosed early but had a rapid downhill course in the second attack with a fatal outcome.
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Affiliation(s)
- Harindra Sandhu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
- General Surgery, Lala Lajpat Rai Memorial Medical College, Meerut, IND
| | - Dhiraj Mallik
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Farhanul Huda
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Somprakas Basu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
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21
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Jia YC, Ding YX, Mei WT, Wang YT, Zheng Z, Qu YX, Liang K, Li J, Cao F, Li F. Extracellular vesicles and pancreatitis: mechanisms, status and perspectives. Int J Biol Sci 2021; 17:549-561. [PMID: 33613112 PMCID: PMC7893579 DOI: 10.7150/ijbs.54858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Comprehensive reviews and large population-based cohort studies have played an important role in the diagnosis and treatment of pancreatitis and its sequelae. The incidence and mortality of pancreatitis have been reduced significantly due to substantial advancements in the pathophysiological mechanisms and clinically effective treatments. The study of extracellular vesicles (EVs) has the potential to identify cell-to-cell communication in diseases such as pancreatitis. Exosomes are a subset of EVs with an average diameter of 50~150 nm. Their diverse and unique constituents include nucleic acids, proteins, and lipids, which can be transferred to trigger phenotypic changes of recipient cells. In recent years, many reports have indicated the role of EVs in pancreatitis, including acute pancreatitis, chronic pancreatitis and autoimmune pancreatitis, suggesting their potential influence on the development and progression of pancreatitis. Plasma exosomes of acute pancreatitis can effectively reach the alveolar cavity and activate alveolar macrophages to cause acute lung injury. Furthermore, upregulated exosomal miRNAs can be used as biomarkers for acute pancreatitis. Here, we summarized the current understanding of EVs in pancreatitis with an emphasis on their biological roles and their potential use as diagnostic biomarkers and therapeutic agents for this disease.
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Affiliation(s)
- Yu-Chen Jia
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Wen-Tong Mei
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | | | - Zhi Zheng
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yuan-Xu Qu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Kuo Liang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
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22
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Hyperbaric Oxygen Ameliorated Acute Pancreatitis in Rats via the Mitochondrial Pathway. Dig Dis Sci 2020; 65:3558-3569. [PMID: 32006213 DOI: 10.1007/s10620-020-06070-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) is a common disease of the digestive system. The mechanism of hyperbaric oxygen (HBO) therapy for AP is not completely clear. AIMS This study investigated the effects of HBO in AP and whether it acts through the mitochondria-mediated apoptosis pathway. METHODS Eighty male Sprague-Dawley rats were randomly assigned to four groups: control (8 rats), sham (24 rats), AP (24 rats), or AP + HBO (24 rats). AP was induced by ligating the pancreatic duct. The AP + HBO group was given HBO therapy starting at 6 h postinduction. Eight rats in each group were killed on days 1, 2, and 3 postinduction to assess pancreatic injury, mitochondrial membrane potential, ATP level, and expression levels of BAX, Bcl-2, caspase-3, caspase-9, and PARP in pancreatic tissue and blood levels of amylase, lipase, and pro-inflammatory cytokines. RESULTS HBO therapy alleviated the severity of AP and decreased histopathological scores and levels of serum amylase, lipase, and pro-inflammatory cytokines. Compared to AP induction alone, HBO therapy increased expression of the apoptotic protein BAX, caspase-3, caspase-9, and PARP and ATP levels in tissues and decreased antiapoptotic protein Bcl-2 expression levels and the mitochondrial membrane potential on the first day; the results on the second day were partly consistent with those on the first day, while there was no obvious difference on the third day. CONCLUSIONS HBO therapy could induce caspase-dependent apoptosis in AP rats to alleviate pancreatitis, which was possibly triggered by mitochondrial apoptosis pathway regulation of Bcl-2 family members.
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23
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Gori E, Pierini A, Ceccherini G, Citi S, Mannucci T, Lippi I, Marchetti V. Pulmonary complications in dogs with acute presentation of pancreatitis. BMC Vet Res 2020; 16:209. [PMID: 32571307 PMCID: PMC7310026 DOI: 10.1186/s12917-020-02427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 06/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background In humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality. Results This prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death (P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar (n = 11) and interstitial pattern (n = 10). Radiographic alterations and mLIS score were both associated with death (P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO2 and HCO3− levels, and higher A-a gradient than survivors (P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality (P < 0.001). Conclusions As with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.
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Affiliation(s)
- Eleonora Gori
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Alessio Pierini
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy.
| | - Gianila Ceccherini
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Simonetta Citi
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Tommaso Mannucci
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Ilaria Lippi
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Veronica Marchetti
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
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24
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Chang YH, Weng SY, Shiue SJ, Cheng CL, Wu MS. Hydrocele in recurrent acute pancreatitis caused by testicular venous obstruction: A case report of a rare complication (CARE-compliant). Medicine (Baltimore) 2020; 99:e19738. [PMID: 32358347 PMCID: PMC7440237 DOI: 10.1097/md.0000000000019738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Scrotal swelling is a rare complication of acute pancreatitis. It had been explained by fluid accumulation in scrotum originated from abdomen. Here we demonstrated a case of recurrent pancreatitis with hydrocele caused by impaired testicular venous drainage. PATIENT CONCERNS A 53-year-old man presented with sudden onset epigastric pain after an alcohol binge. Recurrent acute pancreatitis was confirmed by medical history, physical examination, elevated lipase level and abdominal computed tomography (CT) scan. Right scrotal swelling was noticed on the next day. DIAGNOSIS The scrotal ultrasonography demonstrated fluid accumulation around the testis and varicocele consistent with scrotal hydrocele. CT scans of the abdomen and pelvis showed encasement of the right testicular vein by pancreatic phlegmon. INTERVENTIONS The patient was subject to Nulla per os, hydration, and opioid analgesics for pancreatitis. No intervention was performed for scrotal swelling. OUTCOMES Hydrocele gradually resolved along with acute pancreatitis. LESSONS Pancreatic phlegmon compromised testicular venous return which led to scrotal hydrocele and posed a threat to fertility. The study has provided a novel pathologic linkage. This complication should be taken into account.
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Affiliation(s)
- Yin-Hsi Chang
- Medical Education Department, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
- School of Medicine, College of Medicine, Taipei Medical University
| | - Shih-Yen Weng
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University
- Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences
| | - Sheng-Jie Shiue
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University
| | - Chao-Ling Cheng
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University
| | - Ming-Shun Wu
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine
- Integrative Therapy Center for Gastroenterologic Cancers, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Chang JC. Acute Respiratory Distress Syndrome as an Organ Phenotype of Vascular Microthrombotic Disease: Based on Hemostatic Theory and Endothelial Molecular Pathogenesis. Clin Appl Thromb Hemost 2020; 25:1076029619887437. [PMID: 31775524 PMCID: PMC7019416 DOI: 10.1177/1076029619887437] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening noncardiogenic circulatory disorder of the lungs associated with critical illnesses such as sepsis, trauma, and immune and collagen vascular disease. Its mortality rate is marginally improved with the best supportive care. The demise occurs due to progressive pulmonary hypoxia and multi-organ dysfunction syndrome (MODS) with severe inflammation. Complement activation is a part of immune response against pathogen or insult in which membrane attack complex (MAC) is formed and eliminates microbes. If complement regulatory protein such as endothelial CD59 is underexpressed, MAC may also cause pulmonary vascular injury to the innocent bystander endothelial cell of host and provokes endotheliopathy that causes inflammation and pulmonary vascular microthrombosis, leading to ARDS. Its pathogenesis is based on a novel "two-path unifying theory" of hemostasis and "two-activation theory of the endothelium" promoting molecular pathogenesis. Endotheliopathy activates two independent molecular pathways: inflammatory and microthrombotic. The former triggers the release inflammatory cytokines and the latter promotes exocytosis of unusually large von Willebrand factor multimers (ULVWF) and platelet activation. Inflammatory pathway initiates inflammation, but microthrombotic pathway more seriously produces "microthrombi strings" composed of platelet-ULVWF complexes, which become anchored on the injured endothelial cells, and causes disseminated intravascular microthrombosis (DIT). DIT is a hemostatic disease due to lone activation of ULVWF path without activated tissue factor path. It leads to endotheliopathy-associated vascular microthrombotic disease (EA-VMTD), which orchestrates consumptive thrombocytopenia, microangiopathic hemolytic anemia, and MODS. Thrombotic thrombocytopenic purpura (TTP)-like syndrome is the hematologic phenotype of EA-VMTD. ARDS is one of organ phenotypes among MODS associated with TTP-like syndrome. The most effective treatment of ARDS can be achieved by counteracting the activated microthrombotic pathway based on two novel hemostatic theories.
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Affiliation(s)
- Jae C Chang
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
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Shah J, Rana SS. Acute respiratory distress syndrome in acute pancreatitis. Indian J Gastroenterol 2020; 39:123-132. [PMID: 32285399 DOI: 10.1007/s12664-020-01016-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
Development of organ failure is one of the major determinants of mortality in patients with acute pancreatitis (AP). Acute respiratory distress syndrome (ARDS) is an important cause of respiratory failure in AP and is associated with high mortality. Pathogenesis of ARDS in AP is incompletely understood. Release of various cytokines plays an important role in development of ARDS in AP. Increased gut permeability due to various toxins, inflammatory mediators, and pancreatic enzymes potentiates lung injury by gut-lymph-lung axis leading on to increased translocation of bacterial endotoxins. Various scoring systems, serum levels of various cytokines and lung ultrasound have been evaluated for prediction of development of ARDS in AP with varying results. Various drugs have shown encouraging results in prevention of ARDS in animal models but these encouraging results in animal models are yet to be confirmed in clinical studies. There is no specific effective treatment for ARDS. Treatment of sepsis and local complications of AP should be done according to the standard management strategies. Lung protective ventilatory strategies are of paramount importance to improve outcome of patients of AP with ARDS and therefore effective coordination between gastroenterologists and intensivists is needed for effective management of these patients.
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Affiliation(s)
- Jimil Shah
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India
| | - Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India.
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Iyer H, Elhence A, Mittal S, Madan K, Garg PK. Pulmonary complications of acute pancreatitis. Expert Rev Respir Med 2019; 14:209-217. [PMID: 31779502 DOI: 10.1080/17476348.2020.1698951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Acute pancreatitis is an inflammatory condition of the pancreas, which runs a severe course in 20% of patients, wherein it is associated with high mortality. It is associated with several pleuro-pulmonary complications with variable severity that may occur either in isolation but are frequently present in combination. Clinicians need to be aware of these complications for early and appropriate management.Areas covered: We performed a systematic search of the PUBMED database (1970-2019) to identify relevant articles focusing on pleuro-pulmonary complications that may occur in patients with acute pancreatitis. We also retrieved articles describing the pathophysiological mechanisms and treatment approach of the various complications.Expert opinion: Acute pancreatitis is usually a self-limiting disease, but the development of organ failure during the course worsens the clinical outcome. Pulmonary complications usually occur early in the course of acute pancreatitis. Clinicians need to recognize the various pulmonary complications of acute pancreatitis, early during the disease, and manage them appropriately and aggressively to improve outcomes.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine. All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine. All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine. All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Huda T, Mohan A, Parwez MM, Pandya B. An Unusual Combination of Three Rare Complications: Pleuro-Pancreatic Fistula, Chylous Ascites, and Renal Vein Thrombosis, in a Case of Acute Severe Pancreatitis. Surg J (N Y) 2019; 5:e188-e191. [PMID: 31763461 PMCID: PMC6872457 DOI: 10.1055/s-0039-1700807] [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: 07/30/2019] [Accepted: 09/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background
Acute pancreatitis is fraught with a variety of complications, which account for the mortality associated. Our case had a fulminant course, with three rare, near-fatal complications and was successfully managed conservatively. Pleural effusion due to pleuro-pancreatic fistula is uncommon, seen in only 1% cases, of which right-sided effusions are rarer still. Management modalities include conservative, endoscopic, and surgical options. Chylous ascites is an extremely rare complication of pancreatitis and is managed with high protein, low lipid diet, restricted to medium-chain triglycerides (MCTs). Extra-splanchnic venous thrombosis is uncommon in pancreatitis, and isolated renal vein thrombosis is very rare.
Case Presentation
A 34-year-old, chronic alcoholic male, presented to the outpatient department (OPD) in a state of shock and respiratory distress. Chest radiograph showed massive right-sided pleural effusion. The pleural fluid was hemorrhagic with markedly elevated amylase levels, and contrast-enhanced computed tomography (CECT) confirmed the presence of a right-sided pleuro-pancreatic fistula. Left renal vein thrombosis was also noted. The patient improved with chest drain, intravenous (IV) octreotide, and anticoagulants. Subsequently, he developed hemorrhagic pancreatic ascites, which later turned chylous. This was managed with dietary modifications. The patient had a prolonged recovery but was finally discharged after 45 days.
Conclusion
It is a challenge managing the various complications of acute severe pancreatitis. We describe this case to emphasize maintaining a high sensitivity for timely diagnosis and appropriate addressal of all the complications for better patient outcomes.
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Affiliation(s)
- Tanweerul Huda
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anjaly Mohan
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohammad Masoom Parwez
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bharati Pandya
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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IL-38 is a biomarker for acute respiratory distress syndrome in humans and down-regulates Th17 differentiation in vivo. Clin Immunol 2019; 210:108315. [PMID: 31756565 DOI: 10.1016/j.clim.2019.108315] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/21/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022]
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30
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Romanucci M, Defourny SVP, Massimini M, Bongiovanni L, Aste G, Vignoli M, Febo E, Boari A, Della Salda L. Inflammatory myofibroblastic tumor of the pancreas in a dog. J Vet Diagn Invest 2019; 31:879-882. [PMID: 31585512 DOI: 10.1177/1040638719879737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A large, ill-defined, firm, multinodular mass involving the pancreas was confirmed on postmortem examination of a 5-y-old, male Rottweiler that died following acute respiratory distress syndrome, after a period of anorexia and lethargy. Histologically, the mass consisted of plump spindle cells admixed with a variable number of macrophages, lymphocytes, plasma cells, and neutrophils. Foci of coagulative necrosis and hemorrhage were also observed. Spindle cells strongly reacted to antibodies against vimentin, α-smooth muscle actin, and calponin, whereas desmin was expressed only mildly and focally. Pan-cytokeratin, KIT, glial fibrillary acidic protein, and S100 protein were nonreactive. Variable numbers of MAC 387-positive cells, CD3+ lymphocytes, and numerous blood vessels were also detected throughout the mass. Histologic and IHC findings were consistent with a diagnosis of inflammatory myofibroblastic tumor of the pancreas.
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Affiliation(s)
| | | | | | | | - Giovanni Aste
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - Elettra Febo
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
| | - Andrea Boari
- Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy
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Goodchild G, Chouhan M, Johnson GJ. Practical guide to the management of acute pancreatitis. Frontline Gastroenterol 2019; 10:292-299. [PMID: 31288253 PMCID: PMC6583768 DOI: 10.1136/flgastro-2018-101102] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 02/04/2023] Open
Abstract
Acute pancreatitis (AP) is characterised by inflammation of the exocrine pancreas and is associated with acinar cell injury and both a local and systemic inflammatory response. AP may range in severity from self-limiting, characterised by mild pancreatic oedema, to severe systemic inflammation with pancreatic necrosis, organ failure and death. Several international guidelines have been developed including those from the joint International Association of Pancreatology and American Pancreatic Association, American College of Gastroenterology and British Society of Gastroenterology. Here we discuss current diagnostic and management challenges and address the common dilemmas in AP.
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Affiliation(s)
- George Goodchild
- Department of Gastroenterology, University College Hospital, London, UK
| | - Manil Chouhan
- Department of Radiology, University College Hospital, London, UK
| | - Gavin J Johnson
- Department of Gastroenterology, University College Hospital, London, UK
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32
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Madhi R, Rahman M, Mörgelin M, Thorlacius H. c-Abl kinase regulates neutrophil extracellular trap formation, inflammation, and tissue damage in severe acute pancreatitis. J Leukoc Biol 2019; 106:455-466. [PMID: 30861207 DOI: 10.1002/jlb.3a0618-222rr] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 01/08/2023] Open
Abstract
Neutrophil extracellular traps (NETs) are involved in acute pancreatitis (AP) but mechanisms controlling NET expulsion in AP are incompletely understood. Herein, we examined the role of c-Abelson (c-Abl) kinase in NET formation and tissue damage in severe AP. AP was induced by taurocholate infusion into pancreatic duct or intraperitoneal administration of l-arginine in mice. Pancreatic, lung, and blood samples were collected and levels of phosphorylated c-Abl kinase, citrullinated histone 3, DNA-histone complexes, myeloperoxidase, amylase, cytokines, and CXC chemokines were quantified. Citrullinated histone 3, reactive oxygen species (ROS), and NET formation were determined in bone marrow neutrophils. Taurocholate challenge increased phosphorylation of c-Abl kinase and levels of citrullinated histone 3 in the pancreas as well as DNA-histone complexes in the plasma. Administration of the c-Abl kinase inhibitor GZD824 not only abolished activation of c-Abl kinase but also decreased levels of citrullinated histone 3 in the pancreas and DNA-histone complexes in the plasma of animals with AP. Moreover, GZD824 decreased plasma levels of amylase, IL-6, and MMP-9 as well as edema, acinar cell necrosis, hemorrhage, CXC chemokine formation, and neutrophil infiltration in the inflamed pancreas. A beneficial effect of c-Abl kinase inhibition was confirmed in l-arginine-induced pancreatitis. In vitro, inhibition of c-Abl kinase reduced TNF-α-induced formation of ROS, histone 3 citrullination, and NETs in isolated bone marrow neutrophils. Our findings demonstrate that c-Abl kinase regulates NET formation in the inflamed pancreas. In addition, inhibition of c-Abl kinase reduced pancreatic tissue inflammation, and damage in AP. Thus, targeting c-Abl kinase might be a useful way to protect the pancreas in severe AP.
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Affiliation(s)
- Raed Madhi
- Department of Clinical Science, Malmö, Section for Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Milladur Rahman
- Department of Clinical Science, Malmö, Section for Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Henrik Thorlacius
- Department of Clinical Science, Malmö, Section for Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
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Bae GS, Kim DG, Jo IJ, Choi SB, Kim MJ, Shin JY, Kim DU, Song HJ, Joo M, Park SJ. Heme oxygenase-1 induced by desoxo-narchinol-A attenuated the severity of acute pancreatitis via blockade of neutrophil infiltration. Int Immunopharmacol 2019; 69:225-234. [PMID: 30738992 DOI: 10.1016/j.intimp.2019.01.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/07/2023]
Abstract
Heme oxygenase-1 (HO-1) has an anti-inflammatory action in acute pancreatitis (AP). However, its mechanism of action and natural compounds/drugs to induce HO-1 in pancreas are not well understood. In this study, we investigated the regulatory mechanisms of HO-1 during AP using desoxo-narchinol-A (DN), the natural compound inducing HO-1 in the pancreas. Female C57/BL6 Mice were intraperitoneally injected with supramaximal concentrations of cerulein (50 μg/kg) hourly for 6 h to induce AP. DMSO or DN was administered intraperitoneally, then mice were sacrificed 6 h after the final cerulein injection. Administration of DN increased pancreatic HO-1 expression through activation of activating protein-1, mediated by mitogen-activated protein kinases. Furthermore, DN treatment reduced the pancreatic weight-to-body weight ratio as well as production of digestive enzymes and pro-inflammatory cytokines. Inhibition of HO-1 by tin protoporphyrin IX abolished the protective effects of DN on pancreatic damage. Additionally, DN treatment inhibited neutrophil infiltration into the pancreas via regulation of chemokine (C-X-C motif) ligand 2 (CXCL2) by HO-1. Our results suggest that DN is an effective inducer of HO-1 in the pancreas, and that HO-1 regulates neutrophil infiltration in AP via CXCL2 inhibition.
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Affiliation(s)
- Gi-Sang Bae
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea; Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Dong-Goo Kim
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Il-Joo Jo
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea; Division of Beauty Sciences, School of Natural Sciences, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Sun-Bok Choi
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea; Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Myoung-Jin Kim
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Joon Yeon Shin
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Dong-Uk Kim
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Ho-Joon Song
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea
| | - Myungsoo Joo
- School of Korean Medicine, Pusan National University, Yangsan 50621, South Korea
| | - Sung-Joo Park
- Department of Herbology, School of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk 54538, South Korea; Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, Iksan, Jeonbuk 54538, South Korea.
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Darrivere L, Lapidus N, Colignon N, Chafai N, Chaput U, Verdonk F, Paye F, Lescot T. Minimally invasive drainage in critically ill patients with severe necrotizing pancreatitis is associated with better outcomes: an observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:321. [PMID: 30466472 PMCID: PMC6249885 DOI: 10.1186/s13054-018-2256-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/04/2018] [Indexed: 12/17/2022]
Abstract
Background Infected pancreatic necrosis, which occurs in about 40% of patients admitted for acute necrotizing pancreatitis, requires combined antibiotic therapy and local drainage. Since 2010, drainage by open surgical necrosectomy has been increasingly replaced by less invasive methods such as percutaneous radiological drainage, endoscopic necrosectomy, and laparoscopic surgery, which proved effective in small randomized controlled trials in highly selected patients. Few studies have evaluated minimally invasive drainage methods used under the conditions of everyday hospital practice. The aim of this study was to determine whether, compared with conventional open surgery, minimally invasive drainage was associated with improved outcomes of critically ill patients with infection complicating acute necrotizing pancreatitis. Methods A single-center observational study was conducted in patients admitted to the intensive care unit for severe acute necrotizing pancreatitis to compare the characteristics, drainage techniques, and outcomes of the 62 patients managed between September 2006 and December 2010, chiefly with conventional open surgery, and of the 81 patients managed between January 2011 and August 2015 after the introduction of a minimally invasive drainage protocol. Results Surgical necrosectomy was more common in the early period (74% versus 41%; P <0.001), and use of minimally invasive drainage increased between the early and late periods (19% and 52%, respectively; P <0.001). The numbers of ventilator-free days and catecholamine-free days by day 30 were higher during the later period. The proportions of patients discharged from intensive care within the first 30 days and from the hospital within the first 90 days were higher during the second period. Hospital mortality was not significantly different between the early and late periods (19% and 22%, respectively). Conclusion In our study, the implementation of a minimally invasive drainage protocol in patients with infected pancreatic necrosis was associated with shorter times spent with organ dysfunction, in the intensive care unit, and in the hospital. Mortality was not significantly different. These results should be interpreted bearing in mind the limitations inherent in the before-after study design.
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Affiliation(s)
- Lucie Darrivere
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathanael Lapidus
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Public Health Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nikias Colignon
- Radiology Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Najim Chafai
- Digestive Surgery Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ulriikka Chaput
- Endoscopy Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Franck Verdonk
- Sorbonne University, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Paye
- Sorbonne University, Digestive Surgery Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Sorbonne University, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Kumar P, Gupta P, Rana S. Thoracic complications of pancreatitis. JGH OPEN 2018; 3:71-79. [PMID: 30834344 PMCID: PMC6386740 DOI: 10.1002/jgh3.12099] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Abstract
Acute pancreatitis in its severe form may lead to systemic inflammatory response syndrome and multisystem organ dysfunction. Acute lung injury is an important cause of mortality in the setting of severe acute pancreatitis. Besides lung involvement, acute and chronic pancreatitis may also lead to the involvement of other thoracic compartments, including mediastinum, pleura, and vascular structures. These manifestations are an important cause of morbidity and may pose diagnostic and therapeutic challenges. These manifestations have not been discussed in detail in the available literature. In this review, we discuss the thoracic complications of pancreatitis, including lung, pleural, mediastinal, and vascular manifestations.
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Affiliation(s)
- Prem Kumar
- Department of Radiodiagnosis and Imaging Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Pankaj Gupta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Surinder Rana
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
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Koop AH, Bailey RE, Lowman PE. Acute pancreatitis-induced takotsubo cardiomyopathy and cardiogenic shock treated with a percutaneous left ventricular assist device. BMJ Case Rep 2018; 2018:bcr-2018-225877. [PMID: 30317201 DOI: 10.1136/bcr-2018-225877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A 63-year-old man was admitted for severe acute pancreatitis. On day 3 of hospitalisation, he developed shortness of breath and acute pulmonary oedema. Echocardiogram revealed global hypokinesis with a left ventricular ejection fraction of 20%, and he was diagnosed with takotsubo cardiomyopathy. He developed cardiogenic shock which was treated successfully with a percutaneous left ventricular assist device. His left ventricular ejection fraction improved by hospital follow-up 3 weeks later.
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Affiliation(s)
- Andree H Koop
- Department of Critical Care Medicine, Mayo Clinic's Campus in Florida, Jacksonville, Florida, USA
| | - Ryan E Bailey
- Department of Critical Care Medicine, Mayo Clinic's Campus in Florida, Jacksonville, Florida, USA
| | - Philip E Lowman
- Department of Critical Care Medicine, Mayo Clinic's Campus in Florida, Jacksonville, Florida, USA
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Affiliation(s)
- Apurwa Karki
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 32610, United States
| | - Leonard Riley
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 32610, United States
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 32610, United States
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Rd, M452, PO Box 100225, Gainesville, FL 32610, United States.
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38
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Is MicroRNA-127 a Novel Biomarker for Acute Pancreatitis with Lung Injury? DISEASE MARKERS 2017; 2017:1204295. [PMID: 29434409 PMCID: PMC5757136 DOI: 10.1155/2017/1204295] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/23/2017] [Accepted: 10/15/2017] [Indexed: 02/05/2023]
Abstract
Background and Aims The aim of this study was to determine the expression of microRNA-127 (miR-127) in both rat models and patients of acute pancreatitis (AP) with lung injury (LI). Methods Rats were administrated with retrograde cholangiopancreatography injection of 0.5% or 3.5% sodium taurocholate to induce AP with mild or severe LI and were sacrificed at 6, 12, and 24 h. Rats from the control group received a laparotomy only. Plasma from a prospective cohort of AP patients was collected. The levels of miR-127 in the tissues and plasma were detected using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Results The upregulation of miR-127 in the lungs of rats was detected in the groups of AP with severe LI at 6 h and 24 h, whereas it was scarcely detectable in plasma. In the pilot study that included 18 AP patients and 5 healthy volunteers, the plasma miR-127 level was significantly downregulated in AP patients with respiratory failure compared with the healthy volunteers (P = 0.014) and those without respiratory failure (P = 0.043). Conclusion miR-127 might serve as a potential marker for the identification of AP with LI.
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Zhu R, Zhao Y, Li X, Bai T, Wang S, Wang W, Sun Y. Effects of penehyclidine hydrochloride on severe acute pancreatitis-associated acute lung injury in rats. Biomed Pharmacother 2017; 97:1689-1693. [PMID: 29793332 DOI: 10.1016/j.biopha.2017.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/28/2022] Open
Abstract
Penehyclidine hydrochloride (PHC) is a selective M1 and M3 receptor antagonist. This study was designed to investigate the effect of PHC on acute lung injury (ALI) induced by severe acute pancreatitis (SAP) and the expression of hypoxia-inducible factor-1α (HIF-1α) in rats. A total of 45 healthy adult male SD rats were randomly divided into 3 groups: an S group, sham operation; an ALI group, pancreatitis-associated acute lung injury (PALI); and a P group, PALI treated with PHC. Rats from the ALI and P groups were used to establish a model of acute lung injury associated with SAP by retrograde injection of 4% sodium taurocholate into the biliopancreatic duct. Rats in the P group, reflecting acute lung injury caused by SAP, were treated with PHC immediately following SAP. Rats in the S and ALI groups were injected with the same amount of 0.9% sodium chloride solution. After modeling, the rats were sacrificed at 12h. The wet/dry weight (W/D) ratios of lung tissue were calculated. Pathological changes in pancreatic and lung tissues were scored. The expression levels of TLR4 and NF-κB p65 in lung tissue were detected by Western blot. RT-PCR was used to detect HIF-1α mRNA in lung tissue. The HIF-1α, IL-1β, and IL-6 expression levels in lung tissues and serum amylase levels were detected by ELISA. The results showed extensive infiltration of neutrophils, alveolar hemorrhage and necrosis and fat necrosis in the pancreatic tissue of rats in the PALI and P groups. Their pancreatic tissue injury scores were significantly higher than the score of the S group (P<0.01). However, no statistically significant difference was observed in the serum amylase levels of the P and ALI groups (P>0.05). The W/D ratios of lung tissue in the ALI and P group rats were significantly higher than those in the S group (P<0.05). Compared with those of the ALI group rats, the lung tissue pathological changes of the P group were significantly improved, and the lung W/D value was significantly lower than that of the ALI group (P<0.05). Compared with those of the S group, the TLR4, NF-κB p65, HIF-1α mRNA, and HIF-1α expression levels in the lung tissue of the ALI and P groups were significantly higher (P<0.01), and the TLR4, NF-κB p65, HIF-1α mRNA, HIF-1α, IL-1β and IL-6 expression levels in the P group were significantly lower than those in the ALI group (P<0.05). The current work indicates that PHC could not alleviate the damage to pancreatic tissue caused by SAP. However, PHC did suppress HIF-1α, IL-1β and IL-6 expression levels and reduced the acute lung injury induced by SAP in rats, which might depend on suppression of the expression of inflammatory factors, such as HIF-1α.
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Affiliation(s)
- Rongtao Zhu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yipu Zhao
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Xiaobo Li
- College of Clinical Medicine, Xinxiang Medical University, Xinxiang, Henan, 453003, PR China
| | - Tao Bai
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Shuai Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Weijie Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yuling Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China.
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Deschemin JC, Mathieu JRR, Zumerle S, Peyssonnaux C, Vaulont S. Pulmonary Iron Homeostasis in Hepcidin Knockout Mice. Front Physiol 2017; 8:804. [PMID: 29089902 PMCID: PMC5650979 DOI: 10.3389/fphys.2017.00804] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/29/2017] [Indexed: 12/29/2022] Open
Abstract
Pulmonary iron excess is deleterious and contributes to a range of chronic and acute inflammatory diseases. Optimal lung iron concentration is maintained through dynamic regulation of iron transport and storage proteins. The iron-regulatory hormone hepcidin is also expressed in the lung. In order to better understand the interactions between iron-associated molecules and the hepcidin-ferroportin axis in lung iron balance, we examined lung physiology and inflammatory responses in two murine models of systemic iron-loading, either hepcidin knock-out (Hepc KO) or liver-specific hepcidin KO mice (Hepc KOliv), which do (Hepc KOliv) or do not (Hepc KO) express lung hepcidin. We have found that increased plasma iron in Hepc KO mice is associated with increased pulmonary iron levels, consistent with increased cellular iron uptake by pulmonary epithelial cells, together with an increase at the apical membrane of the cells of the iron exporter ferroportin, consistent with increased iron export in the alveoli. Subsequently, alveolar macrophages (AM) accumulate iron in a non-toxic form and this is associated with elevated production of ferritin. The accumulation of iron in the lung macrophages of hepcidin KO mice contrasts with splenic and hepatic macrophages which contain low iron levels as we have previously reported. Hepc KOliv mice with liver-specific hepcidin deficiency demonstrated same pulmonary iron overload profile as the Hepc KO mice, suggesting that pulmonary hepcidin is not critical in maintaining local iron homeostasis. In addition, the high iron load in the lung of Hepc KO mice does not appear to enhance acute lung inflammation or injury. Lastly, we have shown that intraperitoneal LPS injection is not associated with pulmonary hepcidin induction, despite high levels of inflammatory cytokines. However, intranasal LPS injection stimulates a hepcidin response, likely derived from AM, and alters pulmonary iron content in Hepc KO mice.
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Affiliation(s)
- Jean-Christophe Deschemin
- Institut National de la Santé et de la Recherche Médicale, U1016 Institut Cochin, Paris, France.,Centre National de la Recherche Scientifique, UMR 8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Jacques R R Mathieu
- Institut National de la Santé et de la Recherche Médicale, U1016 Institut Cochin, Paris, France.,Centre National de la Recherche Scientifique, UMR 8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Sara Zumerle
- Institut National de la Santé et de la Recherche Médicale, U1016 Institut Cochin, Paris, France.,Centre National de la Recherche Scientifique, UMR 8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Carole Peyssonnaux
- Institut National de la Santé et de la Recherche Médicale, U1016 Institut Cochin, Paris, France.,Centre National de la Recherche Scientifique, UMR 8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Sophie Vaulont
- Institut National de la Santé et de la Recherche Médicale, U1016 Institut Cochin, Paris, France.,Centre National de la Recherche Scientifique, UMR 8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
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Xu J, Huang B, Wang Y, Tong C, Xie P, Fan R, Gao Z. Emodin ameliorates acute lung injury induced by severe acute pancreatitis through the up-regulated expressions of AQP1 and AQP5 in lung. Clin Exp Pharmacol Physiol 2017; 43:1071-1079. [PMID: 27452155 DOI: 10.1111/1440-1681.12627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022]
Abstract
The present study investigates the ameliorating effects of emodin on acute lung injury (ALI) induced by severe acute pancreatitis (SAP). An ALI rat model was constructed by sodium ursodeoxycholate and they were divided into four groups: SHAM, ALI, emodin and dexamethasone (DEX) (n=24 per group). Blood samples and lung tissues were collected 6, 12 and 24 hours after the induction of SAP-associated ALI. Lung wet/dry ratio, blood gases, serum amylase and tumor necrosis factor-α (TNF-α) were measured at each time point. The expressions of AQP1 and AQP5 in lung tissue were detected by immunohistochemical staining, western blotting and real-time PCR. As the results show, there were no statistical differences in the levels of serum amylase, lung wet/dry ratio, blood gases indexes, serum TNF-α and pathological changes between emodin and DEX groups. However, significant differences were observed when compared with the ALI group. AQP1 and AQP5 expressions were significantly increased and lung oedemas were alleviated with the treatment of emodin and DEX. The expressions of AQP1 and AQP5 were significantly decreased in SAP-associated ALI rats. Emodin up-regulated the expression of AQP1 and AQP5, it could reduce pulmonary oedema and ameliorate SAP-induced ALI. Regulations on AQP1 and AQP5 expression had a great value in clinical application.
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Affiliation(s)
- Junfeng Xu
- Department of General Surgery, the First People's Hospital of Xiaoshan District of Hangzhou City, Hangzhou, China
| | - Bo Huang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Dalian Medical University, Dalian, China
| | - Yu Wang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Dalian Medical University, Dalian, China
| | - Caiyu Tong
- Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Dalian Medical University, Dalian, China
| | - Peng Xie
- Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Dalian Medical University, Dalian, China
| | - Rong Fan
- VIP Ward No. 2, the Second Hospital of Dalian Medical University, Dalian, China.
| | - Zhenming Gao
- Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Dalian Medical University, Dalian, China.
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Avanesov M, Löser A, Keller S, Weinrich JM, Laqmani A, Adam G, Karul M, Yamamura J. Diagnosing acute pancreatitis-Clinical and radiological characterisation of patients without threefold increase of serum lipase. Eur J Radiol 2017; 95:278-285. [PMID: 28987680 DOI: 10.1016/j.ejrad.2017.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/29/2017] [Accepted: 08/29/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Diagnosing acute pancreatitis (AP) may be challenging in patients with acute abdominal pain but missing threefold increased serum lipase levels (Lip-). This studyaims both to characterize these patients using clinical, radiological and mortality data, and to assess the group of patients who need contrast-enhanced computed tomography (CECT). METHODS In this retrospective, IRB approved study 234 consecutive patients with AP were investigated. Inclusion criteria were single (SAP) and recurrent attacks (RAP) of AP and CECT ≥72h after onset of symptoms. Severity of AP was assessed by C-reactive protein at 48h after hospital admission and using 3 CT-based scores (CTSI, mCTSI, EPIC) by 2 observers. Mortality rates from pancreatic and non-pancreatic causes were noted with regard to lipase increase. Results were compared with paired t-test and Wilcoxon signed-rank test. RESULTS 64/234 (27%) patients belonged to Lip- group and 170/234 (73%) patients were allocated to Lip+ group. Significantly more male patients (78% in Lip- vs. 63% in Lip+, p<0.05) with RAP (63% in Lip- vs. 21% in Lip+, p<0.001) were observed in the Lip- group. EPIC was significantly lower in Lip- group compared to Lip+ group (3(IQR 2-5) vs. 2(IQR 1-3), p<0.001). Mortality from pancreatic and non-pancreatic causes was comparable in Lip- and Lip+ group (pancreatic causes: 9% vs. 6%, p=0.60; nonpancreatic causes: 8% vs. 5%, p=0.58). CONCLUSIONS 27% of all patients with AP presented without threefold increase of lipase levels. Thus, they would be underdiagnosed without confirming CECT, which revealed significantly lower counts of pleural effusions and ascites. Male patients with RAP were found significantly more often among the Lip- group. Hence, they would benefit the most from CECT for diagnosing AP.
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Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Anastassia Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Sarah Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Julius M Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Azien Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Murat Karul
- Department of Diagnostic and Interventional Radiology, Marienkrankenhaus Hamburg, Alfredstraße 9, 22087, Hamburg, Germany.
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Sağlam K, Alhan E, Türkyılmaz S, Vanizor BK, Erçin C. The anti-inflammatory effect of hydrogen sulphide on acute necrotizing pancreatitis in rats. Turk J Surg 2017; 33:158-163. [PMID: 28944326 DOI: 10.5152/ucd.2017.3653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/04/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the dose-dependent anti-inflammatory effect of the Hydrogen sulfidedonor sodiumhydrosulphide on acute necrotizing pancreatitis in rats. MATERIAL AND METHODS A total of 42 male Sprague-Dawley rats were divided into 4 groups: sham+saline (group 1), sham+NaHS (group 2), acute necrotizing pancreatitis+saline (group 3), and acute necrotizing pancreatitis+NaHS (group 4). Acute pancreatitis was induced in rats in groups 3 and 4 with the infusion of glycodeoxycholic acidinto the biliopancreatic canal and infusion of cerulein parenterally. In group 4, 10 mg/kg NaHS was administered intraperitoneally after cerulein infusion. Tests for liver and kidney function, interleukin-6, lactate dehydrogenase in bronchoalveolar lavage, and malonyaldehyde and myeloperoxidase activities in pancreas and lung tissue were performed, and histopathologic examination of pancreas was conducted. RESULTS In groups 3, a significant increase in amylase, alanine aminotransferase, urea, interleukine-6, lungmalondialdehyde and myeloperoxidase activities, pancreas myeloperoxidase activity, edema, and necrosis in pancreas tissue and a significant decrease in serum calcium levels were detected (p<0.05). In group 4, addition of NaHS resulted in a significant decrease in lactate dehydrogenase level in bronchoalveolar lavage, amount of urea, lung myeloperoxidase activity, and pancreatic edema (p<0.05). CONCLUSION Although not in pancreatic necrosis, hydrogen sulphide has an anti-inflammatory effect especially in the inflammatory process in lung and edema in pancreasin acute necrotizing pancreatitis at particular doses. With further studies evaluating the anti-inflammatory effects of hydrogen sulphide, we believe it can be used in the treatment of edematous acute pancreatitis and the related complications in lungs.
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Affiliation(s)
- Kutay Sağlam
- Department of General Surgery, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Etem Alhan
- Department of General Surgery, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Serdar Türkyılmaz
- Department of General Surgery, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Birgül Kural Vanizor
- Department of Medical Biochemistry, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Cengiz Erçin
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Safadi S, Lee S, Thompson W, McCarthy D. Acute Abdominal Pain: When the Whole Is Greater Than the Sum of Its Parts. Dig Dis Sci 2017; 62:1168-1172. [PMID: 28391414 DOI: 10.1007/s10620-017-4569-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Sarah Safadi
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Sarah Lee
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, MSC10-5550, Albuquerque, NM, 87131, USA.
| | - William Thompson
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, MSC10-5550, Albuquerque, NM, 87131, USA
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Morphological and immunobiochemical analysis of the liver in L-arginine induced experimental chronic pancreatitis. Pancreatology 2017; 17:247-254. [PMID: 28131523 DOI: 10.1016/j.pan.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 12/21/2016] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical evidence indicates that hepatic abnormalities in patients with chronic pancreatitis are not uncommon. Here we aimed to study the possible association between liver and pancreatic damage in a recently described experimental mouse model of CP. METHODS The severity of the damage to pancreas, liver and other organs was assessed by biochemical markers and histopathology. The methods applied included Hematoxylin Eosin staining, electron microscope examination, biochemical measurements, RT-PCR, ELISA, and the correlations among some of the parameters contributing to these changes were statistically analyzed. RESULTS The hepatic aberrations were mainly represented by mild infiltration of inflammatory cells in portal triad and congestion of central vein of liver, and the main features of drug-induced hepatotoxicity could not be observed. Severe fibrosis of pancreatic tissue was noticed in experimental group, and the existence of multiple organ injuries was also seen under the microscope. Hepatic pathologic scores were positively correlated with those from the corresponding pancreatic specimens (r = 0.72, P < 0.01). TGF-β1 protein levels significantly elevated both in the test pancreas and liver (P < 0.05) and these values were positively correlated (r = 0.86, P < 0.01). The level of interleukin-1β was increased in the serum and tissue of the liver. In addition, cardiac troponin (Tn-I) level not only significantly increased in myocardial homogenates (P < 0.05) but also was positively correlated with the corresponding pathologic score of the liver (r = 0.88, P < 0.01). CONCLUSION The liver aberrations might be associated with L-arginine induced chronic pancreatitis.
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Akhter S, Khan ZURR, Ahmed B, Ahmed F, Memon ZA. Complications of acute pancreatitis in tertiary care hospital. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2017. [DOI: 10.5348/ijhpd-2017-69-oa-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kim JH, Oh MJ. Acute Pancreatitis Complicated with Diabetic Ketoacidosis in a Young Adult without Hypertriglyceridemia: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 68:274-278. [PMID: 27871165 DOI: 10.4166/kjg.2016.68.5.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic complications related to acute pancreatitis include acute respiratory distress syndrome, multiple organ dysfunction syndrome, disseminated intravascular coagulation, hypocalcemia, hyperglycemia, and insulin dependent diabetes or diabetic ketoacidosis. In practice, the development of diabetic ketoacidosis induced by acute pancreatitis is rare and generally associated with hypertriglyceridemia. However, herein we report a case of a 34-year-old female without hypertriglyceridemia, who was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis. The patient was admitted with complaints of febrile sensation, back pain, and abdominal pain around the epigastric area. Levels of serum amylase and lipase were elevated to 663 U/L and 3,232 U/L. Contrast-enhanced abdominal CT showed pancreatic swelling, peri-pancreatic fat infiltration and fluid collection. The patient was initially diagnosed with simple acute pancreatitis. Though the symptoms were rapidly relieved after initiation of treatment, severe hyperglycemia (575 mg/dL), severe metabolic acidosis (pH 6.9), and ketonuria developed at four days after hospitalization. However, serum triglyceride levels remained within the normal range (134 mg/dL). Finally, the patient was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis unrelated to hypertriglyceridemia. She recovered through insulin and fluid therapy, and receives insulin therapy at the outpatient clinic.
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Affiliation(s)
- Jung Hyun Kim
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
| | - Myung Jin Oh
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
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Wetterholm E, Linders J, Merza M, Regner S, Thorlacius H. Platelet-derived CXCL4 regulates neutrophil infiltration and tissue damage in severe acute pancreatitis. Transl Res 2016; 176:105-18. [PMID: 27183218 DOI: 10.1016/j.trsl.2016.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/22/2022]
Abstract
Platelets are known to play an important role in acute pancreatitis (AP) via promotion of neutrophil accumulation, although mechanisms behind platelet-dependent accumulation of neutrophils in the pancreas remain elusive. Platelets contain a wide spectrum of different pro-inflammatory compounds, such as chemokines. CXCL4 (platelet factor 4) is one of the most abundant chemokine in platelets, and we hypothesized that CXCL4 might be involved in platelet-dependent accumulation of neutrophils in the inflamed pancreas. The aim of this study was to examine the role of CXCL4 in severe AP. Pancreatitis was provoked by infusion of taurocholate into the pancreatic duct or by intraperitoneal administration of L-arginine in C57BL/6 mice. Animals were treated with an antibody against platelets or CXCL4 before induction of pancreatitis. Plasma and lung levels of CXCL2, CXCL4, and interleukin (IL)-6 were determined by use of enzyme-linked immunosorbent assay. Flow cytometry was used to examine surface expression of macrophage-1 (Mac-1) on neutrophils. Plasma was obtained from healthy individuals (controls) and patients with AP. Challenge with taurocholate increased plasma levels of CXCL4, and depletion of platelets markedly reduced plasma levels of CXCL4 indicating that circulating levels of CXCL4 are mainly derived from platelets in AP. Inhibition of CXCL4 reduced taurocholate-induced neutrophil recruitment, IL-6 secretion, edema formation, amylase release, and tissue damage in the pancreas. However, immunoneutralization of CXCL4 had no effect on CXCL2-evoked neutrophil expression of Mac-1 or chemotaxis in vitro, suggesting an indirect effect of CXCL4 on neutrophil recruitment in AP. Targeting CXCL4 significantly attenuated plasma and lung levels of CXCL2, which is a potent neutrophil chemoattractant, and inhibition of the CXCL2 receptor attenuated neutrophil infiltration and tissue damage in the inflamed pancreas. A significant role of CXCL4 was confirmed in an alternate model of AP induced by L-arginine challenge. Moreover, patients with AP had significantly increased plasma levels of CXCL4 compared with healthy controls. These findings' results suggest that platelet-derived CXCL4 is a potent stimulator of neutrophil accumulation in AP and that this is mediated via generation of CXCL2 in the inflamed pancreas. We conclude that CXCL4 plays an important role in pancreatic inflammation and that targeting CXCL4 might be a useful way to ameliorate tissue damage in AP.
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Affiliation(s)
- Erik Wetterholm
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, Malmö, Sweden
| | - Johan Linders
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, Malmö, Sweden
| | - Mohammed Merza
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, Malmö, Sweden
| | - Sara Regner
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, Malmö, Sweden
| | - Henrik Thorlacius
- Department of Clinical Sciences, Malmö, Section for Surgery, Lund University, Malmö, Sweden.
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Vrolyk V, Wobeser BK, Al-Dissi AN, Carr A, Singh B. Lung Inflammation Associated With Clinical Acute Necrotizing Pancreatitis in Dogs. Vet Pathol 2016; 54:129-140. [DOI: 10.1177/0300985816646432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Although dogs with acute necrotizing pancreatitis (ANP) can develop respiratory complications, there are no data describing lung injury in clinical cases of ANP in dogs. Therefore, we conducted a study to characterize lung injury and determine if pulmonary intravascular macrophages (PIMs) are induced in dogs with ANP ( n = 21) compared with control dogs ( n = 6). Two pathologists independently graded histologic sections of pancreas from clinical cases to characterize the severity of ANP (total scores of 3–10) compared with controls showing histologically normal pancreas (total scores of 0). Based on histological grading, lungs from dogs with ANP showed inflammation (median score, 1.5; range, 0–3), but the scores did not differ statistically from the control lungs (median score, 0.5; range, 0–2). A grid intersects-counting method showed an increase in the numbers of MAC387-positive alveolar septal mononuclear phagocyte profiles in lungs of dogs with ANP (ratio median, 0.0243; range, 0.0093–0.0734, with 2 outliers at 0.1523 and 0.1978) compared with controls (ratio median, 0.0019; range, 0.0017–0.0031; P < .0001). Only dogs with ANP showed labeling for von Willebrand factor in alveolar septal capillary endothelial cells, septal inflammatory cells, and alveolar macrophages. Toll-like receptor 4 and interleukin 6 were variably expressed in alveolar macrophages and septal inflammatory cells in lungs from both ANP and control dogs. Inducible nitric oxide synthase was detected in alveolar macrophages of dogs with ANP only. These data show that dogs with ANP have lung inflammation, including the recruitment of PIMs and expression of inflammatory mediators.
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Affiliation(s)
- V. Vrolyk
- Departments of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - B. K. Wobeser
- Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - A. N. Al-Dissi
- Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - A. Carr
- Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - B. Singh
- Departments of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Srettabunjong S, Limgitisupasin W. Severe acute hemorrhagic pancreatitis secondary to cholelithiasis as a rare cause of sudden unexpected death in medico-legal case: A case report. Medicine (Baltimore) 2016; 95:e4680. [PMID: 27559973 PMCID: PMC5400340 DOI: 10.1097/md.0000000000004680] [Citation(s) in RCA: 2] [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] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Acute pancreatitis (AP) is an uncommon disease with a wide clinical course varying from mild and self-limiting to severe with eventual death. However, death caused by AP is rare. Most cases of AP reported in the English-language literature are based on clinical data; few are medico-legal studies. CASE PRESENTATION The author recently experienced a case of sudden unexpected death in a young man caused by extensive severe hemorrhagic AP secondary to cholelithiasis, not chronic alcoholism, which is a much more prominent etiology of AP in medico-legal perspectives. The deceased had complained of dizziness, nausea, and fatigue without significant abdominal pain for about 1 week and received some home medications for symptomatic treatment including an antibiotic drug from a clinic just 2 days prior to his death. He had complained of lower extremity weakness, intense thirst, and subsequently collapsed and was brought to a nearby hospital where he was pronounced dead shortly after his admission following unsuccessful advanced cardiopulmonary resuscitation attempts. CONCLUSION This case is herein reported with an extensive review of the pertinent literature to highlight the findings of the case and raise awareness within the medico-legal profession and also the medical profession.
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Affiliation(s)
- Supawon Srettabunjong
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Supawon Srettabunjong, Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (e-mail: )
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