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Li C, Wen Y, Tong Q, Peng Y, Yu D, Rao Y, Zeng Y. Gut microbiota-melatonin signaling axis in acute pancreatitis: Revealing the impact of gut health on pancreatic inflammation and disease severity in a case-control study. Medicine (Baltimore) 2024; 103:e38689. [PMID: 38996098 PMCID: PMC11245267 DOI: 10.1097/md.0000000000038689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/03/2024] [Indexed: 07/14/2024] Open
Abstract
Acute pancreatitis (AP), a severe inflammatory condition affecting the pancreas requires investigation into its predictors. Melatonin, a compound with anti-inflammatory and antioxidant properties, has shown promise in managing AP. Additionally, the gut microbiota, a community of microorganisms residing in the intestines has been linked to AP development. This study aims to explore the correlation between melatonin and gut microbiota in predicting AP severity. This study involved 199 participants, with 99 diagnosed with AP and 100 serving as healthy controls. The AP patients were categorized into 2 groups based on the severity of their condition: mild AP (MAP) and severe AP (SAP). Serum melatonin levels were measured on Days 1, 3, and 5 of hospitalization, and gut microbiota composition was examined via 16S rRNA gene sequencing. Other parameters were evaluated, such as the Acute Physiology and Chronic Health Evaluation (APACHE) score, Ranson, and Acute Gastrointestinal Injury (AGI) scores. Melatonin levels were significantly lower in subjects with severe AP compared those with mild AP (18.2 ng/mL vs 32.2 ng/mL, P = .001), and melatonin levels decreased significantly in patients with AP on Days 3 and 5. The study also revealed that individuals with AP exhibited a significantly altered gut microbiota composition compared to control individuals, with a lower Shannon index and higher Simpson index. The AUCs for Simpson index and F/B ratio were significantly higher than those for other biomarkers, indicating that these gut microbiota markers may also be useful for AP prediction. The study proposes that there is a relationship between melatonin levels and the dynamics of gut microbiota profiles in relation to the severity of AP. As a result, the severity of the disease can be assessed by assessing the levels of serum melatonin and gut microbiota profiles.
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Affiliation(s)
- Chao Li
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yangfen Wen
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Qiwen Tong
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yi Peng
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Dan Yu
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yisong Rao
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
| | - Yuehong Zeng
- Department of General Surgery, Yiyang Central Hospital, Yiyang City, China
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Garcia Borobia F, Flores Clotet R, Bejarano Gonzalez N, Gonzalez Martinez S, Garcia Monforte N, Romaguera Monzonis A, Gonzalez Abos C, Gonzalez Abos S, Lucas Guerrero V, Perez Perarnau A, Mota Villaplana F. Predictive Value of Antithrombin III and d -Dimer in the Development of Moderate-To-Severe Acute Pancreatitis : A Prospective, Observational Study (AT-PROPANC). Pancreas 2023; 52:e241-e248. [PMID: 37801622 DOI: 10.1097/mpa.0000000000002245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To analyze if antithrombin III (AT-III) and d -dimer levels at admission and at 24 hours can predict acute pancreatitis (AP) progression to moderately severe AP (MSAP) to severe AP (SAP) and to determine their predictive value on the development of necrosis, infected necrosis, organ failure, and mortality. METHODS Prospective observational study conducted in patients with mild AP in 2 tertiary hospitals (2015-2017). RESULTS Three hundred forty-six patients with mild AP were included. Forty-four patients (12.7%) evolved to MSAP/SAP. Necrosis was detected in 36 patients (10.4%); in 10 (2.9%), infection was confirmed. Organ failure was recorded in 9 patients (2.6%), all of whom died. Those who progressed to MSAP/SAP showed lower AT-III levels; d -dimer and C-reactive protein (CRP) levels increased. The best individual marker for MSAP/SAP at 24 hours is CRP (area under the curve [AUC], 0.839). Antithrombin III (AUC, 0.641), d -dimer (AUC, 0.783), and creatinine added no benefit compared with CRP alone. Similar results were observed for patients who progressed to necrosis, infected necrosis, and organ failure/death. CONCLUSION Low AT-III and high d -dimer plasma levels at 24 hours after admission were significantly associated with MSAP/SAP, although their predictive ability was low. C-reactive protein was the best marker tested. CLINICAL STUDY IDENTIFIER ClinicalTrials.gov NCT02373293.
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Affiliation(s)
- Francisco Garcia Borobia
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | - Roser Flores Clotet
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | - Natalia Bejarano Gonzalez
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | | | - Neus Garcia Monforte
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | - Andreu Romaguera Monzonis
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
| | | | - Sandra Gonzalez Abos
- Department of General Surgery, Consorci Sanitari Integral, L'Hospitalet de Llobregat
| | - Victoria Lucas Guerrero
- From the Department of General Surgery, Hepatobiliopancreatic Surgical Unit, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell
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Li J, Huang T, Xia M, Lu J, Xu X, Liu H, Zhang W. Exogenous melatonin mediates radish ( Raphanus sativus) and Alternaria brassicae interaction in a dose-dependent manner. FRONTIERS IN PLANT SCIENCE 2023; 14:1126669. [PMID: 36923135 PMCID: PMC10009256 DOI: 10.3389/fpls.2023.1126669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
Radish (Raphanus sativus L.) is an economically important vegetable worldwide, but its sustainable production and breeding are highly threatened by blight disease caused by Alternaria brassicae. Melatonin is an important growth regulator that can influence physiological activities in both plants and microbes and stimulate biotic stress resistance in plants. In this study, 0-1500 μM melatonin was exogenously applied to healthy radish seedlings, in vitro incubated A. brassicae, and diseased radish seedlings to determine the effects of melatonin on host, pathogen, and host-pathogen interaction. At sufficient concentrations (0-500 μM), melatonin enhanced growth and immunity of healthy radish seedlings by improving the function of organelles and promoting the biosynthesis of antioxidant enzymes, chitin, organic acid, and defense proteins. Interestingly, melatonin also improved colony growth, development, and virulence of A. brassicae. A strong dosage-dependent effect of melatonin was observed: 50-500 μM promoted host and pathogen vitality and resistance (500 μM was optimal) and 1500 μM inhibited these processes. Significantly less blight was observed on diseased seedlings treated with 500 μM melatonin, indicating that melatonin more strongly enhanced the growth and immunity of radish than it promoted the development and virulence of A. brassicae at this treatment concentration. These effects of MT were mediated by transcriptional changes of key genes as identified by RNA-seq, Dual RNA-seq, and qRT-PCR. The results from this work provide a theoretical basis for the application of melatonin to protect vegetable crops against pathogens.
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Affiliation(s)
- Jingwei Li
- Institute of Vegetable Industry Technology Research, Guizhou University, Guiyang, China
- College of Agriculture, Guizhou University, Guiyang, China
| | - Tingmin Huang
- Institute of Vegetable Industry Technology Research, Guizhou University, Guiyang, China
- College of Agriculture, Guizhou University, Guiyang, China
| | - Ming Xia
- Institute of Vegetable Industry Technology Research, Guizhou University, Guiyang, China
- College of Agriculture, Guizhou University, Guiyang, China
- School of Computing, Chongqing College of Humanities, Science and Technology, Hechuan, China
| | - Jinbiao Lu
- Institute of Vegetable Industry Technology Research, Guizhou University, Guiyang, China
- College of Agriculture, Guizhou University, Guiyang, China
| | - Xiuhong Xu
- Institute of Vegetable Industry Technology Research, Guizhou University, Guiyang, China
- College of Agriculture, Guizhou University, Guiyang, China
| | - Haiyi Liu
- Institute of Vegetable Industry Technology Research, Guizhou University, Guiyang, China
- College of Agriculture, Guizhou University, Guiyang, China
| | - Wanping Zhang
- Institute of Vegetable Industry Technology Research, Guizhou University, Guiyang, China
- College of Agriculture, Guizhou University, Guiyang, China
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Lila A, Hiljadnikova Bajro M. Biochemical markers for diagnosing and monitoring of acute pancreatitis. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Anel Lila
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Mother Theresa 47, 1000 Skopje, R.N. Macedonia
| | - Marija Hiljadnikova Bajro
- Ss Cyril and Methodius University in Skopje, Faculty of Pharmacy, Mother Theresa 47, 1000 Skopje, R.N. Macedonia
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Yan XB, Shen DC. Overview and prospect of serum markers for early prediction of severity of acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2020; 28:796-801. [DOI: 10.11569/wcjd.v28.i16.796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis (AP) is one of the most common and potentially fatal emergencies of the digestive system. Aseptic inflammation of the pancreas caused by self-digestion of trypsin is considered to be the main pathogenesis of AP. The clinical course and prognosis of AP with different degrees of severity vary greatly, so early prediction of the severity of AP is of great significance to the diagnosis and treatment of this disease. In recent years, great progress has been made in the early risk assessment and severity stratification of AP patients with serum markers. This article gives an overview and discuss the prospects of serum markers for early prediction of the severity of AP.
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Affiliation(s)
- Xue-Bo Yan
- Department of Hepatobiliary and Pancreatosplenic Surgery, The Affiliated Zhuzhou Hospital Xiangya Medical College of Central South University, Zhuzhou 412007, Hunan Province, China
| | - Ding-Cheng Shen
- Department of Hepatobiliary and Pancreatosplenic Surgery, The Affiliated Zhuzhou Hospital Xiangya Medical College of Central South University, Zhuzhou 412007, Hunan Province, China
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Leja-Szpak A, Nawrot-Porąbka K, Góralska M, Jastrzębska M, Link-Lenczowski P, Bonior J, Pierzchalski P, Jaworek J. Melatonin and its metabolite N1-acetyl-N2-formyl-5-methoxykynuramine (afmk) enhance chemosensitivity to gemcitabine in pancreatic carcinoma cells (PANC-1). Pharmacol Rep 2018; 70:1079-1088. [PMID: 30308458 DOI: 10.1016/j.pharep.2018.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gemcitabine is a standard chemotherapeutic agent for patients suffering from pancreatic cancer. However, the applied therapy is not effective due to the resistance of tumor cells to cytostatics, caused by inefficiency of the apoptotic mechanisms. Herein, we present the hypothesis that melatonin and its metabolite N1-acetyl-N2-formyl-5-methoxykynuramine (AFMK) modify the effect of gemcitabine on PANC-1 cells and that this phenomenon is dependent on the modulation of apoptosis. METHODS PANC-1 cells have been incubated with melatonin, AFMK or gemcitabine alone or in combination to determine the cytotoxity and proliferative effects. In subsequent part of the study, cells were harvested, the proteins were isolated and analyzed employing immunoprecipitation/immunoblotting. RESULTS Incubation of PANC-1 cells with gemcitabine resulted in upregulation of pro-apoptotic bax and caspases proteins expression, downregulation of anti-apoptotic Bcl-2, heat shock proteins (HSPs) and modulation of cellular inhibitors of apoptosis (IAPs). Both melatonin and AFMK administered to PANC-1 in combination with gemcitabine inhibited the production of HSP70 and cIAP-2 as compared to the results obtained with gemcitabine alone. These changes were accompanied by upregulation of Bax/Bcl-2 ratio and reduction of procaspases-9 and -3 abundance, followed by an increase in the formation of active caspase of PANC-1 cells with combination of gemcitabine plus low doses of melatonin or AFMK led to enhanced cytotoxicity and resulted in the inhibition of PANC-1 cells growth as compared to effects of gemcitabine alone. CONCLUSION Melatonin and AFMK could improve the anti-tumor effect of gemcitabine in PANC-1 cells presumably through the modulation of apoptotic pathway.
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Affiliation(s)
- Anna Leja-Szpak
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland.
| | - Katarzyna Nawrot-Porąbka
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland
| | - Marta Góralska
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland
| | - Martyna Jastrzębska
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland
| | - Paweł Link-Lenczowski
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland
| | - Joanna Bonior
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland
| | - Piotr Pierzchalski
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland
| | - Jolanta Jaworek
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University School of Medicine, Kraków, Poland
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Qi H, Wang W, Gao X, Xiao Q, Zhu B, Li W, Liu Y, Li J, Wang P, Ma G. Effect of soluble CD14 subtype on the prognosis evaluation of acute paraquat poisoning patients. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:10392-10398. [PMID: 31966375 PMCID: PMC6965770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/04/2017] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To study the relationship between soluble CD14 subtype (also named presepsin) and the prognosis of acute paraquat poisoning (APP) patients. METHODS We studied 85 APP patients who were divided into three groups: light (21 cases), moderate (37 cases) and heavy poisoning (27 cases) groups. Fifty healthy subjects were as control group. According to the conditions of prognosis, they were divided into two groups: survive group (28 cases) and death group (57 cases). We measured the concentration of presepsin in serum and the levels of CRP, TNF-α, IL-6 and IL-10 in venous blood. APACHE II scores were observed before treatment, 72 h and 7 d after treatment. RESULTS The levels of presepsin, CRP, TNF-α, IL-6 and the scores of APACHE II in patients of three poisoning groups were increased at three different time points compared with control group, while the level of IL-10 was decreased. And there were significant differences between each poisoning groups (P<0.05). The levels of prespsin, CRP, TNF-α, IL-6 and the scores of APACHE II in patients of death group were higher than survive group at three different time points, while the level of IL-10 was lower (P<0.05). The mortality rates of three poisoning groups were 28.57%, 70.27% and 92.59%, and there were significant differences between each poisoning groups (P<0.05). The area under curve (AUC) of presepsin level and APACHE II scores of APP patients on admission were 0.862 and 0.731, respectively. Presepsin had a better predictive ability than APACHE II score for 28-day mortality rate in APP patients (P<0.05). The level of presepsin was negatively correlated with survival rates (r=0.291, P=0.007). CONCLUSION Monitoring the level of presepsin in serum has an important role in assessing the severity of APP patients, guiding treatment and predicting prognosis.
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Jaworek J, Leja-Szpak A, Nawrot-Porąbka K, Szklarczyk J, Kot M, Pierzchalski P, Góralska M, Ceranowicz P, Warzecha Z, Dembinski A, Bonior J. Effects of Melatonin and Its Analogues on Pancreatic Inflammation, Enzyme Secretion, and Tumorigenesis. Int J Mol Sci 2017; 18:ijms18051014. [PMID: 28481310 PMCID: PMC5454927 DOI: 10.3390/ijms18051014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 12/14/2022] Open
Abstract
Melatonin is an indoleamine produced from the amino acid l-tryptophan, whereas metabolites of melatonin are known as kynuramines. One of the best-known kynuramines is N1-acetyl-N1-formyl-5-methoxykynuramine (AFMK). Melatonin has attracted scientific attention as a potent antioxidant and protector of tissue against oxidative stress. l-Tryptophan and kynuramines share common beneficial features with melatonin. Melatonin was originally discovered as a pineal product, has been detected in the gastrointestinal tract, and its receptors have been identified in the pancreas. The role of melatonin in the pancreatic gland is not explained, however several arguments support the opinion that melatonin is probably implicated in the physiology and pathophysiology of the pancreas. (1) Melatonin stimulates pancreatic enzyme secretion through the activation of entero-pancreatic reflex and cholecystokinin (CCK) release. l-Tryptophan and AFMK are less effective than melatonin in the stimulation of pancreatic exocrine function; (2) Melatonin is a successful pancreatic protector, which prevents the pancreas from developing of acute pancreatitis and reduces pancreatic damage. This effect is related to its direct and indirect antioxidant action, to the strengthening of immune defense, and to the modulation of apoptosis. Like melatonin, its precursor and AFMK are able to mimic its protective effect, and it is commonly accepted that all these substances create an antioxidant cascade to intensify the pancreatic protection and acinar cells viability; (3) In pancreatic cancer cells, melatonin and AFMK activated a signal transduction pathway for apoptosis and stimulated heat shock proteins. The role of melatonin and AFMK in pancreatic tumorigenesis remains to be elucidated.
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Affiliation(s)
- Jolanta Jaworek
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
| | - Anna Leja-Szpak
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
| | - Katarzyna Nawrot-Porąbka
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
| | - Joanna Szklarczyk
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
| | - Michalina Kot
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
| | - Piotr Pierzchalski
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
| | - Marta Góralska
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Kraków, Poland.
| | - Zygmunt Warzecha
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Kraków, Poland.
| | - Artur Dembinski
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Kraków, Poland.
| | - Joanna Bonior
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Kraków, Poland.
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Uysal P, Avcil S, Abas Bİ, Yenisey Ç. Evaluation of Oxidant-Antioxidant Balance in Children with Atopic Dermatitis: A Case-Control Study. Am J Clin Dermatol 2016; 17:527-537. [PMID: 27417112 DOI: 10.1007/s40257-016-0210-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Increased reactive oxygen species (ROS) and oxidative stress (OS) has been reported in many allergic and inflammatory skin diseases, including urticaria, psoriasis, and atopic dermatitis (AD). Melatonin is a hormone secreted from the pineal gland and is a potent antioxidant. OBJECTIVE The aim of the study was to measure serum antioxidant melatonin, oxidants of nitric oxide (NO), and malondialdehyde levels to calculate the serum oxidant-antioxidant balance based on the NO/melatonin and malondialdehyde/melatonin ratios and to determine the correlation with the disease severity in children with AD. METHODS Seventy-three children with AD and 67 healthy controls were included in the study. The clinical diagnosis of AD was based on the diagnostic criteria of Hanifin-Rajka. The severity of AD was evaluated by the scoring AD (SCORAD) index, and atopy was determined by skin prick tests (SPTs) with commercial extracts. The OS-related parameters of serum melatonin, NO, malondialdehyde, and the NO/melatonin and malondialdehyde/melatonin ratios were calculated and compared with the results of healthy controls. RESULTS Serum melatonin levels were higher (p < 0.0001) and serum NO levels and the NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls (p = 0.045, p < 0.0001, p < 0.0001, respectively). There was no difference between children with AD and healthy controls in terms of serum malondialdehyde levels (p = 0.119). Serum melatonin levels were significantly lower in severe AD than in mild AD (p = 0.012). However, in terms of serum melatonin levels, there was no difference between mild and moderate AD (p = 0.742) and moderate to severe AD (p = 0.301). There was no significant difference in serum NO and malondialdehyde levels and NO/melatonin and malondialdehyde/melatonin ratios among children with mild, moderate, and severe AD (p > 0.05). A negative correlation was found between serum melatonin levels and the SCORAD index (r = -0.252, p = 0.031), and a positive correlation was found between NO/melatonin and malondialdehyde/melatonin ratios (r = 0.511, p < 0.0001). There was no statistically significant relationship between age (≤24 or >24 months), disease duration (≤6 or >6 months), and sex for the OS-related parameters (p > 0.05). CONCLUSION The serum oxidant-antioxidant balance was impaired in children with AD. Serum melatonin levels were higher in children with AD; however, this was negatively correlated with disease severity. Serum NO levels and NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls. Melatonin might be used as a promising antioxidant to evaluate disease severity in children with AD. Thus, further studies are needed to clarify the role of melatonin in AD pathogenesis.
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Affiliation(s)
- Pınar Uysal
- Department of Pediatric Allergy and Immunology, Adnan Menderes University Hospital, 09200, Aydın, Turkey.
| | - Sibelnur Avcil
- Department of Child and Adolescent Psychiatry, Adnan Menderes University Hospital, 09200, Aydın, Turkey
| | - Burçin İrem Abas
- Department of Biochemistry, Adnan Menderes University Hospital, 09200, Aydın, Turkey
| | - Çiğdem Yenisey
- Department of Biochemistry, Adnan Menderes University Hospital, 09200, Aydın, Turkey
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Hernández-Velázquez B, Camara-Lemarroy CR, González-González JA, García-Compean D, Monreal-Robles R, Cordero-Pérez P, Muñoz-Espinosa LE. Effects of melatonin on the acute inflammatory response associated with endoscopic retrograde cholangiopancreatography: A randomized, double-blind, placebo-controlled trial. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2016; 81:141-8. [PMID: 27320538 DOI: 10.1016/j.rgmx.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an acute inflammatory response and melatonin has a variety of immunomodulatory and antioxidant effects studied experimentally in pancreatobiliary pathology. AIMS The aim of our study was to evaluate the effects of peri-procedural administration of melatonin on the inflammatory response and lipid peroxidation associated with ERCP. METHODS In this proof-of-concept clinical trial, 37 patients with a high probability of choledocholithiasis were randomized to receive peri-procedure (ERCP) melatonin or placebo. We measured the serum concentration of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), lipid peroxidation, amylase, and liver function tests 24h before and after the procedure. RESULTS We found no pre-procedure or post-procedure differences between the melatonin group or the placebo group (P>.05) in the serum concentrations of TNF-alpha (melatonin: 153.8 vs. 149.4ng/m; placebo: 103.5 vs. 107.3ng/ml), IL-6 (melatonin: 131.8 vs. 133.3ng/ml; placebo: 177.8 vs. 197.8ng/ml), or VEGF (melatonin: 157.3 vs. 157.8pg/ml; placebo: 97.3 vs. 97.8pg/ml), or in relation to lipid peroxidation (melatonin: 39.2 vs. 72.3μg/ml; placebo: 66.4 vs. 90.5μg/ml). After ERCP, a significant decrease in the AST, ALT, and total bilirubin levels was found only in the melatonin group (P<.05). The administration of melatonin was safe and tolerable. CONCLUSIONS Melatonin is safe and tolerable in patients undergoing ERCP, but it does not appear to affect inflammatory cytokine concentrations or lipid peroxidation.
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Affiliation(s)
- B Hernández-Velázquez
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
| | - C R Camara-Lemarroy
- Departamento de Medicina Interna, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - J A González-González
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - D García-Compean
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - R Monreal-Robles
- Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - P Cordero-Pérez
- Unidad de Hígado, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - L E Muñoz-Espinosa
- Unidad de Hígado, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Hernández-Velázquez B, Camara-Lemarroy C, González-González J, García-Compean D, Monreal-Robles R, Cordero-Pérez P, Muñoz-Espinosa L. Effects of melatonin on the acute inflammatory response associated with endoscopic retrograde cholangiopancreatography: A randomized, double-blind, placebo-controlled trial. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2016.06.014] [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: 02/07/2023] Open
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Gillick K, Elbeltagi H, Bhattacharya S. Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis. Ann R Coll Surg Engl 2016; 98:61-6. [PMID: 26688403 PMCID: PMC5234374 DOI: 10.1308/rcsann.2015.0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Introduced originally to stratify risk for developing decubitus ulcers, the Waterlow scoring system is recorded routinely for surgical admissions. It is a composite score, reflecting patients' general condition and co-morbidities. The aim of this study was to investigate whether the Waterlow score can be used as an independent surrogate marker to predict severity and adverse outcome in acute pancreatitis. Methods In this retrospective analysis, a consecutive cohort was studied of 250 patients presenting with acute pancreatitis, all of whom had their Waterlow score calculated on admission. Primary outcome measures were length of hospital stay and mortality. Secondary outcome measures included rate of intensive care unit (ICU) admission and development of complications such as peripancreatic free fluid, pancreatic necrosis and pseudocyst formation. Correlation of the Waterlow score with some known markers of disease severity and outcomes was also analysed. Results The Waterlow score correlated strongly with the most commonly used marker of disease severity, the Glasgow score (analysis of variance, p=0.0012). Inpatient mortality, rate of ICU admission and length of hospital stay increased with a higher Waterlow score (Mann-Whitney U test, p=0.0007, p=0.049 and p=0.0002 respectively). There was, however, no significant association between the Waterlow score and the incidence of three known complications of pancreatitis: presence of peripancreatic fluid, pancreatic pseudocyst formation and pancreatic necrosis. Receiver operating characteristic curve analysis demonstrated good predictive power of the Waterlow score for mortality (area under the curve [AUC]: 0.73), ICU admission (AUC: 0.65) and length of stay >7 days (AUC: 0.64). This is comparable with the predictive power of the Glasgow score and C-reactive protein. Conclusions The Waterlow score for patients admitted with acute pancreatitis could provide a useful tool in prospective assessment of disease severity, help clinicians with appropriate resource management and inform patients.
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Affiliation(s)
- K Gillick
- Royal Devon and Exeter NHS Foundation Trust , UK
| | - H Elbeltagi
- Royal Devon and Exeter NHS Foundation Trust , UK
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Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis. J Biomark 2015; 2015:519534. [PMID: 26345247 PMCID: PMC4541003 DOI: 10.1155/2015/519534] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis is a potentially life threatening disease. The spectrum of severity of the illness ranges from mild self-limiting disease to a highly fatal severe necrotizing pancreatitis. Despite intensive research and improved patient care, overall mortality still remains high, reaching up to 30–40% in cases with infected pancreatic necrosis. Although little is known about the exact pathogenesis, it has been widely accepted that premature activation of digestive enzymes within the pancreatic acinar cell is the trigger that leads to autodigestion of pancreatic tissue which is followed by infiltration and activation of leukocytes. Extensive research has been done over the past few decades regarding their role in diagnosis and prognostic evaluation of severe acute pancreatitis. Although many standalone biochemical markers have been studied for early assessment of severity, C-reactive protein still remains the most frequently used along with Interleukin-6. In this review we have discussed briefly the pathogenesis and the role of different biochemical markers in the diagnosis and severity evaluation in acute pancreatitis.
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Staubli SM, Oertli D, Nebiker CA. Laboratory markers predicting severity of acute pancreatitis. Crit Rev Clin Lab Sci 2015; 52:273-83. [PMID: 26173077 DOI: 10.3109/10408363.2015.1051659] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute pancreatitis (AP) is an inflammatory disease of highly variable severity, ranging from mild cases with low mortality to severe cases with high mortality. Numerous biomarkers have been studied as potential early predictors of the severity of this disease so that treatment can be optimally tailored to prevent complications. We aim to present and discuss the most relevant biomarkers for early severity assessment in AP that have been studied to date. We review the current literature on biomarkers that have been used to predict the severity in AP. C-reactive protein (CRP) is still considered to be the gold standard, with a cut-off value of 150 mg/ml 48 h after disease onset. Other markers, including procalcitonin (PCT) and interleukin 6 (IL-6) have been implemented in some hospitals, but are not used on a routine basis. Most other markers, including acute phase proteins (LBP, SAA, PTX3), cytokines (Il-8, TNF-a, MIF), activation peptides of pancreatic proteases (TAP, CAPAP, PLAP), antiproteases (AAT, a2M), adhesion molecules (ICAM-1, selectins, E-cadherin) and leukocyte-derived enzymes (PA2, PMN-E) have shown some promising results but have not been routinely implemented. Furthermore, new and interesting biomarkers (Copeptin, TRX-1, Ang-2, E-2) have shown good results, but more research is needed to determine if they could play a role in the future. Various reasons why new markers for disease severity have not been adopted in daily routine include low accuracy, cumbersome laboratory techniques and high cost. Despite these difficulties, research is still very active in finding new markers to predict the severity of AP.
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Affiliation(s)
| | - Daniel Oertli
- a Department of General Surgery , University Hospital Basel , Basel , Switzerland
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Jaworek J, Konturek SJ. Hormonal protection in acute pancreatitis by ghrelin, leptin and melatonin. World J Gastroenterol 2014; 20:16902-16912. [PMID: 25493003 PMCID: PMC4258559 DOI: 10.3748/wjg.v20.i45.16902] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/15/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis is a nonbacterial disease of the pancreas. The severe form of this ailment is characterized by high mortality. Whether acute pancreatitis develops as the severe type or resolves depends on the intensity of the inflammatory process which is counteracted by the recruitment of innate defense mechanisms. It has been shown that the hormones ghrelin, leptin and melatonin are able to modulate the immune function of the organism and to protect the pancreas against inflammatory damage. Experimental studies have demonstrated that the application of these substances prior to the induction of acute pancreatitis significantly attenuated the intensity of the inflammation and reduced pancreatic tissue damage. The pancreatic protective mechanisms of the above hormones have been related to the mobilization of non-specific immune defense, to the inhibition of nuclear factor kappa B and modulation of cytokine production, to the stimulation of heat shock proteins and changes of apoptotic processes in the acinar cells, as well as to the activation of antioxidant system of the pancreatic tissue. The protective effect of ghrelin seems to be indirect and perhaps dependent on the release of growth hormone and insulin-like growth factor 1. Leptin and ghrelin, but not melatonin, employ sensory nerves in their beneficial action on acute pancreatitis. It is very likely that ghrelin, leptin and melatonin could be implicated in the natural protection of the pancreatic gland against inflammatory damage because the blood levels of these substances increase in the initial phase of pancreatic inflammation. The above hormones could be a part of the innate resistance system which might remove noxious factors and could suppress or attenuate the inflammatory process in the pancreas.
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Senapati D, Debata PK, Jenasamant SS, Nayak AK, Gowda S M, Swain NN. A prospective study of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score in acute pancreatitis: an Indian perspective. Pancreatology 2014; 14:335-9. [PMID: 25278302 DOI: 10.1016/j.pan.2014.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/30/2014] [Accepted: 07/14/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A simple and easily applicable system for stratifying patients with acute pancreatitis is lacking. The aim of our study was to evaluate the ability of BISAP score to predict mortality in acute pancreatitis patients from our institution and to predict which patients are at risk for development of organ failure, persistent organ failure and pancreatic necrosis. METHODS All patients with acute pancreatitis were included in the study. BISAP score was calculated within 24 h of admission. A Contrast CT was used to differentiate interstitial from necrotizing pancreatitis within seven days of hospitalization whereas Marshall Scoring System was used to characterize organ failure. RESULTS Among 246 patients M:F = 153:93, most common aetiology among men was alcoholism and among women was gallstone disease. 207 patients had no organ failure and remaining 39 developed organ failure. 17 patients had persistent organ failure, 16 of those with BISAP score ≥3. 13 patients in our study died, out of which 12 patients had BISAP score ≥3. We also found that a BISAP score of ≥3 had a sensitivity of 92%, specificity of 76%, a positive predictive value of 17%, and a negative predictive value of 99% for mortality. DISCUSSION The BISAP score is a simple and accurate method for the early identification of patients at increased risk for in hospital mortality and morbidity.
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Affiliation(s)
- Debadutta Senapati
- Department of General Surgery, SCB Medical College, Cuttack, Odisha, 753007, India.
| | | | | | - Anil Kumar Nayak
- Department of General Surgery, SCB Medical College, Cuttack, Odisha, 753007, India
| | - Manoj Gowda S
- Department of General Surgery, SCB Medical College, Cuttack, Odisha, 753007, India
| | - Narendra Nath Swain
- Department of General Surgery, SCB Medical College, Cuttack, Odisha, 753007, India
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Saxena P, Chen JA, Mullin GE. The Role of Complementary and Alternative Medicine for Pancreatic Disorders. Nutr Clin Pract 2014; 29:409-11. [DOI: 10.1177/0884533614528987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Payal Saxena
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jason A. Chen
- Department of Family Medicine, Johns Hopkins Medical Institutions, Glen Burnie, Maryland
| | - Gerard E. Mullin
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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