Study Protocol for the Feasibility and Acceptability of Remote Food Photography Method (RFPM) to Document Dietary Intake Among Individuals With Spinal Cord Injury (SCI)

Objectives

There is a high prevalence of neurogenic obesity among individuals with spinal cord injury (SCI) with percentages reaching 97% when using body fat percentage cutoff of 22% for men and 35% for women. Accurately measuring energy intake in individuals with SCI is crucial to assess if they are exceeding caloric needs, which can further contribute to obesity. Currently, the pen/paper food record is commonly used to track dietary intake in both the able-bodied (AB) and persons with SCI; however this method is known to be burdensome and to under-report true dietary intake by up to 37% in AB persons. The remote food photography method (RFPM) is a reliable and validated method to accurately measure dietary intake by taking pictures of food and beverages before and after consumption. This method of tracking dietary intake has been validated in individuals without SCI, but not in persons with SCI. Persons with SCI may benefit from a convenient method to track dietary intake due to SCI-specific challenges, such as difficulty writing. The objective of this study protocol is to assess feasibility and acceptability of RFPM in individuals with chronic SCI.

Methods

20 participants with SCI (10 with paraplegia and 10 with tetraplegia) will be recruited. Participants must be at least 18 years of age and have chronic SCI (at least 1-year post-injury). Participants will track their dietary intake for a total of two weeks (2 weekdays and 1 weekend for each week) by using RFPM for one week and the traditional pen/paper method for another week. Participants will be randomly assigned to track their intake using either method (RFPM or pen/paper food record) the first week and then cross-over to using the remaining method the second week. Photos of dietary intake will be sent electronically (i.e., smartphone, tablet, etc.). A registered dietitian will review dietary entries for completeness per week with each participant. Feasibility of the RFPM of tracking dietary intake in individuals with SCI will be measured by the number of entries that are documented using RFPM compared to dietary intake as reported by the participant at the end of the week. Acceptability of the RFPM will be assessed by a short survey at the end of the study examining the acceptance of the RFPM for capturing and tracking dietary intake.

Results

N/A - Protocol Abstract

Conclusions

N/A - Protocol Abstract

Funding Sources

N/A.

Unmasking the Structure of Gross Anatomy Laboratory Sessions During Covid‐19

INTRODUCTION/OBJECTIVE

Covid‐19 created immediate challenges to anatomy education. The traditional format of gross laboratory sessions experienced a direct impact and few reports documented curricular delivery changes specific to laboratory format. The purpose of this study was to assess the adaptations incorporated in gross anatomy laboratories by anatomists, during May‐August 2020, in response to Covid‐19.

MATERIALS/METHODS

Data were collected through the IRB‐approved Virtual Anatomy During Covid‐19 survey that consisted of 20 questions, including open‐ended prompts asking participants to describe the structure of a “typical” laboratory session during Covid‐19. Responses were solicited from professional anatomy associations during June 2020. Open‐ended responses describing anatomy laboratory teaching methods used during Covid‐19 were coded. Descriptive codes were applied to the data according to published methods to summarize verbatim responses. Responses were tabulated and converted to frequencies and percentages. Chi square test assessed differences among the responses when applicable. Alpha<5%.

RESULTS

Descriptions of gross anatomy lab teaching during Covid‐19 were coded into four categories : (1) delivery format, (2) format of laboratory practice, (3) type of anatomy digital resources used, and (4) format of student teaching groups. In the first category, synchronous (46.7%), asynchronous (15.6%), and/or a combination of the two (18.8%) were the most frequent laboratory delivery formats (P<0.001). In the second category, student‐led dissection (17.2%), prosection (10.9%), and/or utilization of commercial and/or in‐house anatomical resources (26.2%) were the most frequent laboratory practices (P<0.001). Within this category, a subcategory was discovered in which physical distancing and personal protective equipment practices were reported (15.6%). Concerning the third category, anatomy digital resources (26.2%) were used for asynchronous laboratory preparation and laboratory sessions. In the final category, student small groups (29.7%) were used in remote sessions where “breakout rooms” permitted students to meet with peers and/or faculty. Large groups (9.4%) were used for faculty to review and present the assigned laboratory topic.

CONCLUSION

Anatomists largely taught through a remote, synchronous delivery format that relied on cadaveric specimens and digital anatomy resources, as well as small group learning.

SIGNIFICANCE/IMPLICATION: This study shows that anatomists were able to adapt the gross anatomy laboratory sessions to synchronous, virtual mediums; however, the impact of these changes to the learner during this unconventional time remains to be determined.

Changes in Gross Anatomy Laboratory Assessment During Covid‐19

INTRODUCTION & OBJECTIVE:

Traditional gross anatomy lab assessment involves in‐person examination using cadavers or models. Covid‐19 related restrictions introduced challenges to gross anatomy education due to the discipline's reliance on lab‐based learning and assessment. Therefore, the objective of this study was to assess changes made by anatomy educators to gross anatomy lab assessments during May‐August 2020.

MATERIALS & METHODS:

A 20‐item survey assessed gross anatomy pedagogy, teaching resources, and assessment before and during the pandemic. The survey was distributed online to anatomy educators through professional associations and listservs in June 2020. Data were obtained from two survey items that asked respondents for narrative descriptions of their lab‐based assessment before and during Covid‐19. Open coding was used to apply descriptive codes relating to 3 categories: (1) setting of the assessment, (2) format of the assessment, and (3) materials used for the questions. The last author coded the data, while the first author reviewed the coding. Both authors reconciled and re‐coded discrepancies. Code frequencies and percentages were calculated. Chi‐square or Fisher's exact test was used to assess differences in frequencies before and during Covid‐19. Alpha<5%.

RESULTS:

Of the 61 respondents who described lab assessment, the use of the physical lab setting decreased (before: 82%, during: 20%; P<0.001) while computer‐based platforms increased (before: 9%, during: 61%; P<0.001). The use of medical imaging and other anatomical images were maintained (before: 11%, during: 51%; P=0.37), but there were decreases in the use of cadavers (before: 63%, during: 14%; P<0.001) as well as bones, plastic models, and plastinates (before: 12%, during: 0%; P<0.001). There were no significant changes in assessment structure, with the majority of participants maintaining a practical examination (i.e. “bell ringer”) format during Covid‐19 (before: 66%, during: 62%; P=0.39).

CONCLUSION:

Anatomy educators continued the use of “bell ringer” style lab assessments during the early part of the Covid‐19 pandemic. The setting shifted towards computer‐based examinations due to Covid‐19 restrictions; thus, the use of digital images was maintained while cadaver use decreased.

SIGNIFICANCE/IMPLICATION:

The early adaptations made by anatomy educators to their lab assessments during Covid‐19 provide insight into how assessment may be offered in dire circumstances when the physical lab is unavailable, when accommodating students with extenuating circumstances preventing them from attending in‐person lab assessments, and for remediation assessments.

Shifts in Digital Resources Usage for Gross Anatomy Education During Covid‐19

INTRODUCTION/OBJECTIVE:

Covid‐19 has led to sudden changes to gross anatomy education when traditional dissection‐based laboratories had to shift towards virtual modalities due to physical distancing and remote learning requirements. The purpose of this study was to determine how the use of digital teaching resources in gross anatomy education changed from before to during Covid‐19.

MATERIAL/METHODS:

Data were obtained from an IRB‐approved survey distributed to professional associations and listservs targeting anatomy educators from June to November 2020. Respondents were asked to select the digital resources they used before and during Covid‐19. Data were analyzed during the early and latter parts of the pandemic as May‐August (T1) and August‐December (T2), as well as overall (T3). T2 data were classified into five categories: 2D illustrations, dissection media, interactive software, in‐house, and open access. Total usage for each timepoint, the proportions of digital resources, and the 5 categories before and during Covid‐19 were compared using McNemar's test with alpha<5%. Data are presented as percent increase (+value) or decrease (‐value).

RESULTS:

60 and 208 responses were received for T1 and T2, respectively. The total number of digital resources used for anatomy education increased from before to during COVID‐19 as seen in the data analysis from T1 (+47%), T2 (+41%), and T3 (+43%) (P≤0.003). In T1, the use of BlueLink (+122%) and Complete Anatomy (+140%) software increased (P<0.04), while Acland's Anatomy (+68%), Anatomy.TV (+1300%), Complete Anatomy (+89%), and BlueLink (+148%) increased in T2 (P≤0.03). During T3, the usage of Acland's Anatomy (+60%), Anatomy.TV (+750%), Complete Anatomy (+102%), BlueLink (+143%), and VisibleBody (+100%) increased (P≤0.03). All other digital resources did not change (P>0.05). When data for T2 were categorized, dissection media (+44%), interactive software (+87%), and open‐access (+100%) content increased (P≤0.008), while 2D illustrations (‐3%) and in‐house content (‐23%) decreased (P>0.05).

CONCLUSIONS:

This study demonstrates sustained increases in digital resource usage for gross anatomy education during Covid‐19. This was particularly pronounced for interactive software, open access resources and dissection media that allowed educators to mimic features of a dissection lab.

SIGNIFICANCE:

These rapid shifts in both commercial and free digital resources are likely to drive innovation in anatomy education for years to come. It remains unknown if the current findings are transient Covid‐19‐related changes or if they will persist long‐term.

Changes in Anatomy Lecture and Laboratory Instruction During Covid‐19

Introduction/Objective

Covid‐19 created challenges to anatomy education, particularly gross anatomy given the traditional in‐person format of lectures and lab. The objective of this study was to assess the changes in lecture methods and lab materials used in anatomy courses that ran between May‐August (T1) and August‐December (T2) 2020 responding to Covid‐19 restrictions.

Materials/Methods

A survey was distributed to anatomy educators through professional associations from June‐November 2020. Respondents indicated (1) their institution; (2) programs taught (professional health (PH), medicine (MED), or undergraduate (UG)); (3) course type (integrated or stand‐alone); (4) percentage of lab time before and during Covid‐19 that utilized cadaveric, plastic, and/or other teaching materials; and (5) lecture format. Institutions were classified as public or private via institution websites. Mann‐Whitney U and Wilcoxon signed‐rank tests with Bonferroni correction compared responses before and during Covid‐19 across programs, course type, and institution. Data are presented as percent increase (+value) or decrease (‐value). Alpha<5%.

Results

T1 and T2 received 67 and 191 responses, respectively. During T1 and T2, cadaver use decreased in PH (‐58% & ‐28%), MED (‐55% & ‐34%), and UG (‐57% & ‐55%) programs (P≤0.045); stand‐alone (‐58% & ‐33%,P<0.001) and integrated (‐48% & ‐28%, P≤0.004) courses; and private (‐49% & ‐25%, P<0.001) and public (‐65% & ‐34%, P<0.001) institutions. During T1 and T2, plastic use did not change for programs, institutions, or courses (P>0.05), except UG decreased plastic usage during T2 (‐20%; P=0.033). During T1 and T2, use of other teaching materials increased in PH (+1180% & +278%), MED (+385% & +1000%), and UG (+285% & +246%) (P≤0.015); stand‐alone (+920% & +540%, P<0.001) and integrated (+330% & +500%, P≤0.002) courses; and private (+1233% & +667%, P<0.001) and public (+415% & +400%, P<0.001) institutions. For T1 and T2, in‐person lecture decreased (‐89% & ‐72%, P≤0.001), while remote lecture increased (+509% & +533%, P≤0.001) during Covid‐19.

Conclusion

Reduction in cadaver use and in‐person lecture were most pronounced in T1, but remained diminished through both time points, suggesting a shift from the initial pandemic response to teaching to more complex hybrid programs as regulations permitted.

Significance/Implication

This study provides evidence to better understand how anatomy educators adapted their gross anatomy teaching due to Covid‐19 across programs. In addition, this study provides first of its kind insight into how anatomy was taught across programs prior to Covid‐19. Future studies need to determine whether the findings characterized here were pandemic‐based or if they represent long‐term changes for anatomy education.

Stereoselective coordination: a six-membered P,N-chelate tailored for asymmetric allylic alkylation

Six-membered chelate complexes [Pd(1a–b)Cl₂], (2a–b) and [Pd(1a–b)(η³-PhCHCHCHPh)]BF₄, (3a–b) of P,N-type ligands 1a, ((2S,4S)-2-diphenyl-phosphino-4-isopropylamino-pentane) and 1b, ((2S,4S)-2-diphenyl-phosphino-4-methylamino-pentane) have been prepared.

Polymorph screening of an active material

Polymorph screening is currently one of the most important tasks for innovators and for generic companies from both pharmaceutical and intellectual property rights aspects. The different polymorphs have different physicochemical properties, such as the crystal polymorph-dependent solubility which influences the bioavailability. A former drug candidate obtained from Sanofi Pharmaceutical Company (Hungary) was investigated to explore its polymorphism, to distinguish the morphologies generated by analytical examinations and to investigate their relative stabilities. An Avantium Crystal 16 automatic laboratory reactor system was used for the polymorph studies and the studies of their dissolution. Eight polymorphs were obtained by crystallization and transformation methods then characterized by XRPD, DSC, and Raman spectroscopy, scanning electron microscopy, and light microscopy. All the morphologies could be stored in solid without any form transformation for a long time (2 years investigated). According to the first relative stability results, Form I, III, IVa, V, VI, VII are unambiguously metastable forms. Form II and IVb have similar thermodynamic stabilities, that were higher than those of the other polymorphs. A special dissolution medium was developed in which the eight polymorphs showed clear differences in the rate of dissolution.

DSC, X-ray and FTIR studies of a gemfibrozil/dimethyl-β-cyclodextrin inclusion complex produced by co-grinding

The steps of formation of an inclusion complex produced by the co-grinding of gemfibrozil and dimethyl-β-cyclodextrin were investigated by differential scanning calorimetry (DSC), X-ray powder diffractometry (XRPD) and Fourier transform infrared (FTIR) spectroscopy with curve-fitting analysis. The endothermic peak at 59.25°C reflecting the melting of gemfibrozil progressively disappeared from the DSC curves of the products on increase of the duration of co-grinding. The crystallinity of the samples too gradually decreased, and after 35min of co-grinding the product was totally amorphous. Up to this co-grinding time, XRPD and FTIR investigations indicated a linear correlation between the cyclodextrin complexation and the co-grinding time. After co-grinding for 30min, the ratio of complex formation did not increase. These studies demonstrated that co-grinding is a suitable method for the complexation of gemfibrozil with dimethyl-β-cyclodextrin. XRPD analysis revealed the amorphous state of the gemfibrozil-dimethyl-β-cyclodextrin product. FTIR spectroscopy with curve-fitting analysis may be useful as a semiquantitative analytical method for discriminating the molecular and amorphous states of gemfibrozil.

Observation of few-cycle, strong-field phenomena in surface plasmon fields

We present experimental evidence of the generation of few-cycle propagating surface plasmon polariton wavepackets. These ultrashort plasmonic pulses comprised of only 2-3 field oscillations were characterized by an autocorrelation measurement based on electron photoemission. By exploiting plasmonic field enhancement, we achieved plasmon-induced tunnelling emission from the metal surface at low laser intensity, opening perspectives for strong-field experiments with low pulse energies. All-optical electron acceleration up to keV kinetic energy is also demonstrated in these surface-confined, few-cycle fields with only 1.35×10(12) W/cm2 focused laser intensity. The experimental results are found to be in excellent agreement with the model.

Polymorphisms of beta defensins are associated with the risk of severe acute pancreatitis

AIMS

Bacterial translocation from the intestinal tract plays an important role in severe acute pancreatitis (AP). Human β-defensins are a family of antimicrobial peptides present at the mucosal surface. The aim of this study was to investigate the relevance of single nucleotide polymorphisms (SNPs) in the DEFB1 gene and copy number polymorphisms of the DEFB4 genes in AP.

METHODS

124 AP patients (30 with mild and 94 with severe disease) and 100 healthy controls were enrolled in the study. Three SNPs of the DEFB1 gene [G-20A (c.-20G→A), C-44G (c.-44C→G) and G-52A (c.-52G→A)] were genotyped by Custom TaqMan assay. The DEFB4 gene copy number was determined by means of a TaqMan real-time PCR assay.

RESULTS

Significantly higher frequencies of the AA genotype of G-20A (c.-20G→A) and the AA genotype of G-52A (c.-52G→A) were observed among the patients with severe AP (SAP) compared with the healthy controls (38 vs. 20 and 41 vs. 18%, respectively). The GG protective genotype of C-44G (c.-44C→G) SNP was much less frequent (1%) among the patients than among the controls (9%). A higher frequency of a lower (<4) copy number of the DEFB4 gene was observed in the patients with SAP compared with the healthy controls (62 vs. 24%, respectively).

CONCLUSIONS

The variations in the genes encoding human β-defensin-1 and -2 may be associated with the risk of SAP. and IAP.

Plasma concentrations of high-mobility group box protein 1, soluble receptor for advanced glycation end-products and circulating DNA in patients with acute pancreatitis

AIMS

High-mobility group box protein 1 (HMGB1), a late-acting proinflammatory cytokine, is secreted actively by inflammatory cells, and released passively from necrotic cells. From the aspect that both inflammation and necrosis are involved in the pathogenesis in acute pancreatitis, the aim of the study was a joint investigation of the plasma concentrations of HMGB1, its soluble receptor for advanced glycation end-products (sRAGE), and the circulating DNA as a marker of cell death.

METHODS

62 patients with acute pancreatitis (30 mild, 32 severe), 20 patients with sepsis, and 20 healthy controls were enrolled in the study. HMGB1 and sRAGE plasma levels were measured by means of ELISA. Plasma DNA concentrations were estimated by real-time quantitative PCR for the beta-globin gene.

RESULTS

The circulating HMGB1 level was significantly higher in patients with severe acute pancreatitis (13.33 +/- 2.11 ng/ml) than in healthy controls (0.161 +/- 0.03 ng/ml) or than in patients with mild pancreatitis (2.64 +/- 0.185 ng/ml). The plasma concentration of sRAGE was highest in patients with sepsis (2,210 +/- 252 pg/ml), while the levels of sRAGE correlated inversely with that of HMGB1 in patients with acute pancreatitis. The plasma DNA level was significantly elevated in patients with severe acute pancreatitis (2,206 +/- 452 ng/ml).

CONCLUSION

A complex study of the plasma levels of HMGB1, sRAGE and circulating DNA can be informative in evaluations of acute pancreatitis with different levels of severity.

Polymorphism in the IL-8 gene, but not in the TLR4 gene, increases the severity of acute pancreatitis

BACKGROUND/AIM

Activated granulocytes and inflammatory mediators of the innate immune response play fundamental roles in the pathogenesis of acute pancreatitis. We studied whether polymorphisms of interleukin-8 (IL-8) and Toll-like receptor 4 (TLR4) genes correlate with the severity of acute pancreatitis.

METHODS

Patients with acute pancreatitis (n = 92) were grouped according to the severity of the disease on the basis of the Ranson scores. Healthy blood donors (n = 200) served as controls. The IL-8 -251 gene polymorphism was analyzed by amplification-refractory mutation system; the single-nucleotide polymorphisms (Asp299Gly and Thr399Ile) of TLR4 were investigated by using a real-time polymerase chain reaction method with melting point analysis.

RESULTS

The IL-8 A/T heterozygote mutant variants were detected with a significantly higher frequency among the patients with severe pancreatitis than among the healthy blood donors (60 vs. 42%; p = 0.0264, odds ratio = 2.071, 95% confidence interval = 1.101-3.896), while the frequency of the normal allelic genotype (TT) was higher among the patients with mild pancreatitis than in the group with severe pancreatitis (35 vs. 16%; p = 0.051, odds ratio = 2.917, 95% confidence interval = 1.089-7.811). There was no significant correlation between TLR4 polymorphisms and the acute pancreatitis itself, but nonsignificantly increased frequencies of Asp299Gly and Thr399Ile heterozygotes among patients with severe infected pancreatic necrosis could be observed relative to the patients with mild pancreatitis.

CONCLUSIONS

Determination of the frequency of IL-8 polymorphism in acute pancreatitis may be informative and may provide further evidence concerning the role of IL-8 in the severe form of this disease. The possible role of TLR4 polymorphism in the outcome of severe acute pancreatitis requires further investigations in a larger series of patients.

Organ-preserving pancreatic head resection in chronic pancreatitis

BACKGROUND

Twenty to thirty per cent of patients with chronic pancreatitis develop inflammatory enlargement of the head of the pancreas. A safe procedure has been developed for duodenum-preserving pancreatic head resection; this report describes the preliminary results achieved.

METHODS

Thirty patients, 27 men and three women of mean age 44 years, underwent surgical resection following the development of an inflammatory mass in the pancreatic head. All patients had weight loss and frequent abdominal pain. Jaundice was present in three and diabetes mellitus in ten patients. The diagnosis of chronic pancreatitis was made by a combination of endoscopic retrograde cholangiopancreatography, sonography and computed tomography. Pancreatic function was assessed by amylum tolerance test (ATT), oral glucose tolerance test and stool elastase measurement. The surgical procedure involved wide local resection of the inflammatory tumour in the pancreatic head, without division of the pancreas over the portal vein. Reconstruction involved drainage via a jejunal Roux-en-Y loop. In three icteric cases, prepapillary bile duct anastomosis was also performed using the same jejunal loop.

RESULTS

There were no hospital deaths or major complications. After a median follow-up of 10 (range 6-14) months, all patients were symptom free. The mean increase in body-weight was 8.9 (range 4-20) kg. The ATT and stool elastase level demonstrated improved exocrine function but there was no change in endocrine function.

CONCLUSION

This type of pancreatic head resection is a safe procedure that provides good short-term relief of symptoms associated with inflammatory changes in the head of the pancreas in chronic pancreatitis.

Treatment of Candida infection in patients with infected pancreatic necrosis

Background

The purpose of this review was to determine the incidence of Candida infection in patients with infected pancreatic necrosis, to determine the most frequent risk factors and to assess the best treatment approach for disseminated candidal infections.

Methods

Of 145 patients with infected pancreatic necrosis identified, 30 (21 per cent) were infected with C. albicans. Risk factors identified in patients with Candida infection included the presence of necrotic tissue, and the use of broad-spectrum antibiotics, intravascular catheters and parenteral nutrition.

Results

With one exception, all cases involved mixed bacterial and fungal infections. The positive fungal result was obtained either during or after operation. Sixteen of the 30 patients displayed fungal colonization, while the other 14 had disseminated fungal infection. There were two deaths in the disseminated group, but none in the colonization group. In both fatal cases, flucytosine was applied. When fluconazole was used against disseminated fungal infection, no death was noted. Recently, prophylactic fluconazole has also been used in 20 patients with infected pancreatic necrosis, with no evidence of fungal infection after operation.

Conclusion

The combination of adequate surgical treatment with effective antibiotics and early antifungal therapy is the ideal management approach for infected pancreatic necrosis with Candida infection. Fluconazole may be regarded as an efficient drug for the prophylaxis of candidiasis.

[Dose-dependent effect of pancreatin replacement upon the pancreatic function in the period after pancreatic surgery]

AIMS

Disturbance of the exocrine function can persist for several weeks following pancreatic surgery. Active proteases in the duodenal lumen may help to recover exocrine function, but the effect can depend on dosage.

METHODS

A placebo-controlled trial of enteric-coated pancreatin (Kreon 25,000 U lipase [A] and Kreon 10,000 U lipase [B]; 3 x 1 caps/day) was performed for 2 weeks following pancreatic surgery (resection or drainage operation in each group). A total of 60 patients were randomized, 20 to A and B pancreatin groups each, and 20 to the placebo group. We tested exocrine function via faecal elastase determinations, amylum tolerance test (ATT) and checks on the symptoms of maldigestion.

RESULTS

After medication for 10 days, in group A there was evidence of the beneficial effect of pancreatin suggested by 35% improvement in ATT, unchanged body weight and disappearance of maldigestion. In group B, positive influence of pancreatin was confirmed only in those patients who underwent drainage operation, with moderate improvement of the symptoms of maldigestion and an almost unchanged body weight. In the control group and in resected patients in group B, abnormal ATT and maldigestion remained, while average body weight decreased by 3.5 kg. In all groups, no significant change was noted in the elastase concentration.

CONCLUSION

The results suggest that dose-dependent enteric-coated pancreatin treatment after pancreatic surgery may lead to rapid improvement in the exocrine pancreatic function, probably by reducing the cholecystokinin response to food stimulation. This is an important indication for enteric-coated pancreatin medication.

Ambient temperature modulates hypoxic-induced changes in rat body temperature and activity differentially

When rats, acclimated to an ambient temperature (T(a)) of 29 degrees C, are exposed to 10% O(2) for 63 h, the circadian rhythms of body temperature (T(b)) and level of activity (L(a)) are abolished, T(b) falls to a hypothermic nadir followed by a climb to a hyperthermic peak, L(a) remains depressed (Bishop B, Silva G, Krasney J, Salloum A, Roberts A, Nakano H, Shucard D, Rifkin D, and Farkas G. Am J Physiol Regulatory Integrative Comp Physiol 279: R1378-R1389, 2000), and overt brain pathology is detected (Krasney JA, Farkas G, Shucard DW, Salloum AC, Silva G, Roberts A, Rifkin D, Bishop B, and Rubio A. Soc Neurosci Abstr 25: 581, 1999). To determine the role of T(a) in these hypoxic-induced responses, T(b) and L(a) data were detected by telemetry every 15 min for 48 h on air, followed by 63 h on 10% O(2) from rats acclimated to 25 or 21 degrees C. Magnitudes and rates of decline in T(b) after onset of hypoxia were inversely proportional to T(a), whereas magnitudes and rates of T(b) climb after the hypothermic nadir were directly proportional to T(a). No hyperthermia, so prominent at 29 degrees C, occurred at 25 or 21 degrees C. The hypoxic depression of L(a) was least at 21 degrees C and persisted throughout the hypoxia. In contrast, T(a) was a strong determinant of the magnitudes and time courses of the initial fall and subsequent rise in T(b). We propose that the absence of hyperthermia at 21 and 25 degrees C as well as a persisting hypothermia may protect the brain from overt pathology.

Cytokine level changes in L-arginine-induced acute pancreatitis in rat

The role of different cytokines in the pathogenesis of L-arginine (Arg)-induced acute pancreatitis in rat, and the ability of KSG-504, a novel cholecystokinin receptor antagonist, to exert protection in this type of acute pancreatitis was evaluated. Male Wistar rats received 250 mg/100 g body weight of Arg intraperitoneally twice, at an interval of 1 h. Control rats received instead the same amount of glycine at the same times. Fifty mg/kg KSG-504 was injected subcutaneously 0.5 h before and 6, 18 and 36 h after the first Arg administration. Rats were examined 12, 24 and 48 h after pancreatitis induction. To assess the severity of inflammation, the edema was quantified, the serum amylase level was measured, and histologic examinations were performed. Serum tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels were determined by bioassay, using the TNF-sensitive WEHI 164 and the IL-6-dependent B9 cell lines, respectively. In Arg-induced acute pancreatitis, the amylase level was increased significantly at 12 h (48.600 +/- 3.980 U/l) and 24 h (30.800 +/- 3.813 U/l) vs. the control group (6.382 +/- 184 U/l). No significant alteration in the ratio pancreatic weight/body weight was found in the different groups. However, in Arg-induced acute pancreatitis, both the TNF-alpha (15.1 +/- 6.9 U/ml) and the IL-6 (39.6 +/- 19.2 pg/ml) levels were already elevated significantly at 12 h vs. the controls (3.1 +/- 0.8 U/ml and 15.2 +/- 3.1 pg/ml, respectively) and remained elevated at 24 and 48 h. Simultaneous KSG-504 administration did not modify the measured cytokine levels. No significant changes in plasma CCK levels were observed. In Arg-induced acute pancreatitis, histological evaluation revealed diffuse but microfocal necrobiotic alterations. No marked protective effects of KSG-504 were observed on histological sections. These results suggest that excessive doses of Arg induce severe acute pancreatitis in rat, with a simultaneous cytokine level elevation. Endogenous CCK does not seem to play an essential role in the pathogenesis of Arg-induced acute pancreatitis.

TGF-beta 1 and IL-6--new aspects in pancreas regeneration?

Plasma levels of interleukin-6 (IL-6) and transforming growth factor-beta (TGF-beta 1) were studied during cholecystokinin octapeptide (CCK-8)-induced regeneration after pancreas resection in rats. The weight of the pancreas and the DNA and protein contents increased significantly. The serum levels of TGF-beta 1 and IL-6 were increased significantly on days 7 and 14. There was no significant change in serum amylase levels. These findings indicate that cytokines such as TGF-beta 1 and IL-6 may play a role in the pathomechanism of pancreas regeneration.

Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis

BACKGROUND

Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM 1.

PATIENTS AND METHODS

A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R&D). PCT was determined in cell lysates by ECL Western blot.

RESULTS

PCT was found in relatively high concentrations (8.5 +/- 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin ( 15 +/- 5.4 ng/mL). Positive values (> 1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100% for PCT (p < 0.0001); 100, 20, and 55% for IL-6 (p 0.474 n.s.) and 90, 10, and 50% for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines.

CONCLUSION

Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.

Circadian rhythms of body temperature and activity levels during 63 h of hypoxia in the rat

The hypothermic response of rats to only brief ( approximately 2 h) hypoxia has been described previously. The present study analyzes the hypothermic response in rats, as well as level of activity (L(a)), to prolonged (63 h) hypoxia at rat thermoneutral temperature (29 degrees C). Mini Mitter transmitters were implanted in the abdomens of 10 adult Sprague-Dawley rats to continuously record body temperature (T(b)) and L(a). After habituation for 7 days to 29 degrees C and 12:12-h dark-light cycles, 48 h of baseline data were acquired from six control and four experimental rats. The mean T(b) for the group oscillated from a nocturnal peak of 38.4 +/- 0.18 degrees C (SD) to a diurnal nadir of 36.7 +/- 0.15 degrees C. Then the experimental group was switched to 10% O(2) in N(2). The immediate T(b) response, phase I, was a disappearance of circadian rhythm and a fall in T(b) to 36.3 +/- 0.52 degrees C. In phase II, T(b) increased to a peak of 38.7 +/- 0.64 degrees C. In phase III, T(b) gradually decreased. At reoxygenation at the end of the hypoxic period, phase IV, T(b) increased 1.1 +/- 0.25 degrees C. Before hypoxia, L(a) decreased 70% from its nocturnal peak to its diurnal nadir and was entrained with T(b). With hypoxia L(a) decreased in phase I to essential quiescence by phase II. L(a) had returned, but only to a low level in phase III, and was devoid of any circadian rhythm. L(a) resumed its circadian rhythm on reoxygenation. We conclude that 63 h of sustained hypoxia 1) completely disrupts the circadian rhythms of both T(b) and L(a) throughout the hypoxic exposure, 2) the hypoxia-induced changes in T(b) and L(a) are independent of each other and of the circadian clock, and 3) the T(b) response to hypoxia at thermoneutrality has several phases and includes both hypothermic and hyperthermic components.

Chromatin organization and transcriptional control of gene expression in Drosophila

It is increasingly clear that the packaging of DNA in nucleosome arrays serves not only to constrain the genome within the nucleus, but also to encode information concerning the activity state of the gene. Packaging limits the accessibility of many regulatory DNA sequence elements and is functionally significant in the control of transcription, replication, repair and recombination. Here, we review studies of the heat-shock genes, illustrating the formation of a specific nucleosome array at an activatable promoter, and describe present information on the roles of DNA-binding factors and energy-dependent chromatin remodeling machines in facilitating assembly of an appropriate structure. Epigenetic maintenance of the activity state within large domains appears to be a key mechanism in regulating homeotic genes during development; recent advances indicate that chromatin structural organization is a critical parameter. The ability to utilize genetic, biochemical and cytological approaches makes Drosophila an ideal organism for studies of the role of chromatin structure in the regulation of gene expression.

Protein kinase C decreases the hepatocyte growth factor-induced activation of Erk1/Erk2 MAP kinases

HGF and phorbol ester induce the scattering of HepG2 cells. Recently, we have reported that the motility and morphological responses that accompany this process require the activation of Erk1/Erk2 MAP kinases, and phosphatidylinositol 3-kinase contributes to the activation of Erk1/Erk2 in HGF-induced cells. The cell scattering-associated appearance of a high-M(r) (>300 kDa) protein pair has also been observed, and has been proven to be a sensitive marker of the intensity of Erk1/Erk2 activation. Our present study demonstrates that in HGF-induced cells protein kinase C and phosphatidylinositol 3-kinase regulate oppositely the expression of these cell scattering-associated proteins. While in phorbol ester-treated cells the sustained activation of protein kinase C is essential for this expression, in HGF-induced cells the inhibition of protein kinase C with bisindolylmaleimide I stimulates the expression. Protein kinase C reduces the HGF-induced phosphorylation of Erk1/Erk2, and in this way it can limit the intensity of Erk1/Erk2-dependent gene-expression

Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis

BACKGROUND

Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM 1.

PATIENTS AND METHODS

A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R&D). PCT was determined in cell lysates by ECL Western blot.

RESULTS

PCT was found in relatively high concentrations (8.5 +/- 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin ( 15 +/- 5.4 ng/mL). Positive values (> 1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100% for PCT (p < 0.0001); 100, 20, and 55% for IL-6 (p 0.474 n.s.) and 90, 10, and 50% for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines.

CONCLUSION

Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.

Characterization of subterranean bacteria in the Hungarian Upper Permian Siltstone (Aleurolite) Formation

The main purpose of this work was to study the microbiology of the Hungarian Upper Permian Siltstone (Aleurolite) Formation, to assess the safety of future underground repositories for nuclear waste. Sixty-seven air, groundwater, technical water, rock, and surface samples were collected aseptically from different depths. The number of aerobic and anaerobic isolates was 277. The mesophilic minimum and maximum CFU counts of the air samples were 1.07-5.84 x 10(2).mL-1 (aerobic) and 0.22-1.04 x 10(2).mL-1 (anaerobic), respectively; those of the water samples were 0.39-1.25 x 10(5).mL-1 (aerobic) and 0.36-3.9 x 10(3).mL-1 (anaerobic); those of the technical water samples were 0.27-5.03 x 10(6).mL-1 (aerobic) and 4 x 10(5)-->10(6).mL-1 (anaerobic); and those of the aleurolite samples were 2.32 x 10(2)-2.47 x 10(5).g-1 (aerobic) and 0.45-9.5 x 10(2).g-1 (anaerobic). In the groundwater, the thermophilic aerobic bacteria count was 0-2.4 x 10(2).mL-1 and the thermophilic anaerobic bacteria count was 0.43-4.6 x 10(4).mL-1. The gases produced by the 16 gas-forming isolates were CO2 (aerobic isolates), and CO2 and H2 (anaerobic isolates). About 20% of the aerobic isolates produced siderophores. The proportions of organic acid producers were lowest in aerobic and anaerobic isolates from the aleurolite, 13% and 14%, respectively. The highest proportions of acid producers in the aerobic and anaerobic isolates from the air samples were 63% and 54%. Altogether 160 of the aerobic isolates and 52 of the anaerobic isolates were spore formers. The radiosensitivity of the aerobic isolates was also determined; the D10 values of the sporeformers ranged between 0.8-2.44 kGy. Our results indicate that the sulfate-reducing bacteria and the production of complexing agents (siderophores) may contribute to the mobilization of radionuclides from underground repositories. As well, microbial gas production can influence the environmental conditions. The variability in bacterial radiotolerance indicates the biodiversity at this potential disposal site. These facts must be considered during the planning of a nuclear waste repository.

[Effect of pancreatin replacement on pancreatic function in the postoperative period after pancreatic surgery]

There is evidence that disturbances of exocrine function can persist for several weeks following pancreatic surgery. Active proteases in the duodenal lumen may help to recovery of exocrine function. A placebo-controlled trial of enteric-coated pancreatin (25,000 U lipase; 3 x 1 caps/day) was performed during 2 weeks following pancreatic surgery (resection and drainage operation). A total of 39 patients were randomized, 20 to pancreatin group and 19 to placebo group. The exocrine function was tested via serum and faecal elastase determinations, the amylum tolerance test (ATT) and checks on the symptoms of maldigestion. After medication for 10 days, there was evidence of the beneficial effect of pancreatin suggested by a 35% improvement in ATT, an unchanged body weight and the disappearance of symptoms of maldigestion. In the control group, abnormal ATT and symptoms of maldigestion were remained, while the body weight decreased with by 3.5 kg. In both groups, no significant change was noted in the elastase concentration. The results suggest that enteric-coated pancreatin treatment after pancreatic surgery may lead to a rapid improvement of exocrine pancreatic function, probably by reducing the cholelcystokinin response to stimulation by food and represent a new indication of the enteric-coated pancreatin medication.

Phosphatidylinositol 3-kinase contributes to Erk1/Erk2 MAP kinase activation associated with hepatocyte growth factor-induced cell scattering

MAP kinase cascade-dependent responses were investigated during scattering of HepG2 human hepatoma cells stimulated by HGF or phorbol ester. Inhibition of phosphatidylinositol 3-kinase with LY294002 prevented completely the dissociation of cells. Inhibition of MAP kinase kinase (MEK) with PD98059 prevented the development of characteristic morphological changes associated with cell migration. EGF, which failed to induce cell scattering, caused a short-term increase in the phosphorylation of Erk1/Erk2 MAP kinases. On the contrary, HGF or phorbol ester stimulated the phosphorylation of MAP kinases for a long time. Experiments performed with LY294002 indicated that phosphatidylinositol 3-kinase contributed to the HGF-stimulated phosphorylation of Erk1/Erk2. This finding was confirmed by the demonstration that the MAP kinase cascade-dependent expression of a high-Mr (>300 kDa) protein pair appearing in the course of cell scattering was inhibited by LY294002 in HGF-induced cells but was not inhibited in phorbol ester-treated cells.

[Diagnostic value of fecal elastase test in pancreatic exocrine deficiency]

The diagnostic value of the estimation of faecal elastase-1, the new noninvasive direct pancreatic function test was evaluated in a total of 35 patients. Twenty one patients were diagnosed with chronic pancreatitis and categorized according to grades of exocrine pancreatic insufficiency based on the Lundh test, 14 patients in the control group had gastrointestinal disorders. Faecal elastase 1 was measured by ELISA method. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of elastase determination was 71.4%, 92.8%, 88.2%, 81.2% and 83.7%, respectively in chronic pancreatitis. In the severe exocrine pancreas insufficiency group (n = 14), the sensitivity was 85.7%, while in the group with mild insufficiency (n = 7) the sensitivity was only 42.8%. The determination of faecal elastase is useful in the diagnosis of severe exocrine pancreas insufficiency, but it is not sensitive enough in the mild form of the disease.

[Leukocyte scintigraphy in the diagnosis of acute pancreatitis]

The authors investigate the place and clinical usability of the 99mTc-HM-PAO leukocyte scintigraphy (LS) in patients with acute pancreatitis. Another purpose was to establish the diagnostic value of LS to differenciate between infected and noninfected pseudocysts following acute pancreatitis. Seventy-five patients with acute pancreatitis were examined and divided into two groups. In group 1, LS was performed in 46 consecutive patients in the early phase (mean 3 days following the beginning of the symptoms, range 1-6 days) of acute pancreatitis. In group 2, LS was performed in 29 patients with pancreatic pseudocysts following acute pancreatitis. The diagnosis of acute pancreatitis was based on the typical clinical symptoms, laboratory parameters, Ranson criteria, US and CT findings. In group 1, most of the cases with a severe clinical outcome (Ranson classification) gave positive LS results (13/15). Leukocyte accumulation was also detected in patients with mild acute pancreatitis (5/26), but at a lower frequency. The scintigraphic activity correlated with the leukocyte count, fever, and duration of hospitalization. In group 2, there were seven LS positive cases. A pancreatic abscess or infected pseudocyst was found in all of them during surgery. In 9 LS negative cases surgery and bacterial culturing revealed sterile pseudocyst. In conclusion, a positive LS indicated a severe course of acute pancreatitis. The method also seems useful for differentiation between infected and noninfected pancreatic pseudocysts.

Progress in the management and treatment of infected pancreatic necrosis

Infected pancreatic necrosis and sepsis are the leading causes of mortality in necrotizing pancreatitis. A review has been undertaken of the results of the past two decades relating to different surgical treatments of infected pancreatic necrosis. During the period 1978-85, the surgical treatment of necrotizing pancreatitis and its complications in our department consisted of the 'conventional' therapy (resection of the involved pancreatic tissue, or necrosectomy and drainage) in 61 patients, with a mortality rate of 36% (22 patients died). Since 1986, we have performed necrosectomy and other surgical interventions combined with continuous widespread lavage in 142 patients with infected pancreatic necrosis. The overall mortality decreased significantly to 6.3% (9 patients died). This result was achieved by means of aggressive surgical treatment, continuous, prolonged washing and suction drainage and supportive therapy, including immunonutrition, modifying the cytokine production and adequate antibiotic and antifungal medication. This surgical strategy provides the possibility for recovery in cases of necrotizing pancreatitis with septic complications.

Beneficial effect of octreotide treatment in acute pancreatitis in rats

CONCLUSIONS

Octreotide treatment contributes to the regulation of tumor necrosis factor (TNF) production in sodium taurocholate-induced acute necrotizing pancreatitis in rats. Owing to its complex effect, octreotide can partially ameliorate the deleterious consequences of acute necrotizing pancreatitis. Elevated TNF and interleukin-6 (IL-6) levels in the peritoneal fluid may be considered a consequence of the activation of peritoneal macrophages.

BACKGROUND

The effects of octreotide on exocrine pancreatic function have been investigated in numerous studies, but little attention has been paid to its influence on cytokine production in acute pancreatitis.

METHODS

Acute pancreatitis was induced by the retrograde injection of taurocholic acid into the pancreatic duct in male Wistar rats. Serum amylase activity, wet pancreatic weight/body weight (pw/bw) ratio, and TNF and IL-6 levels were measured. Four micrograms/kg of octreotide was administered subcutaneously at the time of induction of pancreatitis and 24 or 48 h later. Rats were sacrificed 6, 24, 48, or 72 h after the operation.

RESULTS

The serum amylase level and pancreatic weight to body weight ratio were decreased significantly in the octreotide-treated group. The serum TNF level was decreased significantly in the octreotide-treated group as compared with the control group at 6, 24, and 48 h (0.6 +/- 1.5, 2.0 +/- 3.3, and 0 vs 50 +/- 15.5, 37.5 +/- 18.4, and 13.1 +/- 12.5 U/mL, respectively). The ascites TNF level was decreased to 0 in the octreotide-treated group and was elevated in the control group at 72 h (28.0 +/- 49.0 U/mL). IL-6 production in ascites was extremely high in both groups at 6 h (80,000 +/- 43,817 pg/mL and 58,500 +/- 33,335 pg/mL), but the difference was not significant.

Albuminuria after fetal pancreatic islet transplantation: a 10-year follow-up

AIM OF THE STUDY

The prevention of diabetic nephropathy is as yet an unresolved issue. The aim of our study was to assess the effects of transplantation of long-term cultured and cryopreserved fetal pancreas islets on metabolic control and the development of diabetic nephropathy.

METHODS

Serum C-peptide, glucose, HbA1c, insulin requirements, urinary albumin excretion rate, and blood pressure of 10 insulin-dependent diabetic patients after transplantation were compared with a group of 27 insulin-dependent diabetic controls on insulin therapy only during a 10-year follow-up.

RESULTS

In the first year after transplantation mean insulin requirement decreased from 53.6+/-2.2 to 35.8+/-1.2 units. C-peptide levels appeared (0.55+/-0.08 ng/ml) and remained detectable throughout the follow-up. Blood glucose and HbA1c were significantly (P<0.05) lower than in the controls. Mean albumin excretion rates of the transplant and the control groups during the follow up were 18.8+/-8.5 and 11.7+/-2.0, 16.6+/-6.6 and 14.0+/-2.3, 15.0+/-5.0 and 15.1+/-2.7, 15.3+/-7.5 and 20.4+/-4.2, 19.8+/-6.2 and 36.7+/-11.1, 11.7+/-3.6 and 51.3+/-14.6, 14.1+/-4.2 and 71.4+/-23.1, 22.7+/-8.6 and 92.0+/-28.1, 18.0+/-5.9 and 107.6+/-35.6, 21.7+/-11.0 and 101.5+/-29.3 microg/min respectively. From the 6th year the difference between the two groups was significant (P<0.001). In the transplant group initial mean systolic and diastolic blood pressure values were 132.0+/-3.3 and 81.5+/-1.5 mmHg, in the controls 130.4+/-3.4 and 79.6+/-1.6 mmHg respectively. Significant changes (P<0.05) of blood pressure during the follow-up or differences between the two groups were not observed.

CONCLUSIONS

We conclude that fetal islet transplantation is effective in achieving good long-term diabetes control and in the prevention of diabetic nephropathy.

[Complex treatment of infected necrotizing pancreatitis]

Pancreatic necrosis associated with septic conditions is the leading cause of mortality in acute pancreatitis. Since 1986, 155 patients with infected pancreatic necrosis have been treated. The mean APACHE II score was 18.5 (range 11-32). In all cases, the infected pancreatic necrosis was combined with retroperitoneal abscesses. The surgical treatment was performed on average 18.5 days (range 8-25 days) after the onset of acute pancreatitis. The operative management consisted of wide-ranging necrosectomy in the total affected area, combined with widespread lavage and suction drainage. In 69 of the 155 cases (45%), some other surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colon resection) was also performed. Following surgery supportive therapy was applied in all patients, which also consisted orf immunonutrition (glutamine and arginine supplementation) and modification of cytokine production by petoxyfillin and dexamethasone from 1992. TNF and IL-6 serum levels were measured by ELISA and in vitro stimulation of leukocytes were induced by E. coli LPS. Following surgery, continuous lavage and suction drainage were applied for an average of 41.5 days (range 21-90 days), with an average of 9.5 (range 5-20) litres of saline per day. The bacteriologic findings revealed mainly enteral bacteria, but Candida infection was also frequently detected. The incidence of fungal infection was 20%. Thirty-two patients (21%) had to undergo reoperation. The cytokine production capacity (TNF and IL-6) was shown to correlate with the prognosis. As a consequence of pentoxifyllin and dexamethasone therapy, the TNF production generally dropped to the normal level. The overall hospital mortality was 6.4% (10 patients died). In our experience, infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, long-standing lavage and suction drainage, together with supportive therapy consisting of immunonutrition and modification of cytokine production, combined with adequate antibiotic and antifungal medication.

Beneficial effects of pentoxifylline treatment of experimental acute pancreatitis in rats

The purposes of this study were to determine the tumor necrosis factor (TNF) and interleukin-6 (IL-6) levels after the induction of acute necrotizing pancreatitis, and to establish the effects of pentoxifylline on cytokine production.

METHODS

acute pancreatitis was induced by the retrograde injection of 200 microliters taurocholic acid into the pancreatic duct in male Wistar rats. The serum amylase activity, the wet pancreatic weight/body weight ratio, and the TNF and IL-6 levels were measured. Seven mg/kg pentoxifylline were administered intraperitoneally at the time of operation 6, 12 or 24 h later. Rats were killed 6, 24, 48 or 72 h after the operation.

RESULTS

the TNF bioassay revealed high levels of TNF (30.2 +/- 5.4 U/ml, 35.0 +/- 5.0 U/ml and 36.6 +/- 6.0 U/ml) in the control group at 6, 24 and 48 h and (54.1 +/- 20 U/ml and 10.9 +/- 4.2 U/ml) in the pentoxifylline-treated group at 6 and 24 h, respectively, whereas the level had decreased to zero in the pentoxifylline-treated group at 48 h. The IL-6 bioassay likewise demonstrated high levels of IL-6 in the control group at 48 h and in the pentoxifylline-treated group at 6 and 24 h, and markedly decreased levels in the pentoxifylline-treated group at 48 h (7083 +/- 2844 pg/ml, 6463 +/- 1307 pg/ml, 10,329 +/- 5571 pg/ml vs 137.5 +/- 85.5 pg/ml, respectively, P < 0.05). The high mortality observed in the pancreatitis group (43%) was decreased by pentoxifylline administration to 11%.

CONCLUSION

these results demonstrate that pentoxifylline very effectively inhibits cytokine production in acute pancreatitis.

[The place of enalapril in the management of hypertension]

In Hungary the use of angiotensin converting enzyme inhibitor enalapril has emerged as one of the most important drugs in the treatment of hypertension. The aim of our study was to evaluate the antihypertensive effect of enalapril of Hungarian production in combination therapy and alone, according to sexes, to the body mass index, among smokers and non smokers as well as non diabetic and in patients with diabetes (IDDM and NIDDM). The diurnal blood pressure values were registered by a 24 hour ambulatory blood pressure monitor. During the 6 weeks of the enalapril therapy (n = 28) both the daytime (141/84 vs. 135/80 mmHg) and the night-time (130/78 vs. 124/72 mmHg) blood pressure values decreased; the increase of diurnal indices during the therapy (SI/DI 6/8% vs. 8/10) reflect the 24 hour long lasting effect of the drug. The body mass index had no influence on the efficacy of treatment. Our results indicate that enalapril manufactured in Hungary is an effective antihypertensive drug both in monotherapy and in combination, in both sexes (especially in men), irrespective of the body weight, in non-smokers and especially in smokers, in insulin dependent and in non-insulin dependent diabetes mellitus alike.

Experimental acute pancreatitis results in increased blood-brain barrier permeability in the rat: a potential role for tumor necrosis factor and interleukin 6

Pancreatic encephalopathy is a severe complication of acute pancreatitis. Proinflammatory cytokines may play a role in the development of multi-organ failure during pancreatitis. In the present study, we measured the changes in the blood-brain barrier (BBB) permeability concomitantly with the determination of serum tumor necrosis factor (TNF) and interleukin-6 (IL-6) levels in rats before, as well as 6, 24 and 48 h after the beginning of intraductal taurocholic acid-induced acute pancreatitis. Cytokine concentrations were measured in bioassays with specific cell lines (WEHI-164 for TNF and B-9 for IL-6), while the BBB permeability was determined for a small (sodium fluorescein, molecular weight (MW) 376 Da), and a large (Evans' blue-albumin, MW 67000 Da) tracer by spectrophotometry in the parietal cortex, hippocampus, striatum, cerebellum and medulla of rats. The serum TNF level was significantly (P < 0.05) increased 6 and 24 h after the induction of pancreatitis, while the IL-6 level increased after 24 and 48 h. A significant (P < 0.05) increase in BBB permeability for both tracers developed at 6 and 24 h in different brain regions of animals with acute pancreatitis. We conclude that cytokines, such as TNF and IL-6, may contribute to the vasogenic brain edema formation during acute pancreatitis.