Association between probiotics and enteral nutrition in an experimental acute pancreatitis model in rats

Background/objectivesRecently, a randomized controlled trial showed that probiotic prophylaxis was associated with an increased mortality in enterally fed patients with predicted severe pancreatitis. In a rat model for acute pancreatitis, we investigated whether an association between probiotic prophylaxis and enteral nutrition contributed to the higher mortality rate.MethodsMale Sprague–Dawley rats were allocated to four groups: 1) acute pancreatitis (n = 9), 2) acute pancreatitis and probiotic prophylaxis (n = 10), 3) acute pancreatitis and enteral nutrition (n = 10), and 4) acute pancreatitis, probiotic prophylaxis and enteral nutrition (n = 11). Acute pancreatitis was induced by intraductal glycodeoxycholate and intravenous cerulein infusion. Enteral nutrition, saline, probiotics and placebo were administered through a permanent jejunal feeding. Probiotics or placebo were administered starting 4 days before induction of pancreatitis and enteral nutrition 1 day before start until the end of the experiment, 6 days after induction of pancreatitis. Tissue samples and body fluids were collected for microbiological and histological examination.ResultsIn all animals, serum amylase was increased six hours after induction of pancreatitis. After fulfilling the experiment, no differences between groups were found in histological severity of pancreatitis, degree of discomfort, weight loss, histological examination of small bowel and bacterial translocation (all p > 0.05). Overall mortality was 10% without differences between groups (p = 0.54).ConclusionNo negative association was found between prophylactic probiotics and enteral nutrition in acute pancreatitis. No new clues for a potential mechanism responsible for the higher mortality and bowel ischaemia in the PROPATRIA study were found.     

Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis

AIM: To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis.METHODS: Thirty-one intensive care unit(ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group(n = 15; July 1, 2012 to June 30, 2014) or a control group(n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration(CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 m L/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups.RESULTS: The mortality rate on day 28 was significantly lower in the study group than in the control group(13.33% vs 37.50%; P 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group(7.4 ± 1.35 d vs 9.19 ± 2.99 d, P 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group(3.47 ± 0.52 d vs 7.90 ± 1.14 d, P 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups(60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment(37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups.CONCLUSION: Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.     

Pancreatic enzymes and abdominal adipose tissue distribution in new-onset prediabetes/diabetes after acute pancreatitis

BACKGROUNDNew-onset prediabetes/diabetes after acute pancreatitis (NODAP) is the most common sequela of pancreatitis, and it differs from type 2 prediabetes/diabetes mellitus (T2DM).AIMTo study the associations between circulating levels of pancreatic amylase, pancreatic lipase, chymotrypsin and fat phenotypes in NODAP, T2DM, and health. METHODSIndividuals with NODAP (n = 30), T2DM (n = 30), and sex-matched healthy individuals (n = 30) were included. Five fat phenotypes (intra-pancreatic fat, liver fat, skeletal muscle fat, visceral fat, and subcutaneous fat) were determined using the same magnetic resonance imaging protocol and scanner magnet strength for all participants. One-way analysis of covariance, linear regression analysis, and relative importance analysis were conducted.RESULTSIntra-pancreatic fat deposition (IPFD) was higher in NODAP (9.4% ± 1.8%) and T2DM (9.8% ± 1.1%) compared with healthy controls (7.8% ± 1.9%) after adjusting for covariates (P = 0.003). Similar findings were observed in regards to visceral fat volume (P = 0.005), but not subcutaneous fat volume, liver fat, or skeletal muscle fat. Both IPFD (β = -2.201, P = 0.023) and visceral fat volume (β = -0.004, P = 0.028) were significantly associated with circulating levels of pancreatic amylase in NODAP, but not in T2DM or healthy individuals. Of the five fat phenotypes, IPFD explained the highest amount of variance in pancreatic amylase concentration (R² = 15.3% out of 41.2%). None of the phenotypes contributed meaningfully to the variance in pancreatic lipase or chymotrypsin.CONCLUSIONBoth NODAP and T2DM are characterized by increased IPFD and visceral fat volume. However, only NODAP is characterized by significant inverse associations between the two fat phenotypes and pancreatic amylase.     

Effects of nafamostat mesilate,somatostatin, and glucagon on caerulein-induced acute pancreatitis in rats

The inhibitory effects of somatostatin (SMS) and glucagon (Gn) on acute pancreatitis were evaluated in an experimental acute pancreatitis model in male Wistar rats. The effects of these agents were compared with those of nafamostat mesilate (NM). The acute pancreatitis was induced by four serial subcutaneous injections of caerulein. The rats were divided into four groups. The first group (n=28) received SMS daily, the second group (n=28) received Gn daily, and the third group (n=28) received NM daily after the first injection of caerulein. The fourth group (n=42) received caerulein alone and served as the control group. Animals were sacrificed 4, 6, 8, 12, and 24 h, and 3 and 7 days after the first administration of caerulein and the degree of severity of the acute pancreatitis was evaluated by serial morphological and histological examinations of pancreatic tissues, as well as in terms of the serum concentrations of amylase and lipase. The characteristic findings of acute pancreatitis in the animals of all groups treated with SMS, Gn, or NM were markedly attenuated at all time points after the treatments compared with findings in the controls (caerulein alone) in terms of wet weight of pancreas, serum concentrations of amylase and lipase, formation of intracellular vacuoles in acinar cells, interstitial edema, and infiltration of an inflammatory cell component. The inhibitory effects of SMS, Gn, and NM on acute pancreatitis were similar at the doses used. These results suggest that SMS and Gn are as useful as NM, they may be of value for the treatment of acute pancreatitis.     

Protective effect of YHI and HHII against experimental acute pancreatitis in rabbits

AIM: To observe the protective effect of combined i.v. administraction of Yuanhu injection (YHI) and Huoxuehuayu injection-I (HHI-I) against acute pancreatitis (AP) in rabbits.METHODS: Sever acute pancreatitis (SAP) was induced by retrograde infusion of artificial bile juice into biliary-pancreatic duct, and treated with YHI and HHI-I intravenously. The protective effect was judged by the survival time and rate, serum amylase, serum interleukin-6, pancreatic microcirculation and pathological alteration.RESULTS: Combined use of YHI and HHI-I could markedly increase the rabbits’ 5-d survival rate after AP (83.3% in the treatment group and 33.3% in control). The serum amylase value (x^- ± s) decreased to 1596.6 U/L ± 760.50 U/L in the 5th day from the high level (6320.83 U/L ± 2614.12 U/L) in the 1st day after AP in the treatment group, while in the control group the amylase activity in the 5th day was 2095.0 U/L ± 1081.87 U/L, being significantly different from that before AP (837.17 U/L ± 189.12 U/L). YHI and HHI-I also obviously improved the pancreatic microcirculation and lowered the serum interleukin-6 level, one of the indices of severe pancreatitis. Pathological examination indicated all the changes typical for AP in YHI and HHI-I treatment group were milder than those in the control.CONCLUSION: YHI and HHI-I used in combination might have protective effect against acute pancreatitis in rabbits.     

Serum amylase and lipase concentrations and lipase/amylase ratio in assessment of etiology and severity of acute pancreatitis

We studied the behavior of serum amylase and lipase in 66 consecutive patients with acute pancreatitis in order to assess the ability of these tests and of the serum lipase-amylase ratio to establish the etiology and predict the severity of acute pancreatitis. Forty-two patients had biliary acute pancreatitis, 14 had alcoholic acute pancreatitis, and the remaining 10 nonbiliary, nonalcoholic (NBNA) acute pancreatitis. Serum amylase and lipase were abnormally high in all patients. The elevations of both serum amylase and lipase were significantly lower in patients with alcoholic pancreatitis than in those with biliary pancreatitis, although a considerable overlap was observed between the two groups. No statistically significant differences were found between NBNA patients and those with either biliary or alcoholic forms of the disease. The serum lipase-amylase ratios in patients with alcoholic pancreatitis ranged from 0.2 to 5.6, in those with biliary pancreatitis from 0.1 to 7.9, and in those with NBNA pancreatitis from 0.1 to 4.4. These differences were not statistically significant. No differences in serum enzyme levels were observed among patients without apparent imaging signs of acute pancreatitis (N=20), those with signs of Pancreatic edema (N=36), and those with necrotizing pancreatitis (N=10). The results indicate that serum amylase and lipase concentrations are not able to establish either the etiology or to predict the severity of acute pancreatitis as assessed by imaging techniques. Furthermore, the serum lipase-amylase ratio is not useful in distinguishing acute episodes of alcoholic from nonalcoholic acute pancreatitis.     

Low-Dose Rapamycin (Sirolimus) Effects in Autosomal Dominant Polycystic Kidney Disease: An Open-Label Randomized Controlled Pilot Study

Background and objectives

The two largest studies of mammalian target of rapamycin inhibitor treatment of autosomal dominant polycystic kidney disease (ADPKD) demonstrated no clear benefit on the primary endpoint of total kidney volume (TKV) or on eGFR. The present study evaluated two levels of rapamycin on the 12-month change in ¹²⁵I-iothalamate GFR (iGFR) as the primary endpoint and TKV secondarily.

Design, setting, participants, & measurements

In a 12-month open-label pilot study, 30 adult patients with ADPKD were randomly assigned to low-dose (LD) rapamycin (rapamycin trough blood level, 2–5 ng/ml) (LD group, n=10), standard-dose (STD) rapamycin trough level (>5–8 ng/ml) (STD group, n=10), or standard care (SC group, n=10). They were evaluated with iGFR and noncontrast computed tomography.

Results

Change in iGFR at 12 months was significantly higher in the LD group (7.7±12.5 ml/min per 1.73 m²; n=9) than in the SC group (−11.2±9.1 ml/min per 1.73 m²; n=9) (LD versus SC: P<0.01). Change in iGFR at 12 months in the STD group (1.6±12.1 ml/min per 1.73 m²; n=8) was not significantly greater than that in the SC group (P=0.07), but it was in the combined treatment groups (LD+STD versus SC: P<0.01). Neither eGFR calculated by the CKD-Epidemiology Collaboration equation nor TKV (secondary endpoint) changed significantly from baseline to 12 months in any of the groups. On the basis of results of the mixed model, during the study, patients in the LD group had significantly lower trough blood levels of rapamycin (mean range±SD, 2.40±0.64 to 2.90±1.20 ng/ml) compared with those in the STD group (3.93±2.27 to 5.77±1.06 ng/ml) (P<0.01).

Conclusion

Patients with ADPKD receiving LD rapamycin demonstrated a significant increase in iGFR compared with those receiving standard care, without a significant effect on TKV after 12 months.     

Diagnosis and treatment of pancreatic duct disruption or disconnection: an international expert survey and case vignette study

BackgroundPancreatic duct disruption or disconnection is a potentially severe complication of necrotizing pancreatitis. With no existing treatment guidelines, it is unclear whether there is any consensus among experts in clinical practice. We evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in an international case vignette study.MethodsAn online case vignette survey was sent to 110 international expert pancreatologists. Expert selection was based on publications in the last 5 years and/or participation in development of IAP/APA and ESGE guidelines on acute pancreatitis. Consensus was defined as agreement by at least 75% of the experts.ResultsThe response rate was 51% (n = 56). Forty-four experts (79%) obtained a MRI/MRCP and 52 experts (93%) measured amylase levels in percutaneous drain fluid to evaluate pancreatic duct integrity. The majority of experts favored endoscopic transluminal drainage for infected (peri)pancreatic necrosis and pancreatic duct disruption (84%, n = 45) or disconnection (88%, n = 43). Consensus was lacking regarding the treatment of patients with persistent percutaneous drain production, and with persistent sterile necrosis.ConclusionThis international survey of experts demonstrates that there are many areas for which no consensus existed, providing clear focus for future investigation.     

The effect of hyperbaric oxygen on apoptosis and proliferation in severe acute pancreatitis

Objectives:

This paper investigates the significance of apoptosis in severe acute pancreatitis (SAP) and the possible modulating effects of hyperbaric oxygen (HBO).

Methods:

Wistar rats (250–350 g) were induced with SAP by biliopancreatic infusion of 4% sodium taurocholate. Rats were randomized for HBO treatment. Pancreatic tissue was stained for apoptosis with immunohistochemistry (anti-CASPASE-3 antibody and TUNEL), and histopathology haematoxylin and eosin (H&E). Acini were stained for proliferation with an anti-KI67 antibody. ImageProPlus was used to quantify apoptosis and proliferation in acinar cells. Statistical analysis was performed with two-independent-sample t-test or non-parametric Mann–Whitney test.

Results:

In normal acini there is a low rate of apoptosis (0.165 ± 0.157%, 0.181 ± 0.168%, 0.130 ± 0.298% in CASPASE-3, H&E and TUNEL, respectively) and proliferation (0.951 ± 0.926%) (mean ± standard deviation [SD]). When compared with normal, apoptosis (CASPASE-3: 1.28 ± 1.12%, P= 0.008; 2.40 ± 3.04%, P= 0.101; 1.23 ± 0.87%, P= 0.091; H&E: 0.47 ± 0.36%, P= 0.051; 0.69 ± 0.63%, P= 0.001; 0.68 ± 0.28%, P= 0; TUNEL: 1.08 ± 1.42%, P= 0; 1.96 ± 1.87%, P= 0; 2.36 ± 2.26%, P= 0) and proliferation (1.96 ± 1.89%, P= 0.187; 1.73 ± 1.76%, P= 0.165; 1.36 ± 1.40%, P= 0.571) were increased on days 1, 2 and 3 post-induction, respectively. In comparison with the untreated controls, HBO increased apoptosis on day 1 (CASPASE-3: 3.11 ± 1.97%, P= 0.04; H&E: 0.97 ± 0.76%, P= 0.005) and day 2 (TUNEL: 3.61 ± 3.05%, P= 0.034). Treatment with HBO increased proliferation (3.04 ± 3.14%, P= 0.519; 7.33 ± 7.55%, P= 0.153) on days 2 and 3, respectively, compared with the untreated controls.

Conclusions:

During SAP, acini apoptosis and proliferation were increased. Hyperbaric oxygen therapy may improve the condition of SAP by promoting apoptosis and proliferation.     

The Prognostic Significance of HbF in Childhood Haematological Malignancies

The degree of increase in foetal haemoglobin (HbF) synthesis in haematological malignancies may be associated with the degree of malignancy. The aim of the present study was to quantify HbF levels in various childhood haematological malignancies and also, to ascertain its prognostic significance by comparing the results with the already established standard prognostic factors. Newly diagnosed cases of haematological malignancies in the paediatric age group were included in the study. HbF levels were estimated in each case of the study group along with HbF levels of control group comprising healthy children of same age group. The estimation was done by HPLC and Modified Betke’s method. 50 cases of newly diagnosed haematological malignancies were studied out of which most of the cases were of acute lymphoblastic leukaemia (ALL) [n = 30(60 %)] followed by acute myeloid leukaemia (AML) [n = 8(16 %)], Hodgkin’s lymphoma [n = 7(14%)], non-Hodgkin’s lymphoma [n = 5(10 %)]. Raised HbF levels were found in 43.3 % cases of ALL (13/30) and 37.5 % cases of AML (3/8). No significant rise in HbF level was found in cases of lymphomas. There was correlation between raised HbF level and poor prognostic factors in cases of ALL but no such correlation was found in cases of AML. HbF levels are often elevated in childhood leukaemias as compared to childhood lymphomas. Thus, the concentration of HbF in acute childhood leukaemia may be considered as a prognostic factor.     

Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation

AIM: To investigate the need for pancreatic stenting after endoscopic sphincterotomy (EST) in patients with difficult biliary cannulation.METHODS: Between April 2008 and August 2013, 2136 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Among them, 55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method (P-GW) were divided into two groups: a stent group (n = 24; pancreatic stent placed) and a no-stent group (n = 31; no pancreatic stenting). We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis (PEP) in patients undergoing EST after biliary cannulation by P-GW.RESULTS: No differences in patient characteristics or endoscopic procedures were observed between the two groups. The incidence of PEP was 4.2% (1/24) and 29.0% (9/31) in the Stent and no-stent groups, respectively, with the no-stent group having a significantly higher incidence (P = 0.031). The PEP severity was mild for all the patients in the stent group. In contrast, 8 had mild PEP and 1 had moderate PEP in the no-stent group. The mean serum amylase levels (means ± SD) 3 h after ERCP (183.1 ± 136.7 vs 463.6 ± 510.4 IU/L, P = 0.006) and on the day after ERCP (209.5 ± 208.7 vs 684.4 ± 759.3 IU/L, P = 0.002) were significantly higher in the no-stent group. A multivariate analysis identified the absence of pancreatic stenting (P = 0.045; odds ratio, 9.7; 95%CI: 1.1-90) as a significant risk factor for PEP.CONCLUSION: In patients with difficult cannulation in whom the bile duct is cannulated using P-GW, a pancreatic stent should be placed even if EST has been performed.     

The impact of age and 24‐h blood pressure on arterial health in acute ischemic stroke patients: The Norwegian stroke in the young study

The impact of age and 24‐h ambulatory blood pressure (ABPM) on arterial stiffness and carotid intima‐media thickness (cIMT) in ischemic stroke patients younger than 60 years of age is poorly explored. A total of 385 acute ischemic stroke patients (aged 49.6±9.7 years, 68% men) were prospectively included and grouped in younger (15–44 years, n = 93) and middle‐aged (45–60 years, n = 292). Arterial stiffness was measured by carotid‐femoral pulse wave velocity (PWV), and cIMT by carotid ultrasound. 24‐h ABPM was recorded. The middle‐aged stroke patients had higher prevalence of smoking, hypertension, diabetes mellitus, metabolic syndrome and hypercholesterolemia, and had higher PWV and cIMT (all p < .05). In multivariable linear regression analyses adjusted for sex, BMI, smoking, diabetes mellitus, total cholesterol, high‐density lipoprotein cholesterol, triglycerides, eGFR, systolic BP and concomitant antihypertensive treatment, 1SD (4.4 years) higher age was associated with higher PWV (β = 0.44,R² = 0.46, p < .001) in the younger group, and with higher mean cIMT (β = 0.16, R² = 0.21, p = .01) in the middle‐aged group. In the middle‐aged group, 24‐h pulse pressure had a significant association with PWV (β = 0.18, R² = 0.19, p = .009), while the association with cIMT was attenuated (β = 0.13, R² = 0.16, p = .065). 24‐h diastolic BP was associated with higher cIMT in the middle‐aged group (β = 0.24, p < .001, R² = 0.23), but not with PWV in either age groups. Among ischemic stroke patients < 60 years, higher age was associated with increased arterial stiffness for patients up to age 44 years, and with cIMT in middle‐aged patients. 24‐h pulse pressure was associated with arterial stiffness, and 24‐h diastolic BP was associated with cIMT only in middle‐aged patients.     

Breviscapine attenuates acute pancreatitis by inhibiting expression of PKCα and NF-κB in pancreas

AIM: To study the effect of breviscapine (Bre) on activity of protein kinase Cα (PKCα) and nuclear factor (NF)-κB in pancreas, and the mechanism of Bre attenuating acute pancreatitis (AP).METHODS: One hundred and eight rats were randomly divided into acute necrotizing pancreatitis (ANP) group, Bre group (ANP + Bre group) and sham operation (SO) group, 36 rats in each group. ANP model was induced by a retrograde injection of 4% sodium deoxycholate into the bilio-pancreatic duct. Fifteen minutes after the ANP model was induced, the rats in Bre group were intraperitoneally injected with Bre (0.4 mg/100 g body weight or 0.1 mL/100 g body weight). Survival time and mortality of rats were calculated. Serum amylase and malondialdehyde levels were measured, volume of ascites was recorded and morphology of pancreas and lung was evaluated at 1, 5 and 10 h, after the ANP model was induced, respectively. Expressions of PKCα and subunit p65 of NF-κB in pancreas were detected by immunohistochemistry and Western blotting.RESULTS: The life span of rats was longer and the mortality was lower in Bre group than in ANP group 13.51 ±5.46 vs 25.36 ± 8.11 (P < 0.05). The amylase and MDA levels as well as the volume of ascites were lower and the pathological changes in pancreas and lung were less in Bre group than ANP group (P < 0.05), indicating that the pancreatitis is less severe in Bre group than ANP group. The activation of PKCα and NF-κB p65 in pancreas was induced rapidly and reached their peak at 1 h or 5 h after ANP, but their activity in Bre group was significantly inhibited.CONCLUSION: Bre exerts its therapeutic effect on AP by inhibiting the activation of PKCα and NF-κB p65 in pancreas.     

Lycopene supplementation reduces TNF-α via RAGE in the kidney of obese rats

Background:

The kidney is a target organ for injuries caused by advanced glycation end products (AGEs) in obesity. The receptor of AGEs (RAGE) is proinflammatory and appears to have a role in the pathogenesis of renal disease due to obesity.

Objective:

The aim was to verify the effect of obesity on renal damage and the effect of lycopene on these complications

Design and Methods:

Male Wistar rats were randomly assigned to receive a control diet (C, n=7) or a high-fat diet plus sucrose (HD+S, n=14) for 6 weeks. After this period, the HD+S animals were randomized into two groups: HD+S (n=7) and HD+S supplemented with lycopene (HD+S+L, n=7). The animals received maize oil (C and HD+S) or lycopene (HD+S+L) for a 6-week period.

Results:

The HD+S and HD+S+L animals demonstrated insulin resistance (OGTT glucose after 150 min; C: 117.6±3.9<HD+S: 138.1±5.1=HD+S+L: 137.8±5.2 mg dl⁻¹; P=0.01); however, no changes were seen in fasting glucose, plasma lipids, blood pressure or renal function. Renal concentrations of RAGE and TNF-α increased in the HD+S group and lycopene supplementation restored these to control group values (RAGE: C: 3.1±0.3=DH+S+L: 3.1±0.3<DH+S: 3.6±0.4 μg g⁻¹; P=0.014; TNF-α: C: 227.8±2.7=DH+S+L: 227.4±2.2<DH+S: 238.7±3.0 pg/ml; P=0.014).

Conclusions:

Lycopene may be beneficial in the prevention and treatment of oxidative stress and inflammation in the kidney due to obesity.     

Contrasting effects of circulating nitric oxide and nitrergic transmission on exocrine pancreatic secretion in rats

Background—Nitric oxide (NO) blockade byL-nitroarginine methyl ester (L-NAME) inhibitspancreatic secretion in vivo and aggravates caerulein inducedpancreatitis. Nitric oxide synthase (NOS) is present in pancreaticislets, endothelium, and nerve fibres. L-NAME blocks allknown NOS isoforms.
Aim—To investigate the source of NO blocked byL-NAME that inhibits amylase secretion.
Methods—Amylase output was measured in rats inresponse to caerulein (0.1-50 µg/kg) alone or with indazole.Baseline secretion and the response to supramaximal caerulein were alsoexamined after administration of indazole, L-NAME,haemoglobin, or aminoguanidine under continuous blood pressuremeasurement. In separate experiments, pancreatic secretion was measuredafter blockade of afferent nerve fibres by either systemic or localcapsaicin. The effect of neural NOS inhibition on caerulein inducedpancreatitis was also investigated.
Results—L-NAME, haemoglobin, andsupramaximal caerulein (10 µg/kg) increased blood pressure, whereasindazole and suboptimal caerulein (0.1 µg/kg) did not. Indazole andcapsaicin decreased basal amylase output. L-NAME andhaemoglobin reduced basal amylase output to a lesser extent andpotentiated the inhibitory response to supramaximal caerulein. Incontrast, full neural NOS inhibition by L-NAME partiallyreversed the expected caerulein induced suppression of amylase output.This effect was reproduced by indazole and capsaicin. Indazole did notalter responses to either optimal (0.25 µg/kg) or suboptimal (0.1 µg/kg) caerulein, nor, in contrast with L-NAME, aggravatethe outcome of caerulein induced pancreatitis.
Conclusions—Reduction of circulating NOavailability, probably of endothelial origin, is responsible for thedecrease in amylase secretion observed in the early response toL-NAME. Nitrergic neurotransmission plays an important rolein the control of pancreatic secretion and may induce opposite effectsto endothelial NOS activity.

     

Serum lipase and amylase ratio in acute alcoholic and nonalcoholic pancreatitis by using Dupont ACA discrete clinical analyzer

This work involves a retrospective analysis of serum amylase, lipase, and lipase/amylase ratio in alcoholic and nonalcoholic patients diagnosed with acute pancreatitis. The purpose of this study was to test the reliability of the Dupont ACA method with respect to the lipase/amylase ratio as a discriminator, for the etiology of pancreatitis. Thirty-six consecutive patients with the diagnosis of acute pancreatitis were studied. These patients were divided in two groups. Group I consisted of 11 patients who had presumed acute alcoholic pancreatitis. In group II, 19 patients had acute biliary pancreatitis, including two with necrotizing pancreatitis and abscess formation secondary to cholilathiasis, five cases were idiopathic in nature, and one was thought to be medication induced (hydrochlorothiazide). In all cases, the Dupont ACA discrete clinical analyzer was used to determine serum levels of amylase and lipase. Concerning the lipase/amylase ratio, the geometric mean ratio for group I was 0.32 (range: 0.11–0.86) and for group II the mean ratio was 0.22 (range: 0.04–0.93). WithP>0.1, the difference between geometric mean ratios was not statistically significant. This study reveals that the lipase/amylase ratio would not have been a good indicator of alcoholic vs nonalcoholic acute pancreatitis. Although there was no significant statistical difference between geometric means, this study does show a significant difference in the number of individuals with serum amylase >2000 IU/dl in nonalcoholic acute pancreatitis patients (8/25 showed levels above 2000 IU/dl) when compared to alcoholic acute pancreatitis patients (0/11 showed levels above 2000 IU/dl). Chi-square analysis between <2000 IU/dl and >2000 IU/dl for the nonalcoholic vs the alcoholic groups yielded aP value of 0.03.     

Evaluation of the association between admission systolic blood pressure and the choice of initial antiplatelet therapy for minor ischemic stroke in real‐world

To evaluate whether admission systolic blood pressure (SBP) is associated with the choice of initial antiplatelet therapy for minor stroke. Eligible patients retrospectively gathered from 2010 to 2018. Finally, 1312 of 1494 patients were divided into three groups: aspirin monotherapy (AM, n = 538, 41.0%), dual antiplatelet therapy with aspirin and load‐clopidogrel (clopidogrel loading dose of 300 mg on the first day, DAPT‐ALC, n = 474, 35.6%), and dual antiplatelet therapy with aspirin and unload‐clopidogrel (clopidogrel 75 mg daily with no loading dose, DAPT‐AUC, n = 300, 22.9%). The mean ± SD age of final patients was 62.0 ± 12.7 years old; 903 (70.9%) participants were male. Patients in the DAPT‐ALC group were more likely to be younger, to arrive earlier, and to have a lower proportion of intracerebral hemorrhage than those in the AM group. DAPT‐AUC group patients were more like to have a history of acute myocardial infarction and less likely to have a history of ICH than the AM group (4.7% vs. 1.7% and .3% vs. 2.6%, p < .05). Overall, there was a likely “S‐shaped” association between the selection of the DAPT‐ALC or DAPT‐AUC scheme and admission systolic blood pressure (P for nonlinearity = .012). Compared with the SBP < 140 mmHg group, the SBP ≥ 180 mmHg group was more likely to be given DAPT‐AUC (OR = 2.92 [1.62–5.26], p < .001) than DAPT‐ALC. Our findings support that admission SBP is associated with the choice of initial antiplatelet, especially when the SBP was greater than or equal to 180 mmHg.     

Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis(CP) and patient selection.METHODS: All consecutive patients undergoingduodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index(BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index(white blood cells, interleukin(IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data(postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients.RESULTS: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male(85%) and seven were female(16%). The etiology of CP was alcohol in 32 patients(70%) and idiopathic in 14 patients(30%). Stones were found in 38 patients(83%). An inflammatory mass was found in five patients(11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19(9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7(17.8-22.4) kg/m2 and was 20.6 ± 2.9(15.4-27.7) kg/m2 in the opengroup. Allpatientsrequired analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients(43%). Pre-operative complications due to pancreatitis were observed in 18 patients(39%). Pancreatic functional insufficiency was observed in 14 patients(30%). Two laparoscopic patients(2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29(290-370) min. Estimated intra-operativeblood loss was 57 ± 14(40-80) m L. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2(5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass(P 0.001) and acute exacerbation(P 0.001) were risk factors for intra-operative blood loss. CONCLUSION: The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.     

Characteristics of saliva secreted by patients with TCM-Piyinxu

AIM: To investigate various characteristics of saliva secreted by patients with TCM-Piyinxu (Spleen-yin deficiency).METHODS: Twenty-five individuals with Piyinxu (15 males and 10 females; age range 26-70 years, mean age = 45 years) diagnosed based on criteria used in traditional Chinese medicine, were compared with 20 individuals with Shenyinxu (Kidney-yin deficiency) (11 males, 9 females; age range 35-75 years, mean age = 50) and 30 normal individuals (17 males, 13 females; age range 35-65 years, mean age = 49 years). After acid stimulation, the saliva flow in each group was measured, and the levels of amylase and protein in saliva were determined using an automatic biochemical analyzer. The resultant data were analyzed using the Kruskal-Wallis test and one-way factorial ANOVA test.RESULTS: The flow rates of saliva and amylase in Piyinxu patients (0.27 ± 0.016 mL/min and 2134.13 ± 343.51 IU/min, respectively) were lower than those in normal subjects (0.46 ± 0.027 mL/min and 3501.63 ± 1099.63 IU/min, respectively, P < 0.01), but higher than those in the Shenyinxu group (0.13 ± 0.051 mL/min and 951.62 ± 383.17 IU/min, respectively, P < 0.01). The three groups showed no significant difference in their level of total salivary protein (Piyinxu group, 3.07 ± 0.60 g/L; Shenyinxu group, 3.01 ± 0.90 g/L, and control group, 2.94 ± 1.13 g/L, P = 0.869), amount of amylase per saliva volume, or their ratio of amylase to protein in secreted saliva (P = 0.173 and P = 0.436, respectively).CONCLUSION: Piyinxu patients showed altered rates of saliva and amylase secretion when compared with those parameters in patients with Shenyinxu and normal subjects.     

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

We aimed to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) are helpful to identify complete thrombus resolution (CTR) after acute deep venous thrombosis (DVT). Patients who had first-time episode of acute proximal DVT were included in this retrospective study. 100 patients with DVT were divided into two groups according to absence (group 1; n = 68) or presence (group 2; n = 32) of CTR on doppler ultrasonography at month 6. There were no significant difference in admission MPV and PDW levels between group 1 and group 2. MPV (p = 0.03) and PDW (p < 0.001) levels at month 6 were significantly higher in group 1 than in group 2. CTR showed a moderate negative correlation with PDW at month 6 (ρ = -0.47) and a weak negative correlation with MPV at month 6 (ρ = −0.26). Logistic regression analysis showed that PDW (OR, 2.2; p = 0.004) at month 6 was an independent risk factor for the presence of residual venous thrombosis in DVT patients. Receiver operating characteristics analysis revealed that a 8.4 % decrease in admission MPV at month 6 provided 62 % sensitivity and 62 % specificity (AUC: 0.64) and a 15.4 % decrease in admission PDW at month 6 provided 87 % sensitivity and 94 % specificity (AUC: 0.89) for prediction of CTR in DVT patients. Percent change in admission MPV and PDW levels at month 6 may be used to identify the patients with CTR after a first episode of acute proximal DVT.