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1.
Jayanta Samanta Sukhwinder Singh Sunil Arora Gaurav Muktesh Ashutosh Aggarwal Narendra Dhaka Saroj Kant Sinha Vikas Gupta Vishal Sharma Rakesh Kochhar 《Pancreatology》2018,18(8):878-884
Objectives
To study the role of cytokines in prediction of acute lung injury (ALI) in acute pancreatitis.Methods
Levels of TNFα, IL-6, IL-10, IL-8 and IL-1β were measured in 107 patients at presentation and at 72?h in patients who developed acute lung injury. A model was devised to predict development of ALI using cytokine levels and SIRS score.Results
The levels of TNF α (p?<?0.0001), IL-6 (p?<?0.0001), IL-8 (p?<?0.0001) and IL-1β (p?<?0.0001) were significantly higher in the ALI group. IL-10 levels were significantly lower in persistent ALI (p-ALI) than in transient ALI (t-ALI) patients (p?<?0.038). p-ALI group had significant rise of TNFα (p?=?0.019) and IL-1β (p?=?0.001) while t-ALI group had significant rise of only IL-1β (p = 0.044) on day 3 vs day 1. Combined values of IL-6 and IL-8 above 251 pg/ml had sensitivity of 90.9% and a specificity of 100% to predict future development of ALI. Composite marker-I (IL6 ≥ 80 pg/ml + SIRS) yielded sensitivity and specificity of 73% and 98% whereas composite marker-II (IL8 ≥ 100 pg/ml + SIRS) yielded sensitivity and specificity of 73% and 95% to predict future ALI.Conclusions
IL-6 and IL-8 can predict future development of ALI. When they are combined with SIRS, they can be used as comprehensive composite markers. 相似文献2.
Saransh Jain Shallu Midha Soumya Jagannath Mahapatra Swatantra Gupta Manish Kumar Sharma Baibaswata Nayak Tony George Jacob Pramod Kumar Garg 《Pancreatology》2018,18(5):500-506
Background
Predicting severe acute pancreatitis (AP) is important for triage, prognosis, and designing therapeutic trials. Persistent systemic inflammatory response syndrome (SIRS) predicts severe AP but its diagnostic accuracy is suboptimal. Our objective was to study if cytokine levels could improve the predictive value of clinical variables for the development of severe AP.Methods
Consecutive patients with AP were included in a prospective cohort study at a tertiary care center. Serum levels of IL-6, TNF-α, IL-10, MCP-1, GM-CSF and IL-1β were measured at day 3 of onset of AP. Variables such as age, co-morbidity, etiology, SIRS, and cytokines were modeled to predict severe AP by multivariable regression analysis. Genotyping was done to correlate IL-6, TNF-α and MCP-1 gene polymorphisms with cytokine levels.Results
Of 236 patients with AP, 115 patients admitted within 7 days of onset formed the study group. 37 of the 115 (32%) patients developed organ failure. Independent predictors of organ failure were persistent SIRS (OR 34; 95% CI: 7.2–159) and day 3 serum IL-6 of >160?pg/ml (OR 16.1; 95% CI:1.8–142). IL-6 gene (?174?G/C) GG genotype was associated with significantly higher levels of IL-6 compared to CC/CG genotype. Serum IL-6 >160?pg/ml increased the positive predictive value of persistent SIRS from 56% to 85% and specificity from 64% to 95% for predicting OF without compromising its sensitivity and negative predictive value.Conclusion
Serum IL-6 of >160?ng/ml added significantly to the predictive value of SIRS for severe AP. 相似文献3.
Background
Severe acute pancreatitis (SAP) is characterised by two distinct clinical phases. Organ dysfunction and death is initially as a result of a systemic inflammatory response syndrome (SIRS). Systemic sepsis from infected pancreatic necrosis characterises the second phase, the so called 'second hit' of acute pancreatitis (AP). An immune imbalance during the second hit is postulated to contribute to the formation of the septic complications that occur in these patients. The pro-inflammatory T-helper (Th) 17 pathway has been shown to be an initiator of early SIRS in AP, however to date its role has not been established in the second hit in AP.Methods
Thirty-six patients with mild (n?=?16), moderate (n?=?10) and severe (n?=?10) acute pancreatitis were enrolled. Peripheral blood samples were drawn on days 7, 9, 11 and 13 of illness for analysis of routine clinical markers as well as cytokine analysis. Flow cytometry and a IL-17A ELISA was performed to determine cytokine concentrations.Results
There were no significant differences between days 7, 9, 11 and 13 for either the mild/moderate or SAP groups for IL-17A (CBA assay or ELISA), IFN-γ, TNF-α, IL-2 or IL-4. For each of the study days, the mean IL-6 and IL-10 concentrations were significantly higher in the SAP group compared to the mild/moderate group. WCC, CRP and PCT were all significantly higher in severe acute pancreatitis over the study days.Conclusions
An immune imbalance exists in patients with SAP, however secreted IL-17A is not responsible for the second hit in AP. 相似文献4.
Hazel M. Ní Chonchubhair Yasir Bashir Mark Dobson Barbara M. Ryan Sinead N. Duggan Kevin C. Conlon 《Pancreatology》2018,18(4):379-385
Background
Small intestinal bacterial overgrowth (SIBO) is a condition characterised by symptoms similar to pancreatic exocrine insufficiency (PEI) in chronic pancreatitis patients. SIBO is thought to complicate chronic pancreatitis in up to 92% of cases; however, studies are heterogeneous and protocols non-standardised. SIBO may be determined by measuring lung air-expiration of either hydrogen or methane which are by-products of small bowel bacterial fermentation of intraluminal substrates such as carbohydrates. We evaluated the prevalence of SIBO among a defined cohort of non-surgical chronic pancreatitics with mild to severe PEI compared with matched healthy controls.Methods
Thirty-five patients and 31 age-, gender- and smoking status-matched healthy controls were evaluated for SIBO by means of a fasting glucose hydrogen breath test (GHBT). The relationship between SIBO and clinical symptoms in chronic pancreatitis was evaluated.Results
SIBO was present in 15% of chronic pancreatitis patients, while no healthy controls tested positive (P?=?0.029). SIBO was more prevalent in those taking pancreatic enzyme replacement therapy (PERT) (P?=?0.016), with proton pump inhibitor use (PPI) (P?=?0.022) and in those with alcohol aetiology (P?=?0.023). Patients with concurrent diabetes were more often SIBO-positive and this was statistically significant (P?=?0.009). There were no statistically significant differences in reported symptoms between patients with and without SIBO, with the exception of ‘weight loss’, with patients reporting weight loss more likely to have SIBO (P?=?0.047).Conclusion
The prevalence of SIBO in this study was almost 15% and consistent with other studies of SIBO in non-surgical chronic pancreatitis patients. These data support the testing of patients with clinically-relevant PEI unresolved by adequate doses of PERT, particularly in those patients with concurrent diabetes. SIBO can be easily diagnosed therefore allowing more specific and more targeted symptom treatment. 相似文献5.
Increased risk of candidemia in patients with necrotising pancreatitis infected with candida species
Sebastian Rasch Ulrich Mayr Veit Phillip Roland M. Schmid Wolfgang Huber Hana Algül Tobias Lahmer 《Pancreatology》2018,18(6):630-634
Background and objectives
Candida infections are frequent in necrotising pancreatitis. Candidemia is associated with very high mortality and its risk due to infected pancreatic necrosis is unknown. So we aimed to assess potential risk factors and the risk of candidemia in necrotising pancreatitis.Methods
We retrospectively searched our clinical database for the diagnosis necrotising pancreatitis from 2007 till March 2017 and entered relevant information in a database for statistical analysis.Results
in total, 136 patients met the inclusion criteria. Candida infected pancreatic necrosis were found in 54 patients and 7 patients developed candidemia. Patients with Candida infected necrosis had a significantly higher in hospital mortality (35.2% versus 13.4%, p?=?0.003). The highest mortality was observed in patients with candidemia (57.1% versus 20.2%, p?=?0.042). Male gender (OR 0.32, CI 0.13–0.78, p?=?0.013) and post-ERCP pancreatitis (OR 4.32, CI 1.01–18.36, p?=?0.048) had a significant impact on the risk of Candida infections of pancreatic necrosis. Candidemia was significantly more frequent in patients with Candida infected necrosis (11.1% versus 1.2%, p?=?0.016). Candida albicans was the most common species followed by Candida glabrata.Conclusion
Candidemia is a relevant complication of necrotising pancreatitis and associated with high mortality. If patients do not respond to antibiotic therapy empiric antifungal therapy should be discussed. 相似文献6.
Elizabeth Pando Piero Alberti Jimmy Hidalgo Laura Vidal Cristina Dopazo Mireia Caralt Laia Blanco Concepción Gómez-Gavara Itxarone Bilbao Joaquim Balsells Ramon Charco 《Pancreatology》2018,18(5):486-493
Background
The aim of our study was to determine the risk factors for extrapancreatic infection (EPI) occurrence and its predictive power for assessing severity and local complications in acute pancreatitis including infected pancreatic necrosis (IPN).Methods
Clinical data of 176 AP patients prospectively enrolled were analysed. EPI analysed were bacteraemia, lung infection, urinary tract infection and catheter line infection. Risk factors analysed were: Leukocyte count, C-reactive protein, liver function test, serum calcium, serum glucose, Blood urea nitrogen, mean arterial pressure at admission, total parenteral nutrition (TPN), enteral nutrition, hypotension, respiratory, cardiovascular and renal failure at admission, persistent systemic inflammatory response (SIRS) and intrapancreatic necrosis. Severity outcomes assessed were defined according to the Atlanta Criteria definition for acute pancreatitis. The predictive accuracy of EPI for morbidity and mortality was measured using area-under-the-curve (AUC) receiver-operating characteristics.Results
Forty-four cases of EPI were found (25%). TPN (OR:9.2 CI95%: 3.3–25.7), APACHE-II>8 (OR:6.2 CI95%:2.48–15.54) and persistent SIRS (OR:2.9 CI95%: 1.1–7.8), were risk factors related with EPI. Bacteraemia, when compared with others EPI, showed the best accuracy in predicting significantly persistent organ failure (AUC:0.76, IC95%:0.64–0.88), ICU admission (AUC:0.80 IC95%:0.65–0.94), and death (AUC:0.73 CI95%:0.54–0.91); and for local complications including IPN (AUC:0.72 CI95%:0.53–0.92) as well. Besides, it was also needed for an interventional procedure against necrosis (AUC:0.74 IC95%: 0.57–0.91). When bacteraemia and IPN occurs, bacteraemia preceded infected necrosis in all cases. On multivariate analysis, risk factor for IPN were lung infection (OR:6.25 CI95%1.1-35.7 p?=?0.039) and TPN (OR:22.0CI95%:2.4–205.8, p?=?0.007), and for mortality were persistent SIRS at first week (OR: 22.9 CI95%: 2.6–203.7, p?=?0.005) and Lung infection (OR: 9.7 CI95%: 1.7–53.8).Conclusion
In our study, EPI, played a role in predicting the severity and local complications in acute pancreatitis. 相似文献7.
Robbert A. Hollemans Nora D.L. Hallensleben David J. Mager Johannes C. Kelder Marc G. Besselink Marco J. Bruno Robert C. Verdonk Hjalmar C. van Santvoort 《Pancreatology》2018,18(3):253-262
Objectives
This study systematically explores the prevalence of pancreatic exocrine insufficiency (PEI) after acute pancreatitis in different subgroups of etiology (biliary/alcoholic/other), disease severity and follow-up time (<12, 12–36 and?>?36 months after index admission).Methods
PubMed and EMBASE databases were searched, 32 studies were included in this study level meta-analysis.Results
In a total of 1495 patients with acute pancreatitis, tested at a mean of 36 months after index admission, the pooled prevalence of PEI was 27.1% (95%-confidence interval [CI]: 20.3%–35.1%). Patients from seven studies (n?=?194) underwent direct tests with pooled prevalence of 41.7% [18.5%–69.2%]. Patients from 26 studies (n?=?1305) underwent indirect tests with pooled prevalence of 24.4% [18.3%–31.8%]. In subgroup analyses on patients that underwent fecal elastase-1 tests, PEI occurred more often in alcoholic pancreatitis (22.7% [16.6%–30.1%]) than in biliary pancreatitis (10.2% [6.2%–16.4%]) or other etiology (13.4% [7.7%–22.4%]; P?=?0.02). Pooled prevalence of PEI after mild and severe pancreatitis was 19.4% [8.6%–38.2%] and 33.4% [22.6%–46.3%] respectively in studies using fecal elaste-1 tests (P?=?0.049). Similar results were seen in patients without (18.9% [9.3%–34.6%]) and with necrotizing pancreatitis (32.0% [18.2%–49.8%]; P?=?0.053). Over time, the prevalence of PEI decreased in patients who underwent the fecal elastase-1 test and increased in patients who underwent the fecal fat analysis.Conclusions
After acute pancreatitis, a quarter of all patients develop PEI during follow-up. Alcoholic etiology and severe and necrotizing pancreatitis are associated with higher risk of PEI. The prevalence of PEI may change as time of follow-up increases. 相似文献8.
Mariola Sliwinska-Mosson Grzegorz Marek Zygmunt Grzebieniak Halina Milnerowicz 《Pancreatology》2018,18(8):885-891
Objectives
The aim of the analysis is to determine dynamic changes in somatostatin (SS) and interleukin-6 (IL-6) concentrations during in acute pancreatitis (AP).Methods
The influence of tobacco smoking on IL-6 and SS levels in the serum of non-smoking (n?=?10) and smoking (n?=?27) patients with diagnosed AP and control group: non-smoking (n?=?44), smoking (n?=?42) and passive smoking (n?=?29) healthy persons was proved. The concentration of IL-6 and SS was determined by means of ELISA. Differences between the groups analyzed were tested using the U Mann Whitney test. The Spearman rank correlation analysis was used to evaluate the correlations.Results
The concentrations of IL-6 and SS were significantly higher in smoking patients with AP and healthy persons when compared with non-smoking population on every day (1 day: p?=?0.0002, p?=?0.015; 3 day: p?=?0.005, p?=?0.001 and 7 day: p?=?0.025, p?=?0.038). Dynamic changes in concentrations of IL-6 and SS in the serum of patients with AP were demonstrated in the ensuing days of the disease. In case of non-smoking and smoking patients, significant positive correlations between IL-6 and SS was observed.Conclusions
These findings suggest that some of the antiinflammatory effects of SS against acute pancreatitis may be mediated by reducing the local proinflammatory cytokine secretion in the pancreas. 相似文献9.
Background/Objectives
Respiratory dysfunction and/or failure from acute lung injury (ALI) are common in acute pancreatitis (AP), but assessment of ALI in experimental AP has lacked standardisation.Methods
A range of experimental AP models induced in C57BL/6 mice with corresponding controls (n?=?6/group). Full double lung or right lung specimens were taken for histopathological assessment and slides analysed by a pre-set pipeline using Aperio Scanner (Leica), ImageJ software and CellProfiler software. Findings were compared to other routinely assessed parameters.Results
Overall histopathological changes were similar between both lungs. Mean lung field occupancy was significantly different between moderate and severe CER-AP (21.9% v 27.5%, p?<?0.05) and corresponded with lung MPO and local injury severity parameters and was mirrored for all models tested.Conclusion
We have developed a novel, simple method for assessment of ALI to improve measurement of systemic organ injury in experimental AP and contribute to preclinical drug development. 相似文献10.
Claudio Ricci Riccardo Casadei Giovanni Taffurelli Davide Campana Valentina Ambrosini Carlo Alberto Pacilio Donatella Santini Nicole Brighi Francesco Minni 《Pancreatology》2018,18(3):313-317
Background
Adjuvant therapy after curative surgery for sporadic pancreatic neuroendocrine tumor (pNETs) is not currently recommended, assuming that all patients could be cured by a radical resection. The aim of our study is to establish how many and which kind of patients remained uncured after radical resection of pNET.Methods
Retrospective study involving 143 resected sporadic pNETs. The survival analysis was carried out using the cure model, describing the cure fraction and the excess of risk recurrence. Multivariate analyses were made in order to evaluate the non negligible effect of demographics, clinical and pathological factors on survival parameters. The results were reported as percentages, fractions, ORs and HRs with 95% confidence interval (95 CI %).Results
The cure fraction and the excess of hazard rate of the whole population were 57.1% (37.4–74.6, 95% CI) and 0.06 (0.03–0.07, 95% CI), respectively. Two independent factors were related to the cure fraction: TNM stage (OR 0.27?±?0.17; P?=?0.002) and grading (OR 0.11?±?0.18; P?=?0.004). Considering the excess of hazard rate, only two independent factors were related to an increased risk of recurrence: TNM stage (HR 3.49?±?1.12; P?=?0.004) and grading (HR 4.93?±?1.82; P?<?0.001).Conclusion
The radical surgery has a high probability of cure in stages I-II or in grading 1 while, in stages III-IV or in grading 3 tumors, surgery alone failed to achieve a “cure”. A multimodal treatment should be employed in order to avoid a recurrence of the disease. 相似文献11.
Hui Zhang Guang-yu Chen Le Xiao Xiao Ma Li Shi Tao Wang Hong-tao Yan Hong Zou Qi Chen Li-jun Tang Wei-hui Liu 《Pancreatology》2018,18(6):635-641
Background
As the firs-line treatment for acute pancreatitis (AP) related infectious walled-off necrosis (WON), percutaneous catheter drainage (PCD) are usually accomplished under CT or US guidance, either of which has certain disadvantages. It is necessary to verify the clinical effects of using US and CT images fusion as guidance of PCD.Methods
The total 94 consecutive AP patients with infected WON from January of 2013 to January of 2017 were included. Among these patients with infected WON, 48 received PCD under simple US guidance (US-PCD) and 46 under US/CT images fusion guidance (US/CT-PCD). The clinical data consisting of puncture data, drainage effectiveness indicators, intervention complications were collected.Results
The demographic characteristics and disease related characteristics of two groups were comparable. After 48?h of PCD treatment, the US/CT-PCD group achieved a significantly higher imaging effective rate, and significantly lower inflammatory response indexes and severity score, than the US-PCD group (P?<?0.05). The US/CT-PCD group required fewer puncture times and drainage tubes and lower rate of advanced treatment, showing higher operational success rate than the US-PCD group (P?<?0.05). Moreover, the US/CT-PCD group exhibited significantly fewer puncture related complications, lower hospital stay, intubation time, and hospitalization expenses than the US-PCD group (P?<?0.05).Conclusion
PCD treatment under the US/CT images fusion guidance is a reliable intervention with definite clinical effects for AP complicated with infected WON. 相似文献12.
Mariam Adamu Philipp Nitschke Petar Petrov Anke Rentsch Marius Distler Christoph Reissfelder Thilo Welsch Hans-Detlev Saeger Juergen Weitz Nuh N. Rahbari 《Pancreatology》2018,18(5):585-591
Background/objectives
A better stratification of patients into risk groups might help to select patients who might benefit from more aggressive therapy. The aim of this study was to validate five prognostic scores in patients resected for pancreatic ductal adenocarcinoma (PDAC).Methods
Included were 307 PDAC patients who underwent resection with curative intent. Five clinical risk scores were selected and applied to our study population. Survival analyses were carried out using univariate and multivariate proportional hazards regression.Results
Prognostic stratification was strong for the Heidelberg score (p?<?0.001) and the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram (p?=?0.001) and moderate for the Botsis score (p?=?0.033). There was no significant prognostic value for the Early Mortality Risk Score (p?=?0.126) and McGill Brisbane Symptom Score (p?=?0.133). Positive resection margin (HR 1.53, 95% CI 1.08–2.16) and pain [pain (HR 1.40, CI 1.03–1.91), back pain (HR 1.67, 95% CI 1.08–2.57)] were independent prognostic factors on multivariate analysis.Conclusions
The Heidelberg score and MSKCC nomogram provided adequate risk stratification in our independent study cohort. Further studies in independent patient cohorts are required to achieve higher levels of validation. 相似文献13.
Background
Dietary oleic acid may prevent pancreatic ductal adenocarcinoma (PDA) by reducing hyperinsulinaemia which can otherwise promote DNA damage and tumour growth. Results from previous epidemiological studies investigating oleic acid are inconsistent. This study aims to clarify the relationship between dietary oleic acid intake and the risk of developing PDA using nutritional information from food diaries plus published serum biomarker data from HbA1c.Methods
23,658 participants, aged 40–74 years, were recruited into EPIC-Norfolk and completed 7-day food diaries which recorded; foods, brands and portion sizes to calculate nutrient intakes. Serum HbA1c was measured at recruitment in 11,147 participants (48.7% of cohort). Hazard ratios (HRs) for quintiles of dietary oleic acid intake and serum HbA1c were estimated using Cox regression. Additional analyses were made according to whether body mass index (BMI) was greater or less than 25?kg/m2 as this influences hyperinsulinaemia.Results
88 participants (55% women) developed PDA after a mean follow-up of 8.4 years (SD?=?3.9) (mean age at diagnosis?=?72.6 years, SD?=?8.8). A decreased risk of PDA was associated with increased dietary oleic acid intake (highest vs lowest quintile, HR?=?0.29, 95% CI?=?0.10–0.81, P trend across quintiles?=?0.011), with statistical significance maintained when BMI>25?kg/m2 but not if BMI<25?kg/m2. An elevated serum HbA1c was associated with increased risk of disease (highest vs lowest quintiles, HR?=?6.32, 95% CI?=?1.38–28.89, P for trend?=?0.004).Conclusions
The data supports a protective role of oleic acid against development of PDA in those with higher BMIs possibly through influencing hyperinsulinaemia. Oleic acid intake should be accurately measured in future aetiological studies. 相似文献14.
Andrzej Rafal Hellmann Salvatore Paiella Justyna Kostro Iwona Marek Krystian Adrych Zbigniew Śledziński Stanisław Hać Claudio Bassi 《Pancreatology》2018,18(3):275-279
Objectives
The primary aim of this study was to determine the blood levels of SPINK1 in patients with chronic pancreatitis (CP) submitted to surgical or endoscopic decompression of pancreatic duct (PD). Additionally, we measured trypsin activity levels.Methods
Two groups were identified, surgical (group A) and endoscopic (group B). Levels of SPINK1 and trypsin activity were measured at baseline and 6 months after pancreatic duct decompression and then compared within the groups. SPINK1 levels were determined with Human ELISA Kit.Results
Group A and B were made up of 30 and 28 patients, respectively. Baseline features of the groups were similar. A decrease in SPINK1 levels was significant only in group A 46.88 to 16.10?ng/mL (p?=?0.001). On the contrary, trypsin activity changed significantly in group B 40.01 to 34.92 mU/mL (p?=?0.01). Patients of group A showed a significant increase in BMI, before and after treatment. The pain score pre- and post-treatment reduced significantly in both groups (p?<?0.001).Conclusions
We demonstrate for the first time a significant decrease of SPINK1 levels after surgical decompression of PD and a reduction of trypsin activity analysis after endoscopic decompression. The meaning of this phenomena is yet to be explained and it should be further explored. 相似文献15.
Milosz Wiktorowicz Damian Mlynarski Radoslaw Pach Romana Tomaszewska Jan Kulig Piotr Richter Marek Sierzega 《Pancreatology》2018,18(8):977-982
Background
Aberrantly expressed mucin glycoproteins (MUC) play important roles in pancreatic ductal adenocarcinoma (PDAC), yet their use as a diagnostic aid in fine-needle aspiration biopsy (FNAB) is poorly documented. The aim of this study was to investigate the rationale and feasibility of mucin (MUC1, MUC2, MUC3, MUC4, MUC5AC, and MUC6) expression profiling by RT-PCR for diagnostic applications in cytology.Methods
Mucin expression was examined by RT-PCR and immunohistochemistry in specimens resected from patients with pancreatic (n?=?101), ampullary (n?=?23), and common bile duct (n?=?10) cancers and 33 with chronic pancreatitis. Furthermore, mucin profiling by RT-PCR was prospectively compared in surgical and biopsy specimens of 40 patients with pancreatic solid tumours qualified for FNAB prior to surgery.Results
A logistic regression model to distinguish PDAC from chronic pancreatitis using RT-PCR profiling included MUC3, MUC5AC, and MUC6. The same set of mucins differentiated ampullary and bile duct cancers from chronic pancreatitis. AUCs for the ROC curves derived from the two models were 0.95 (95%CI 0.87–0.99) and 0.92 (95%CI 0.81–0.98), respectively. The corresponding positive likelihood ratios were 6.02 and 5.97, while the negative likelihood ratios were 0.10 and 0.12. AUCs of ROC curves obtained by RT-PCR and immunohistochemistry demonstrated that both analytical methods were comparable. Surgical and cytological samples showed significantly correlated values of ΔCt for individual mucins with the overall Pearson's correlation coefficient r?=?0.841 (P?=?0.001).Conclusions
Mucin expression profiling of pancreatic cancer with RT-PCR is feasible and may be a valuable help in discriminating malignant lesions from chronic pancreatitis in FNAB cytology. 相似文献16.
Bipadabhanjan Mallick Narendra Dhaka Pankaj Gupta Ajay Gulati Sarthak Malik Saroj K. Sinha Thakur D. Yadav Vikas Gupta Rakesh Kochhar 《Pancreatology》2018,18(7):727-733
Background and objectives
Percutaneous catheter drainage (PCD) is used as a first step in the management of symptomatic fluid collections in patients with acute pancreatitis (AP). We aimed to compare the outcome of patients with acute necrotic collection (ANC) and those with walled-off necrosis (WON), who had undergone PCD as a part of management of AP.Methods
Consecutive patients of AP with symptomatic ANC or WON undergoing PCD were evaluated. Primary outcome measures were need for additional surgical necrosectomy and mortality. Secondary outcome measures were need for up-gradation of first PCD, need for additional drain, in-hospital as well as total duration of PCD and length of hospital stay.Results
Indications of PCD in 375 patients (258 with ANC and 117 with WON) were suspected infected pancreatic necrosis (n?=?214), persistent organ failure (n?=?117) and pressure symptoms (n?=?44). Need for additional surgical necrosectomy was seen in 14% patients with ANC and in 12% of patients with WON (p?=?0.364) and mortality was 19% in patients with ANC as compared to 13.7% in those with WON (p?=?0.132). There was no significant difference in the secondary outcome parameters between patients who underwent PCD for ANC or WON. Complications of PCD were comparable between patients with ANC and WON except development of external pancreatic fistula which occurred more often in patients with WON than in those with ANC (24.4% versus 34.2% respectively, p?=?0.034).Conclusion
Persistent organ failure in more often an indication of PCD in patients with ANC than in WON and suspected infection is more commonly an indication in WON than in ANC. Early PCD is as efficacious and safe as delayed PCD. 相似文献17.
Meng Yue Tang Tian Wu Chen Thomas L. Bollen Yi Xiang Wang Hua Dan Xue Zheng Yu Jin Xiao Hua Huang Bo Xiao Xing Hui Li Yi Fan Ji Xiao Ming Zhang 《Pancreatology》2018,18(4):363-369
Purpose
To study MRI findings of hemorrhage in acute pancreatitis (AP) and correlate the presence and extent of hemorrhage with the MR severity index (MRSI), Acute Physiology And Chronic Health Evaluation (APACHE) II scores, and clinical outcome.Materials and methods
This retrospective study included 539 patients with AP. Hemorrhage was defined as areas of hyperintensity in or outside the pancreas on liver imaging with volume acceleration flexible (LAVA-Flex). The presence of hemorrhage was classified into three areas: within the pancreatic parenchyma, retroperitoneal space, and sub-or intraperitoneal space. Involvement of each area was awarded 1 point resulting in the hemorrhage severity index (HSI) score. The predicted severity of AP was graded by MRSI and APACHE II score. The association between HSI, MRSI, and APACHE II scores was analyzed. The length of hospital stay and organ dysfunction was used as clinical outcome parameters.Results
Among 539 AP patients, 62 (11.5%) had hemorrhage. The prevalence of hemorrhage was 1.1% (2/186), 13.9% (43/310), and 39.5% (17/43) in predicted mild, moderate, and severe AP, respectively, based on MRSI (χ2?=?55.3, p?=?0.00); and 7.7% (21/273) and 19.2% (18/94) in predicted mild and severe AP, respectively, based on APACHE II (χ2?=?21.2, p?=?0.00). HSI score significantly correlated with MRSI (r?=?0.36, p?<?0.001) and APACHE II scores (r?=?0.21, p?=?0.00). The prevalence of organ dysfunction was higher and length of hospital stay was longer in patients with hemorrhage than in those without hemorrhage (p?<?0.01).Conclusions
Hemorrhage in AP is common. The presence of hemorrhage, rather than its extent, correlates with poor clinical outcome. 相似文献18.
Anna Evans Phillips Jessica LaRusch Phil Greer Judah Abberbock Samer Alkaade Stephen T. Amann Michelle A. Anderson John Baillie Peter A. Banks Randall E. Brand Darwin Conwell Gregory A. Coté Christopher E. Forsmark Timothy B. Gardner Andres Gelrud Nalini Guda Michele Lewis Mary E. Money Dhiraj Yadav 《Pancreatology》2018,18(5):528-535
Background
Multiple pathogenic genetic variants are associated with pancreatitis in patients of European (EA) and Asian ancestries, but studies on patients of African ancestry (AA) are lacking. We evaluated the prevalence of known genetic variations in African-American subjects in the US.Methods
We studied prospectively enrolled controls (n?=?238) and patients with chronic (CP) (n?=?232) or recurrent acute pancreatitis (RAP) (n?=?45) in the NAPS2 studies from 2000-2014 of self-identified AA. Demographic and phenotypic information was obtained from structured questionnaires. Ancestry and admixture were evaluated by principal component analysis (PCA). Genotyping was performed for pathogenic genetic variants in PRSS1, SPINK1, CFTR and CTRC. Prevalence of disease-associated variants in NAPS2 subjects of AA and EA was compared.Results
When compared with CP subjects of EA (n?=?862), prevalence of established pathogenic genetic variants was infrequent in AA patients with CP, overall (29 vs. 8.19%, OR 4.60, 95% CI 2.74–7.74, p?<?0.001), and after stratification by alcohol etiology (p?<?0.001). On PCA, AA cases were more heterogeneous but distinct from EA subjects; no difference was observed between AA subjects with and without CP-associated variants. Of 19?A?A patients with CP who had pathogenic genetic variants, 2 had variants in PRSS1 (R122H, R122C), 4 in SPINK1 (all N34S heterozygotes), 12 in CFTR (2 CFTRsev, 9 CFTRBD, 1 compound heterozygote with CFTRsev and CFTRBD), and 1 in CTRC (R254W).Conclusion
Pathogenic genetic variants reported in EA patients are significantly less common in AA patients. Further studies are needed to determine the complex risk factors for AA subjects with pancreatitis. 相似文献19.
Jae Hyuck Jun Sung Koo Lee So Yeon Kim Dong Hui Cho Tae Jun Song Do Hyun Park Sang Soo Lee Dong-Wan Seo Myung-Hwan Kim 《Pancreatology》2018,18(7):805-811
Background/objectives
The pancreatoduodenal groove (anatomical groove) is a potential space bordered by the head of the pancreas, duodenum, and common bile duct. Discerning between groove carcinoma (GC) and groove pancreatitis (GP) is often difficult, but clinically important. We retrospectively analyzed and compared the findings of computed tomography (CT), laboratory tests, and endoscopic ultrasound-fine needle aspiration (EUS-FNA) for GC and GP.Methods
GC (n?=?36) and GP (n?=?44) patients at Asan Medical Center from January 1, 2000, to May 31, 2017 were retrospectively reviewed. MDCT findings, baseline characteristics, laboratory test results, and EUS and EUS-FNA findings of GC and GP patients were compared.Results
CT showed no significant difference in groove enhancement between the groups. Mass-like lesions, cystic groove lesions, and calcification were observed in 86.1% and 15.9%, 38.9% and 75%, and 2.8% and 29.5% of GC and GP patients, respectively. Patients were tested for total bilirubin (GC: 2.0 vs. GP: 0.6?mg/dL), cancer antigen 19-9 (CA19-9) (GC: 76 vs. GP: 12.5 U/mL), and carcinoembryonic antigen (GC: 2.4 vs. GP: 2?ng/mL). Three GP patients died, and one GP patient was diagnosed with GC. However, among 30?GC patients with at least 1-year follow-up, 20 died. In multivariate logistic regression, CA19-9, and mass-like lesion on multidetector CT (MDCT) were discriminating factors between GC and GP. Among 23 (10?GC, 13?GP) patients who underwent EUS-FNA, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, accuracy of EUS-FNA were 90%, 100%, 100%, 92.86%, and 95.65%, respectively.Conclusions
Several MDCT and laboratory findings favor GC over GP. EUS-FNA should be considered in patients with elevated CA19-9 levels and mass-like lesions on MDCT. 相似文献20.
David W. da Costa Nicolien J. Schepers Stefan A. Bouwense Bob A. Hollemans Eva Doorakkers Djamila Boerma Camiel Rosman Cees H. Dejong Marcel B.W. Spanier Hjalmar C. van Santvoort Hein G. Gooszen Marc G. Besselink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(8):745-751