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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.
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.
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5.
Sararak Choosakul Kamin Harinwan Sakkarin Chirapongsathorn Krit Opuchar Theeranun Sanpajit Wanich Piyanirun Chaipichit Puttapitakpong 《Pancreatology》2018,18(5):507-512
Background/Objectives
Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. However, there are few studies which focus on types of fluid therapy.Methods
We performed a randomized controlled trial in patients with acute pancreatitis. The patients were randomized into two groups. Each group received Normal Saline solution (NSS) or Lactated Ringer's solution (LRS) through a goal-directed fluid resuscitation protocol. Systemic inflammatory response syndrome (SIRS) at 24 and 48?h, mortality, presence of local complications and inflammatory markers were measured.Results
Forty-seven patients were included. Twenty-four patients (51%) received NSS and 23 patients received LRS. There was significant reduction in SIRS after 24?h among subjects who resuscitated with LRS compared with NSS (4.2% in NSS, 26.1% in LRS, P?=?0.02). However, SIRS reduction at 48?h was not different between groups (33.4% in NSS, 26.1% in LRS, P?=?0.88). Mortality was not different between NSS and LRS (4.2% in NSS, 0% in LRS, P?=?1.00). CRP, ESR and procalcitonin increased at 24?h and 48?h after admission with no difference between the two groups. Local complications were 29.2% in NSS and 21.7% in LRS (P?=?0.74). The median length of hospital stay was not significantly different in the two groups (5.5 days in NSS, 6 days in LRS, P?=?0.915).Conclusions
Lactated Ringer's solution was superior to NSS in SIRS reduction in acute pancreatitis only in the first 24?h. But SIRS at 48?h and mortality were not different between LRS and NSS. 相似文献6.
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7.
Maisam Abu-El-Haija Tom K. Lin Soofia Khan Lin Fei Tyler Thompson Jaimie D. Nathan 《Pancreatology》2018,18(5):482-485
Background
Early biomarkers for diagnosis of gallstone pancreatitis (GP) in pediatrics have not been well studied. Reliably differentiating GP from other causes of acute pancreatitis (AP) would allow for early diagnosis and prompt management. We sought to assess biomarkers and clinical variables for early GP diagnosis from a prospectively-enrolled registry of pediatric patients presenting with first AP episode.Methods
Cross-sectional analysis of a prospective acute pancreatitis registry of children enrolled from March 2013 through October 2016 was performed. Fisher's exact test and Wilcoxon rank sum test were used to compare demographic and clinical variables between GP and non-GP groups. A multivariable logistic regression model was derived, and receiver operating characteristic (ROC) curve was built using stepwise selection.Results
114 subjects were enrolled (21 with GP, 93 as non-GP). Median was statistically higher for GP patients in lipase values X upper limit of normal (ULN) on admission, weight percentile for age, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase. By multivariable analysis, significant predictors were ALT and Lipase xULN. A model built using these two variables for prediction of GP identified an AUROC of 0.85. At a predictive probability of 0.35, the model had an 80% sensitivity, 93% specificity, 76% positive predictive value and 95% negative predictive value.Conclusions
We have developed a model for predicting GP in children that could help guide clinical management of AP patients. Future studies are needed to validate use of laboratory findings and clinical variables in evaluation of gallstone etiology in pediatric AP patients. 相似文献8.
Fateh Bazerbachi Samir Haffar Mohammad Tahir Hussain Eric J. Vargas Kymberly D. Watt M. Hassan Murad Suresh Chari Barham K. Abu Dayyeh 《Pancreatology》2018,18(7):691-699
Background
Acute pancreatitis (AP) associated with interferon-α or pegylated interferon-α (AP-IFN) has been described, although the causal relation certitude remains elusive. Some recent studies suggest definite causality, although the relation is grouped in class III of Badalov classification of drug-induced AP.Objectives
Perform systematic review of AP-IFN and assess causality.Methods
Two reviewers independently evaluated the data and quality of studies extracted from multiple databases on March 13, 2017. Studies selection was based on a priori criteria. Naranjo scale, and Badalov classification were applied to determine causality.Results
We identified 16 studies that reported AP-IFN with a total of 23 patients. Fifteen studies had moderate to good methodological quality. The frequency of AP-IFN was 7/3450 (0.2%). The median age of patients was 50 years. In most cases IFN was used for chronic hepatitis C. The latency between IFN and diagnosis of AP was (>30 days). AP was mild or moderately severe and improved with supportive management. No mortality was observed. Re-challenge was done in 5 patients and resulted in AP recurrence in 3 cases. Twenty-one cases were classified as probable and 2 cases as definitive according to Naranjo scale. Evaluations of studies confirm a status Ia for AP-IFN according to Badalov classification.Conclusion
AP-IFN is rare and has a probable or definite causal relation according to Naranjo scale. The evidence supports a class Ia of Badalov classification. Hypertriglyceridemia is not a contributing factor. IFN-induced AP is usually mild or moderately severe, and responds favorably to supportive management. 相似文献9.
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10.
X.J.N.M. Smeets G. Litjens D.W. da Costa W. Kievit H.C. van Santvoort M.G.H. Besselink P. Fockens M.J. Bruno J.J. Kolkman J.P.H. Drenth T.L. Bollen E.J.M. van Geenen 《Pancreatology》2018,18(5):494-499
Background/objectives
Acute pancreatitis (AP) progresses to necrotizing pancreatitis in 15% of cases. An important pathophysiological mechanism in AP is third spacing of fluids, which leads to intravascular volume depletion. This results in a reduced splanchnic circulation and reduced venous return. Non-visualisation of the portal and splenic vein on early computed tomography (CT) scan, which might be the result of smaller vein diameter due to decreased venous flow, is associated with infected necrosis and mortality in AP. This observation led us to hypothesize that smaller diameters of portal system veins (portal, splenic and superior mesenteric) are associated with increased severity of AP.Methods
We conducted a post-hoc analysis of data from two randomized controlled trials that included patients with predicted severe and mild AP. The primary endpoint was AP-related mortality. The secondary endpoints were (infected) necrotizing pancreatitis and (persistent) organ failure. We performed additional CT measurements of portal system vein diameters and calculated their prognostic value through univariate and multivariate Poisson regression.Results
Multivariate regression showed a significant inverse association between splenic vein diameter and mortality (RR 0.75 (0.59–0.97)). Furthermore, there was a significant inverse association between splenic and superior mesenteric vein diameter and (infected) necrosis. Diameters of all veins were inversely associated with organ failure and persistent organ failure.Conclusions
We observed an inverse relationship between portal system vein diameter and morbidity and an inverse relationship between splenic vein diameter and mortality in AP. Further research is needed to test whether these results can be implemented in predictive scoring systems. 相似文献11.
Felix Zubia-Olaskoaga Enrique Maraví-Poma Iratxe Urreta-Barallobre María-Rosario Ramírez-Puerta Mónica Mourelo-Fariña María-Pilar Marcos-Neira Miguel Ángel García-García 《Pancreatology》2018,18(2):161-167
Background/objectives
Development and validation of a multivariate prediction model for patients with acute pancreatitis (AP) admitted in Intensive Care Units (ICU).Methods
A prospective multicenter observational study, in 1 year period, in 46 international ICUs (EPAMI study). Patients: adults admitted to an ICU with AP and at least one organ failure. Interventions: Development of a multivariate prediction model, using the worst data of the stay in ICU, based in multivariate analysis, simple imputation in a development cohort. The model was validated in another cohort.Results
374 patients were included (mortality of 28.9%). Variables with statistical significance in multivariate analysis were age, no alcoholic and no biliary etiology, development of shock, development of respiratory failure, need of continuous renal replacement therapy, and intra-abdominal pressure. The model created with these variables presented an AUC of ROC curve of 0.90 (CI 95% 0.81–0.94) in the validation cohort. We developed a multivariable prediction model, and AP cases could be classified as low mortality risk (between 2 and 9.5 points, mortality of 1.35%), moderate mortality risk (between 10 and 12.5 points, 28.92% of mortality), and high mortality risk (13 points of more, mortality of 88.37%). Our model presented better AUC of ROC curve than APACHE II (0.91 vs 0.80) and SOFA in the first 24?h (0.91 vs 0.79).Conclusions
We developed and validated a multivariate prediction model, which can be applied in any moment of the stay in ICU, with better discriminatory power than APACHE II and SOFA in the first 24?h. 相似文献12.
Kazuki Sasaki Tadafumi Asaoka Hidetoshi Eguchi Yasunari Fukuda Yoshifumi Iwagami Daisaku Yamada Yasuhiro Miyazaki Takehiro Noda Tsuyoshi Takahashi Kunihito Gotoh Koichi Kawamoto Yukinori Kurokawa Shogo Kobayashi Shuji Takiguchi Masaki Mori Yuichiro Doki 《Pancreatology》2018,18(1):73-78
Background/Objectives
The gut peptide hormone ghrelin induces appetite and exhibits an anti-inflammatory effect. Serial perioperative changes in ghrelin have been examined in several surgical procedures, but few in pancreatectomy. The present study analyzed perioperative changes in plasma ghrelin levels after pancreaduodenectomy (PD).Methods
The study included 24 patients undergoing PD between May 2015 and January 2016 at Osaka University Hospital. Plasma ghrelin and interleukin-6 (IL-6) levels, as well as white blood cells (WBCs) and C-reactive protein (CRP), were measured preoperatively and on postoperative day (POD) 1, 3, 7, and 14 by enzyme-linked immunosorbent assay. The relationship between the individual ghrelin ratio relative to preoperative value (IGR) and the development of grade IIIa-V Clavien-Dindo (CD) complications was examined.Results
Twelve patients (50%) developed grade IIIa CD complications (n = 6 [25%] pancreatic fistula, n = 7 [29%] intraabdominal abscess, n = 3 [13%] post-pancreatectomy hemorrhage, n = 5 [21%] wound infection, and n = 1 [4%] lymphorrhea). The IGR on POD 1 was significantly lower (p = 0.014) in patients who developed the complications compared to those who did not, but no significant differences were found in terms of WBC, CRP, or IL-6 on POD 1. When the IGR cut-off was set to 82% by receiver operative curve analysis, the sensitivity was 83%, specificity 75% and area under the curve 0.80. The lower IGR group (≤82%) had more postoperative complications and longer hospital stay.Conclusions
The IGR on POD 1 after PD is a useful marker for predicting postoperative complications. 相似文献13.
Yongzhi Zhai Lu Gan Sai Huang Qinrui Xing Xuan Zhou Lili Wang Cong Feng Li Chen Tanshi Li 《Pancreatology》2019,19(1):158-162
Objectives
To study the therapeutic effect of early peripancreatic lavage of ulinastatin on severe acute pancreatitis(SAP).Methods
Sixteen pigs were divided into 4 groups: model(SAP), saline lavage(SL), ulinastatin lavage(UL), intravenous ulinastatin(IU). UL and SL group were given peripancreatic lavage of ulinastatin by ultrasound-guided perirenal catheterization and IU group was intravenously instilled with ulinastatin. The multi-organ functions and the inflammatory factors were observed.Results
UL group has the best therapeutic effect. The changes of multi-organ functions and the inflammatory factors were compared with SAP group as follows. In time window of treatment: amylase (p?<?0.01), lipase (p?<?0.01), ALT (p?>?0.05), AST (p?<?0.05), CR (p?<?0.01), UR (p?<?0.01), IL-6 (p?<?0.01), IL-10 (p?<?0.01). In post-treatment phase: amylase (p?<?0.01), lipase (p?<?0.01), ALT (p?<?0.01), AST (p?<?0.01), CR (p?<?0.05), UR (p?>?0.05), IL-6 (p?<?0.01), IL-10 (p?<?0.01).Conclusions
Early peripancreatic lavage of ulinastatin in SAP could effectively improve the multi-organ functions and inflammatory response. 相似文献14.
Zheng Junyuan Xu Hui Huang Chunlan Fan Junjie Mei Qixiang Lu Yingying Lou Lihong Wang Xingpeng Zeng Yue 《Pancreatology》2018,18(7):742-752
Objective
To investigate the effects of quercetin on intestinal barrier disruption and inflammation in acute necrotizing pancreatitis (ANP) in rats, and its possible mechanism.Methods
ANP was established by retrograde injection of 3.5% sodium taurocholate into the biliopancreatic duct, and quercetin (50?mg/kg?×?3) was administered by intraperitoneal injection prior to and after ANP induction. Pancreatitis was assessed by pancreatic histopathology, plasma amylase, pancreatic myeloperoxidase (MPO) activity, IL-1β, TNFα and IL-6 levels. Injury of the distal ileum was assessed by histological evaluation. The ultrastructural changes of ileal epithelial cells were examined by transmission electron microscope (TEM). Intestinal barrier function was estimated by plasma diamine oxidase (DAO), d-lactate, endotoxin; and intestinal tight junction proteins including zonula occludens-1 (ZO-1), claudin 1, occludin; and bacterial translocation. Intestinal inflammation was determined by IL-1β, TNFα and IL-17?A expression. TLR4, MyD88, pp38?MAPK, and endoplasmic reticulum stress (ERS)-related molecules (Bip, p-IRE1α, sXBP1, p-eIF2α, ATF6) were measured by immunohistochemistry and WB.Results
Quercetin intervention attenuated pancreatic and ileal pathological damages in ANP (P?<?0.05), ameliorated intestinal barrier disruption and inflammation (P?<?0.05). Meantime, QE significantly suppressed intestinal TLR4/MyD88/p38?MAPK pathway and ERS activation.Conclusions
Quercetin plays a protective role against intestinal barrier disruption and inflammation in ANP, probably partly by inhibiting TLR4/MyD88/p38?MAPK and ERS activation. 相似文献15.
Tao Jin Kun Jiang Lihui Deng Jia Guo Yuwan Wu Zhengyan Wang Na Shi Xiaoxin Zhang Ziqi Lin Varsha Asrani Peter Jones Anubhav Mittal Anthony Phillips Robert Sutton Wei Huang Xiaonan Yang Qing Xia John A. Windsor 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1082-1091
Background
Intravenous (IV) fluid resuscitation remains the cornerstone for early management of acute pancreatitis (AP), but many questions remain unanswered, including how to determine whether patients will benefit from additional fluids. The aim was to investigate the utility of serum biomarkers of responsiveness IV fluid resuscitation in patients with AP and systemic inflammatory response syndrome (SIRS).Methods
Eligible adult patients had abdominal pain for <36 h and ≥2 SIRS criteria. Mean arterial pressure (>65 mmHg) and urine output (>0.5 ml/kg/h) were used to assess responsiveness at 2 and 6–8 h after initiation of IV fluids. Comparison was made between responsive and refractory patients at time points for fluid volume, biomarkers and outcomes.Results
At 2 h 19 patients responded to fluids (Group 1) while 4 were refractory (Group 2); at 6–8 h 14 responded (Group 3) and 9 were refractory (Group 4). No demographic differences between patient groups, but Group 4 had worse prognostic features than Group 3. Refractory patients received significantly more fluid (Group 4 mean 7082 ml vs. Group 3 5022 mL, P < 0.001) in first 24 h and had worse outcome. No significant differences in biomarkers between the groups.Conclusions
The serum biomarkers did not discriminate between fluid responsive and refractory patients. Refractory patients at 6–8 h had more severe disease on admission, did not benefit from additional fluids and had a worse outcome. New approaches to guide fluid resuscitation in patients with AP are required. 相似文献16.
Qian Wang Xin Zhang Shuanghong Lei Yi Wang Yongjing Zhuang Yi Chen Chao Zeng Huan Zhang Chaoxu Liu Gang Wang 《Pancreatology》2018,18(7):753-763
Background
The morbidity and mortality associated with acute pancreatitis (AP) are largely attributable to abnormalities that occur in distant organs, such as liver and lungs. Pancreatitis-associated liver injury (PALI) remains a serious and even fatal complication during the progression of AP. However, the exact pathophysiological mechanism is still unclear.Methods
In the present study, we used, for the first time, RNA-seq method to reveal pathways and candidate genes associated with PALI in rats. AP was induced by retrograde injection of sodium taurocholate (5%) into the biliopancreatic duct. The RNA-seq results of selected genes were validated by RT-PCR and immunohistochemistry assay.Results
GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analysis indicated that Toll like receptor 4 (TLR4) signaling pathway and transforming growth factor β1 (TGF-β1) and p38 mitogen-activated protein kinase (MAPK) signaling pathway (TGF-β1-p38?MAPK) were involved in the course of PALI. In addition, other factors were also found to be involved in the course of PALI, such as the decreased antioxidant activity, excessive production of inflammatory mediators and alterations in liver metabolism.Conclusions
The study sheds some new insight on our understanding of the pathophysiology of PALI and provides some clues to the identification of potential therapeutic targets. 相似文献17.
Takayoshi Komatsu-Fujii Yuko Chinuki Hiroyuki Niihara Kenji Hayashida Masataka Ohta Ryota Okazaki Sakae Kaneko Eishin Morita 《Allergology international》2018,67(1):90-95
Background
In severe drug eruptions, precise evaluation of disease severity at an early stage is needed to start appropriate treatment. It is not always easy to diagnose these conditions at their early stage. In addition, there are no reported prognostic biomarkers of disease severity in drug eruptions. The aim of this study was to test whether the thymus and activation-regulated chemokine (TARC) level in serum at an early stage of a drug eruption can serve as a prognostic biomarker of systemic inflammation.Methods
Study participants included 76 patients who received a diagnosis of a drug eruption, one of the following: drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome, maculopapular exanthema, and erythema multiforme. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) was eliminated in this study because scoring system for evaluating the severity was established. Correlation coefficients between serum TARC levels and indicators of systemic inflammation, including the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, modified systemic inflammatory response syndrome (mSIRS) score, and C-reactive protein in serum were evaluated.Results
Serum TARC levels positively correlated with the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, mSIRS score, C-reactive protein, albumin, white blood cell count, body temperature, and pulse rate. TARC levels negatively correlated with systolic blood pressure. Among these parameters, the mSIRS score showed strong correlation (correlation coefficient: 0.68).Conclusions
Serum TARC levels correlate well with indicators of systemic inflammation and of disease severity among patients with a drug eruption except SJS/TEN. Serum TARC may be a prognostic biomarker of severity of inflammation in drug eruptions. 相似文献18.
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19.
Sergio Moral Hug Cuéllar Gustavo Avegliano Esther Ballesteros Maria Teresa Salcedo Ignacio Ferreira-González David García-Dorado Arturo Evangelista 《Journal of the American College of Cardiology》2017,69(1):28-39
Background
Focal intimal disruption (FID) has been described in >20% of type B intramural hematomas (IMH), with unclear prognosis and management.Objectives
This study aimed to evaluate the short- and long-term evolution of medically treated patients with type B IMH with and without FID.Methods
There were 107 consecutive patients with acute type B IMH were included prospectively in a multicenter protocol of clinical and imaging follow-up. FID was defined as an intimal disruption with contrast material-filled outpouching from the aorta lumen with a communicating orifice of >3 mm.Results
There were 43 patients (40%) who developed an FID with larger basal maximum aortic diameter and hematoma thickness. Patients with acute FID had a higher risk of aorta-related events than those without FID (hazard ratio: 24.43; 95% confidence interval: 7.65 to 78.04; p < 0.001). Of the 94 discharged patients, 33 (35%) developed an FID within the first 6 months of follow-up: 19 evolved with mild (<1 mm/year), 8 with moderate (1 to 2 mm/year), and 6 with severe (>2 mm/year) aortic enlargement. Chronic FID was not associated with aorta-related events (hazard ratio: 0.98; 95% confidence interval: 0.22 to 4.34; p = 0.987).Conclusions
The development of FID in the acute phase of type B IMH has a poor prognosis owing to the high risk of aortic rupture. In the chronic phase, most FIDs evolve with slow aortic dilation and without complications. Although acute FIDs should be treated early and invasively, lesions developing in the subacute-chronic phase can be managed with medical treatment and close imaging surveillance. 相似文献20.
Anne S. Chin Martin J. Willemink Aya Kino Virginia Hinostroza Anna M. Sailer Michael P. Fischbein R. Scott Mitchell Gerald J. Berry D. Craig Miller Dominik Fleischmann 《Journal of the American College of Cardiology》2018,71(24):2773-2785