Pancreatic Morphological Changes in Long-Term Follow-Up after Initial Episode of Acute Alcoholic Pancreatitis

Objective

The long-term morphological changes induced by a single episode of alcoholic pancreatitis are not known. Our aim was to study these morphological changes in secretin-stimulated magnetic resonance cholangiopancreatography (S-MRCP) after the first episode of alcohol-associated acute pancreatitis and to evaluate the risk factors and possible protective factors potentially associated with later chronic findings. We have previously reported 2-year follow-up results in pancreatic morphology. This study extends the follow-up to 9 years.

Patients and Methods

In this prospective follow-up study, S-MRCP imaging was performed for 44 (41 M, 3 F; mean age, 46 (25–68)?years) patients after their first episode of alcohol-associated pancreatitis. Pancreatic morphology was evaluated at 3 months and at 2, 7, and 9 years after hospitalization. Recurrent attacks of pancreatitis were studied and pancreatic function was monitored by laboratory tests. Patients’ alcohol consumption was evaluated with questionnaires, laboratory markers, and self-estimated alcohol consumption via interview. Smoking and body mass index were annually recorded.

Results

At 3 months, 32 % of the patients had normal findings in S-MRCP, 52 % had acute, and 16 % had chronic changes. At 7 years, S-MRCP was performed on 36 patients with normal findings in 53 %, the rest (47 %) having chronic findings. Pancreatic cyst was present in 36 %, parenchymal changes in 28 %, and atrophy in 28 % of the cases. There were no new changes in the pancreas in the attending patients between 7 and 9 years (18 patients). Of the patients with only acute findings at 3 months, 60 % resolved to normal in 7 years, but the rest (40 %) showed chronic changes later on. The initial attack was mild in 65 %, moderate in 25 %, and severe in 10 % of the patients. Patients with mild first attack had fewer chronic changes at 7 years compared to patients with moderate or moderate and severe together (p?=?0.03, p?=?0.01). Of the patients in the seventh year of S-MRCP, 22 % had suffered a recurrent episode of acute pancreatitis (mean, 22 (2–60)?months) and 11 % had a clinical diagnosis of chronic pancreatitis. At 7 years, 88 % of the patients with recurrences had chronic findings in S-MRCP versus 36 % with nonrecurrent pancreatitis (p?=?0.02). Six (17 %) patients abstained from alcohol throughout follow-up (mean, 8.7 (7–9.1)?years), but even one of these developed pancreatic atrophy. Out of the non-abstinent patients who did not suffer recurrences, 4/22 (18 %) had developed new findings during at follow-up S-MRCP (NS). In univariate analysis, heavy smoking showed no correlation with increased chronic changes compared to nonsmoking.

Conclusions

Morphological pancreatic changes increase with recurrent episodes of acute pancreatitis. Patients with mild first attack have fewer chronic changes in the pancreas in the long term. However, even a single episode of acute alcoholic pancreatitis may induce chronic morphological changes in long-term follow-up.     

Genetic specificity of a plant–insect food web: Implications for linking genetic variation to network complexity

Theory predicts that intraspecific genetic variation can increase the complexity of an ecological network. To date, however, we are lacking empirical knowledge of the extent to which genetic variation determines the assembly of ecological networks, as well as how the gain or loss of genetic variation will affect network structure. To address this knowledge gap, we used a common garden experiment to quantify the extent to which heritable trait variation in a host plant determines the assembly of its associated insect food web (network of trophic interactions). We then used a resampling procedure to simulate the additive effects of genetic variation on overall food-web complexity. We found that trait variation among host-plant genotypes was associated with resistance to insect herbivores, which indirectly affected interactions between herbivores and their insect parasitoids. Direct and indirect genetic effects resulted in distinct compositions of trophic interactions associated with each host-plant genotype. Moreover, our simulations suggest that food-web complexity would increase by 20% over the range of genetic variation in the experimental population of host plants. Taken together, our results indicate that intraspecific genetic variation can play a key role in structuring ecological networks, which may in turn affect network persistence.Network theory has provided both a conceptual and a quantitative approach for mapping interactions between species and making predictions about how the gain or loss of species will affect the structure and dynamics of ecological networks (1–3). Representing a network at the species level, however, makes the implicit assumption that each species consists of a homogenous population of individuals, all of which interact equally with individuals of different species. However, most populations are heterogeneous mixtures of individuals that vary in their phenotypes, and there is growing evidence that this intraspecific variation is an important factor governing the assembly of ecological communities (4–6). Consequently, there is a clear need to account for the role of intraspecific variation in structuring ecological networks (7).Genetic variation is a key driver of intraspecific variation and many studies have now demonstrated direct and indirect genetic effects on species interactions (8–10) and the composition of communities across multiple trophic levels (11–14). This prior work forms a clear expectation that intraspecific genetic variation is capable of scaling up to affect the structure of an ecological network. In particular, we expect that network structure will be affected by genetic variation through at least two different mechanisms. For a food web (network of trophic interactions), genetic variation in the quality of a basal resource may alter the (i) abundances or (ii) phenotypes of consumer species or both (15). These direct genetic effects on consumers may then have cascading effects on the strength of trophic interactions between consumers and their predators (15), resulting in distinct compositions of trophic interactions associated with different genotypes of the basal resource (Fig. 1). If such genetic specificity in the composition of trophic interactions occurs, then theory predicts that increasing genetic variation will result in more interactions per species (6, 16) and therefore greater food-web complexity (Fig. 2). Moreover, greater complexity may in turn affect food-web dynamics, as more complex food webs are predicted to be more robust to species extinctions (3, 17). However, whether genetic variation is capable of scaling up to affect food-web complexity is currently unclear.Open in a separate windowFig. 1.Genetic specificity of trophic interactions in a plant–insect food web. The species comprising the food web in this study include a host plant (coastal willow, S. hookeriana), four herbivorous galling insects, and six insect parasitoids (species details in Materials and Methods). The plant–insect food web consists of 16 trophic interactions (4 willow–gall and 12 gall–parasitoid) aggregated from all plant individuals sampled in this common garden experiment, whereas each genotype subweb represents the trophic interactions aggregated from all plant individuals of the corresponding genotype. We depicted three genotype subwebs (of 26) to illustrate the differences in trophic interactions associated with each willow genotype. The width of each gray segment is proportional to the number of individuals associated with each trophic interaction. Note that we scaled the width of trophic interactions to be comparable among genotype subwebs, but not between subwebs and the aggregated food web, to emphasize the differences among subwebs.Open in a separate windowFig. 2.Conceptual model of how increasing genetic variation (number of shades of green circles) results in greater food-web complexity (number of interactions per species). If different genotypes of a basal resource are associated with distinct compositions of trophic interactions (i.e., genetic specificity of trophic interactions), then increasing genetic variation in the resource will result in a more complex food web because of the increase in the number of interactions per species at all three trophic levels. Colors correspond to different trophic levels (green, basal resource; blue, primary consumer; orange, secondary consumer), whereas different shapes within each trophic level correspond to different species.In this study, we quantify the genetic specificity of trophic interactions and use these data to simulate the additive effects of genetic variation on food-web complexity. To do this, we used a common garden experiment of a host plant (26 genotypes of coastal willow, Salix hookeriana) and its associated food web of insect galls and parasitoids (Fig. 1). We focused on this plant–insect food web for three reasons. First, we have demonstrated in previous work that S. hookeriana (hereafter, willow) displays heritable variation in traits associated with leaf quality (36 traits, mean H² = 0.72) and plant architecture (4 traits, mean H² = 0.27), some of which are also associated with resistance to its community of galling herbivores (18). Second, the unique biology of galling insects makes them ideal for building quantitative food webs. In particular, galls provide a refuge for larva from attack by most generalist predators (19); therefore, galls and their natural enemies often form a distinct subset of the larger food web associated with host plants. In our system, all of the natural enemies are insect parasitoids that complete their development within the gall after parasitizing larva, making it easy to identify and quantify all of the trophic interactions within this food web. Third, the biology of galls is also ideal for identifying the mechanisms mediating trophic interactions. In particular, gall size is a key trait that affects the ability of parasitoids to successfully oviposit through the gall wall and into the larva within the gall (i.e., larger galls provide a refuge from parasitism) (20). Moreover, gall size is determined, in part, by the genotype of the plant (20), so we have a clear mechanism by which genetic variation can affect the strength of trophic interactions. Taken together, our study seeks to examine how intraspecific genetic variation influences the structure of ecological networks. In doing so, our study takes a crucial step toward a more predictive understanding of how the gain or loss of genetic variation will affect the dynamics of ecological networks.     

Apolipoprotein E polymorphism is associated with both carotid and coronary atherosclerosis in patients with coronary artery disease

Background and aimsApolipoprotein E (apoE) polymorphism plays a significant role in the development of atherosclerosis and cardiovascular disease. Therefore, the aim of the present study was to examine the association between apoE polymorphism and carotid intima-media thickness (IMT), and severity and extent of coronary artery disease (CAD).Methods and resultsB-mode ultrasound and quantitative coronary angiography (QCA) were used to assess carotid, and coronary artery atherosclerosis in 91 patients with clinically suspected CAD referred for cardiac catheterization. Two apoE phenotype groups were defined: apoE3 (E3/E3) and apoE4 (including E4/E3, E4/E4 phenotypes). Maximum IMT was higher in the apoE4 group than in the apoE3 group (p = 0.022). The global atheroma burden index was similarly higher in the apoE4 group than in the apoE3 group (p = 0.033). ApoE4 subjects had higher levels of apolipoprotein B (apoB) (p = 0.008), triglycerides (p = 0.006), remnant lipoprotein-cholesterol (RLP-C) (p = 0.023), and lipoprotein(a) [(Lp(a)] (p = 0.041) than apoE3 subjects. The mean LDL particle size was smaller in the apoE4 group than in the apoE3 group (p = 0.041).ConclusionsApoE polymorphism was associated with both carotid and coronary atherosclerosis. Patients with the apoE4 isoform had an increased carotid IMT and a more severe and extensive CAD than patients with the apoE3 isoform.     

Lactobacillus rhamnosus GG in adenoid tissue: Double-blind,placebo-controlled,randomized clinical trial

Conclusion: Lactobacillus rhamnosus GG (L.GG) was present in all adenoids of children receiving the L. GG product. However, since L.GG was also found from the placebo group, one cannot confirm its effect on the occurrence of rhinovirus (RV) or enterovirus (EV). Objectives: The present study was conducted to determine whether a 3-week oral consumption of L.GG would lead to presence of the probiotic in adenoid tissue. Furthermore, nasopharyngeal RV and EV findings and symptom data were investigated. Method: The tissue samples were collected from 40 children aged 1–5 years about to undergo adenotomy due to recurrent acute/secretory otitis media, chronic rhinitis, or recurrent sinusitis after a 3-week daily consumption of L.GG (n = 20) or placebo (n = 20). Strain-specific real-time PCR was used to detect RV, EV, and L.GG in adenoid tissue. Results: L.GG was recovered in the adenoid sample in 100% of children in the L.GG group and in 76% in the placebo group (p = 0.07). Both RV and EV were found in 31% of children in the L.GG group and in 18% of children in the placebo group (p = 0.67). The majority of the positive samples were positive for both RV and EV. Study diaries showed no differences in symptoms between the groups.     

Functional parcellation of the human primary somatosensory cortex to natural touch

Despite the significance of human touch, brain responses to interpersonal manual touch have been rarely investigated. We used functional magnetic resonance imaging to study brain activity in eight healthy adults whose left hand was touched by two individuals, in separate runs and in 20‐s blocks, either by holding, smoothing, or poking. Acceleration was measured from both the subject's and the touching person's hands for postimaging control of the stimuli. Independent component analysis of the functional magnetic resonance imaging data unraveled three functional networks involving the primary somatosensory cortex (SI). One network comprised the contralateral and another the ipsilateral Brodmann area 3. The third network included area 2 bilaterally, left‐hemisphere middle temporal gyrus and dorsolateral prefrontal regions, ventral prefrontal cortices bilaterally, and middle cingulate cortex. The response shapes and polarities varied between the three networks. The contralateral area 3 differentiated the responses between the three types of touch stimuli, and the response magnitudes depended on the variability of the touch within each block. However, the responses of the other two networks were strikingly similar to all stimuli. The subjects' reports on the pleasantness of the touch did not correlate with the characteristics of the SI responses. These findings imply area‐specific processing of the natural human touch in three networks including the SI cortex, with only area 2 connected to a functional network of brain areas that may support social interaction.     

Brown adipose tissue function is accompanied by cerebral activation in lean but not in obese humans

Brown adipose tissue (BAT) is able to generate heat and dissipate energy in response to cold exposure in mammals. It has recently been acknowledged that adult humans also have functional BAT, whose metabolic activity is reduced in obesity. In healthy humans, the cerebral mechanisms that putatively control BAT function are unclear. By using positron emission tomography (PET), we showed that cold-induced BAT activation is associated with glucose metabolism in the cerebellum, thalamus, and cingulate, temporoparietal, lateral frontal, and occipital cortices in lean participants, whereas no such associations were found under warm control conditions. The cold-induced increase in cerebral glucose metabolism was more robust in lean than obese participants. Cerebral glucose metabolism was not associated with skeletal muscle or white adipose tissue glucose uptake under warm or cold conditions. In conclusion, BAT metabolism was accompanied by the activation of specific cerebral regions, and this shows an uncharacterized role that the brain plays in the regulation of BAT function. In obese participants, the cold-induced response in cerebral activity was attenuated that provides a clue for obesity-induced impairment in BAT metabolism.