Da-Cheng-Qi Decoction Alleviates Intestinal Injury in Rats with Severe Acute Pancreatitis by Inhibiting the JAK2-STAT3 Signaling Pathway.

OBJECTIVE: To investigate the effect of Da-Cheng-Qi decoction (DCQD) on treating intestinal injury in rats with severe acute pancreatitis (SAP), based on the Janus kinase 2 (JAK2)/signal transducers and transcription 3 (STAT3) signaling pathway. METHODS: Rats were randomly divided into the SAP group, SAP + ruxolitinib (JAK2 inhibitor) group, SAP + Stattic (STAT3 inhibitor) group, SAP + DCQD group, and sham operation group. They were further divided into 3-hour, 6-hour, 12-hour, and 18-hour subgroups. Levels of amylase and the inflammatory cytokines tumor necrosis factor-α, interleukin 6, interleukin 10, and interleukin 4 in plasma were tested. The messenger ribonucleic acid (mRNA) expression of JAK2 and STAT3 and the protein expression of phosphorylated JAK2 (p-JAK2) and phosphorylated STAT3 (p-STAT3) in the pancreas and terminal ileum tissues were examined. RESULTS: Rats with SAP had severe changes in plasma levels of amylase and inflammatory cytokines and showed an overexpression of JAK2 mRNA, STAT3 mRNA, p-JAK2 protein, and p-STAT3 protein in the pancreas and terminal ileum. The events could be downregulated by treatment with DCQD, JAK2 inhibitor, and STAT3 inhibitor. CONCLUSIONS: In rats with SAP, DCQD ameliorated inflammatory cytokines and intestinal injury, which may be closely associated with the inhibition of the JAK2/STAT3 signaling pathway.

The survival outcome and prognostic factors for distal cholangiocarcinoma following surgical resection: a meta-analysis for the 5-year survival.

PURPOSE: To assess the available evidence on the prognostic factors for the 5-year survival for patients with distal cholangiocarcinoma (DCC) following surgical resection. METHODS: We performed a comprehensive search of abstracts included in databases where relevant studies were published between January 2000 and August 2015. Risk ratios (RRs), 95 % confidence intervals (95 % CIs), and random-effects model were calculated using RevMan 5.3 software. RESULTS: A total of 23 observational studies involving 2063 patients with DCC were analyzed. The meta-analysis showed that postoperative adjuvant chemotherapy was not confirmed as a prognostic factor, with similar 5-year survival rates between those receiving and not receiving chemotherapy (RR 0.71; 95 % CI 0.21-2.36; P = 0.57). Perineural invasion (RR 0.51; 95 % CI 0.40-0.64; P < 0.00001), lymph node metastasis (RR 0.51; 95 % CI 0.38-0.70; P < 0.0001), positive resection margin status (RR 2.11; 95 % CI 1.36-3.30; P = 0.001), and not-well-differentiated adenocarcinoma (RR 1.77; 95 % CI 1.39-2.25; P < 0.00001) were associated with shorter survival. CONCLUSIONS: Perineural invasion, lymph node metastasis, resection margin status, and tumor differentiation were the significant prognostic factors for the 5-year survival.

Effect of pharmaconutrition-supplemented parenteral nutrition for severe acute pancreatitis: a meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness of pharmaconutrition-supplemented parenteral nutrition (PN) for severe acute pancreatitis (SAP). METHODS: A comprehensive search of abstracts was performed in the MEDLINE, OVID, Springer, and Cochrane Library database. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of pharmaconutrition-supplemented PN versus PN for patients with SAP were analyzed. The analyzed outcome variables included infection, mortality, intensive care unit (ICU) stay, hospital stay, and leukocytes change. Statistical analyses were performed using the Cochrane Collaboration's RevMan 5.1 software. RESULTS: Four RCTs published in 1998 or later were included in this meta-analysis, in which 76 patients with pharmaconutrition-supplemented PN and 77 patients with PN. Pharmaconutrition-supplemented PN showed significantly better results in terms of infection (OR, 0.42; 95% CI, 0.20-0.91; P =0.03) and leukocytes change (before treated: mean different, 0.93; 95% CI, 0.21-1.65; P =0.01; after treated: mean different, -0.77; 95% CI, -1.47- -0.08; P =0.03). No significant difference could be found in mortality (OR, 0.30; 95% CI, 0.07-1.19; P =0.09), ICU stay (mean different, -3.65; 95% CI, -9.39-2.10; P =0.21), and hospital stay (mean different, -1.20; 95% CI, -9.89-7.48; P =0.79). CONCLUSIONS: The current meta-analysis indicates that pharmaconutrition-supplemented PN only show advantages in infection and leukocytes change.

Early enteral nutrition after pancreatoduodenectomy: a meta-analysis of randomized controlled trials.

PURPOSE: The aim of our study was to evaluate the safety and effectiveness of early enteral nutrition (EN) for patients after pancreatoduodenectomy (PD). METHODS: We performed a comprehensive search of abstracts in the MEDLINE database, OVID database, Springer database, the Science Citation Index, and the Cochrane Library database. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of early EN and other nutritional routes for patients after PD were analyzed. The analyzed outcome variables included gastroparesis, intra-abdominal complications (gastroparesis excluded), mortality, infection, and postoperative hospital stay. The Cochrane Collaboration's RevMan 5.1 software was used for statistical analysis. RESULTS: Four RCTs published in 2000 or later were included in this meta-analysis, in which 246 patients underwent early EN and 238 patients underwent other nutritional routes following PD. In the combined results of early EN versus other nutritional routes, no significant difference could be found in gastroparesis (odds ratio (OR), 0.89; 95 % CI, 0.36-2.18; P = 0.79), intra-abdominal complications (gastroparesis excluded) (OR, 0.82; 95 % CI, 0.53-1.26; P = 0.37), mortality (OR, 0.43; 95 % CI, 0.11-1.62; P = 0.21), infection (OR, 0.55; 95 % CI, 0.29-1.07; P = 0.08), postoperative hospital stay (mean difference, -0.93; 95 % CI, -6.51 to 4.65; P = 0.74). CONCLUSIONS: Current RCTs suggests that early EN appears safe and tolerated for patients after PD, but does not show advantages in infection and postoperative hospital stay.

Reconstruction by Pancreaticogastrostomy versus Pancreaticojejunostomy following Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials.

Objectives. The aim of our study was to evaluate and compare the results of pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD). Methods. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of PG versus PJ after PD were analyzed. Two reviewers assessed the quality of each trial and collected data independently. The Cochrane Collaboration's RevMan 5.0 software was used for statistical analysis. Proportions were combined, and the odds ratio (OR) with its 95% CI was used as the effect size estimate. Results. Four RCTs published in 1995 or later were included in this meta-analysis, in which 276 patients underwent PG and 277 patients underwent PJ followed PD. In the combined results of PG versus PJ, a significant difference in the morbidity of intra-abdominal complications (OR, 0.34; 95% CI, 0.23-0.49; P < 0.00001) was found, but no significant difference could be found for pancreatic fistula (OR, 0.69; 95% CI, 0.42-1.12 , P = 0.13) mortality (OR, 1.09; 95% CI, 0.42-2.83; P = 0.87), recovery with no complications (OR, 1.26; 95% CI, 0.90-1.78; P = 0.18), biliary fistula (OR, 0.55; 95% CI, 0.22-1.35; P = 0.19), or in delayed gastric emptying (OR, 0.55; 95% CI, 0.33-1.01; P = 0.06). Conclusions. Current RCTs suggest that PG is better than PJ for pancreatic reconstruction after PD.