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1.
Int J Surg ; 76: 53-58, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32109648

RESUMO

BACKROUND: C-reactive protein (CRP) and procalcitonin (PCT) have shown to be reliable predictors of inflammatory complications and anastomotic leak after colorectal surgery. Their predictive value after partial pancreaticoduodenectomy (PD) remains unclear. MATERIALS AND METHODS: All consecutive pancreaticoduodenectomies (2009-2018) at our hospital were included. Drain amylase was evaluated on postoperative day (POD) 1, serum CRP and PCT were evaluated on POD 1-3. Receiver-operating characteristics curves were performed and significant cut-off values were tested using logistic regression. RESULTS: Among 188 patients who underwent partial PD, clinically relevant pancreatic fistulas (POPF) occurred in 30 (16%) patients, including 20 (10.6%) with Grade B and 10 (5.3%) patients with Grade C. Postoperative complications (Clavien-Dindo ≥ III) were reported in 46 (24.5%) patients, including Grade IIIa in 16 (8.5%), IIIb in 18 (9.6%), IVa in 3 (1.6%), IVb in 2 (1.1%) and V in 7 (3.7%) patients. Drain amylase on POD 1 showed the largest area under the curve (0.872, p < 0.001), followed by CRP (0.803, p < 0.001) and PCT on POD 3 (0.651, p < 0.011). Drain amylase on POD 1 > 303 U/l (OR 0.045, 95% CI 0.010-0.195, p < 0.001), CRP > 203 mg/l (OR 0.098, 95% CI 0.041-0.235, p < 0.001) and PCT > 0.85 µg/l (OR 0.393, 95%CI 0.178-0.869, p = 0.02) were significant predictors of relevant POPF in the univariate analysis. CRP > 203 mg/l (OR 0.098, 95% CI 0.024-0.403, p = 0.001) and drain amylase > 303 U/l (OR 0.064, 95% CI 0.007-0.554, p = 0.01) remained independent predictors in the multivariable analysis. The combination of drain amylase on POD 1 and CRP on POD 3 had a sensitivity and specificity of 87.4% and 90.9% to predict relevant POPF. CONCLUSION: Drain amylase on POD 1 and CRP on POD 3 can accurately predict clinically relevant POPF after partial pancreaticoduodenectomy. The accuracy of PCT on POD 3 is limited.


Assuntos
Amilases , Proteína C-Reativa , Fístula Pancreática , Pancreaticoduodenectomia , Idoso , Amilases/sangue , Biomarcadores/análise , Proteína C-Reativa/análise , Drenagem/efeitos adversos , Feminino , Humanos , Jejunostomia/efeitos adversos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Fístula Pancreática/diagnóstico , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Curva ROC , Sensibilidade e Especificidade
2.
Life Sci ; 245: 117385, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32014425

RESUMO

AIM: The influence of thyroid hormones on exocrine pancreas function is poorly understood, and limited to the postnatal development period. Here, we evaluated the effects of hypo- and hyperthyroidism on the morphology and enzyme content of this tissue. MAIN METHODS: To induce hypothyroidism male Wistar rats were subjected to a thyroidectomy (Tx) or sham operated (SO). After 40 days, some of the Tx and SO rats were treated with T3 for 7 days. Following euthanization, the pancreas was removed and evaluated for morphology, as well as amylase, lipase and trypsin content, using histological and immunoreactive techniques analyses, respectively. Serum amylase levels were also evaluated. KEY FINDINGS: The pancreatic acinar cells of Tx rats were smaller, exhibited reduced Haematoxyllin stained areas, and contained lower amylase and lipase levels, indicative of low cell activity. Tx rats also presented higher collagen levels, and high trypsin content in pancreatic extracts. Interestingly, T3 administration reversed the observed acinar cell alterations and restored pancreatic enzyme content, by augmenting amylase and lipase and attenuating trypsin levels, but failed to change collagen content. Increased levels of lipase and decreased trypsin were also observed in T3-treated SO rats. SIGNIFICANCE: Thyroid hormones play an important role in acinar cell morphology and function. In the hypothyroid state there is a decrease in pancreatic enzyme levels that is restored with T3 treatment. In addition to participating in insulin sensitivity and glycemic control, THs also modulate enzyme expression and activity in the exocrine pancreas, consequently, delivering metabolic substrates to specific organs and tissues.


Assuntos
Pâncreas Exócrino/patologia , Hormônios Tireóideos/fisiologia , Amilases/sangue , Animais , Western Blotting , Hipertireoidismo/complicações , Hipertireoidismo/patologia , Hipotireoidismo/complicações , Hipotireoidismo/patologia , Masculino , Pâncreas Exócrino/efeitos dos fármacos , Pâncreas Exócrino/fisiopatologia , Ratos , Ratos Wistar , Tireoidectomia , Tireotropina/sangue , Tri-Iodotironina/farmacologia
3.
Mymensingh Med J ; 29(1): 21-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915331

RESUMO

This cross sectional study was done to compare serum levels of amylase and lipase between predialysis and maintenance haemodialysis chronic kidney disease (CKD) patients and also to find out their relationship between degrees of renal impairment in Mymensingh Medical College Hospital and National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh from May 2016 to April 2017. A total of 80 patients were included purposively as study subjects and made into two groups namely predialysis CKD group comprising 50 patients and other as maintenance haemodialysis group comprising of 30 patients. Among the predialysis group majority of the CKD was caused by glomerulonephritis (48%) followed by diabetes (26%), HTN (2%) and large portion undiagnosed (24%) whereas in the haemodialysis group ESRD was caused by diabetes (46%) followed by glomerulonephritis (16%), HTN (13%) and undiagnosed (23%). This study showed that mean serum amylase (158±718U/L vs. 111±41U/L) did not significantly differ between study groups except being above reference level but serum lipase (739±888U/L vs. 434±214U/L) was significantly higher in the predialysis group. There was a correlation between rising serum creatinine with serum amylase and lipase.


Assuntos
Amilases/sangue , Lipase/sangue , Insuficiência Renal Crônica/enzimologia , Adulto , Bangladesh , Biomarcadores/sangue , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia
4.
Oncology ; 98(2): 111-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31600759

RESUMO

INTRODUCTION: Postoperative pancreas-related complications (PPRC) can cause critical conditions, including sepsis and intra-abdominal bleeding. Thus, it is important to identify patients who are at risk of clinically significant PPRC as early as possible in the postoperative period. Some authors have reported the use of amylase concentration of the drainage fluid (dAmy) to predict PPRC. However, the positive predictive value of dAmy alone is not sufficient. OBJECTIVE: The aim of this study is to evaluate the predictive value of combined use of dAmy and serum C-reactive protein (sCRP) for PPRC. METHODS: The clinicopathological data of 327 patients who underwent elective gastrectomy for gastric cancer were reviewed. There were 18 patients who developed PPRC. Univariate and multivariate analyses were conducted to identify the risk factors of PPRC. Receiver operating characteristic curves were used to identify the cut-off values of dAmy and sCRP on postoperative day 3 (dAmy3 and sCRP3) to predict the risk of PPRC. RESULTS: In the multivariate analysis, splenectomy alone correlated with PPRC. The cut-off values of dAmy3 and sCRP3 were 761 IU/L and 15.15 mg/dL, respectively. Among the 17 patients with both dAmy3 and sCRP3 above the thresholds, 10 (58.8%) had PPRC with Clavien-Dindo classification (CD) ≥II and 7 (41.2%) had PPRC with CD ≥III. In contrast, among the 236 patients with both parameters below the thresholds, 233 (98.7%) did not develop PPRC, and only 1 (0.4%) had PPRC with CD ≥III. CONCLUSIONS: Splenectomy correlates with PPRC, which is consistent with results from large clinical trials. A combined use of dAmy3 and sCRP3 can be useful in predicting the risks of PPRC.


Assuntos
Amilases/sangue , Proteína C-Reativa , Gastrectomia/efeitos adversos , Pancreatopatias/sangue , Pancreatopatias/etiologia , Complicações Pós-Operatórias , Idoso , Biomarcadores , Proteína C-Reativa/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/diagnóstico , Prognóstico , Curva ROC , Esplenectomia/efeitos adversos , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
5.
Life Sci ; 241: 117118, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31790686

RESUMO

AIMS: Acute pancreatitis (AP) is usually complicated with multiple organ insufficiency, including renal injury. Hyperlipidemia is regarded as a risk factor to induce AP. High-fat diet-induced hyperlipidemic pancreatitis (HP) increased nowadays and showed more severe symptoms and complications than other AP. However, detailed mechanisms or mediators involved in HP complicated with acute renal injury were less studied. Here, we aimed to study how miR-214 expresses in the HP and whether miR-214 has functions to regulate pathological kidney damages induced by HP. MAIN METHODS: Sprague-Dawley rats were adopted to establish HP model complicated with acute renal injury through long-term high-fat diet and sodium taurocholic injection. Models were injected with LV-rno-miR-214-3p or LV-anti-rno-miR-214-3p to exogenously regulate miR-214-3p to study its impacts on HP via a series of molecular and histological experiments. KEY FINDINGS: MiR-214-3p was found to be up-regulated in the kidney, pancreas and serum of HP rats and also could intensify the pathological alterations, kidney and pancreas damages and fibrosis induced by HP. Inflammatory response in HP was enhanced when miR-214-3p was overexpressed. Besides, miR-214-3p up-regulation was showed to inhibit PTEN expression but increased P-Akt levels in the HP kidney, which might be a possible mechanism to induce severe symptoms of pancreatitis. Knockdown of miR-214-3p showed opposite effects. SIGNIFICANCE: MiR-214-3p is indicated to exacerbate the tissue damages and inflammatory response caused by HP complicated with acute renal injury, which may provide a novel therapeutic perspective targeting miR-214-3p to treat HP with acute renal injury.


Assuntos
Lesão Renal Aguda/genética , Hiperlipidemias/complicações , MicroRNAs/genética , Pancreatite/complicações , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/patologia , Amilases/sangue , Animais , Modelos Animais de Doenças , Regulação da Expressão Gênica , Hiperlipidemias/genética , Rim/patologia , Lipídeos/sangue , Lipídeos/genética , Masculino , PTEN Fosfo-Hidrolase/genética , PTEN Fosfo-Hidrolase/metabolismo , Pancreatite/genética , Pancreatite/patologia , Ratos Sprague-Dawley
6.
Med Sci Monit ; 25: 7694-7701, 2019 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-31606729

RESUMO

BACKGROUND Alprostadil can inhibit inflammation and reduce inflammation-related injury in many inflammatory diseases. However, the anti-inflammatory effect of alprostadil in decreasing acute pancreatitis (AP) injury remains unknow. This study aimed to investigate the possible protective effects and mechanism of alprostadil against AP in rats. MATERIAL AND METHODS Forty healthy Sprague­Dawley rats were randomly divided into a control group, an AP group, an AP-alprostadil group, an AP-AG490 group, and an AP-(alprostadil+AG490) group. An animal model of acute pancreatitis was established. The pathological changes of the pancreases in each group were observed. We assessed levels of malondialdehyde (MDA), superoxide dismutase (SOD), and myeloperoxidase (MPO), as well as serum IL-1ß, IL-6, IL-10, and TNF-alpha. TUNEL assay was used to detect apoptosis of pancreatic cells. The proteins p-Jak2 and p-Stat3 were investigated by Western blot. RESULTS Compared with the control group, pancreatic pathological score, pancreatic apoptosis, MDA, MPO, serum IL-1ß, IL-6, and TNF-alpha levels were significantly higher in the AP group, and SOD levels were significantly decreased. Compared with the AP group, after treatment with alprostadil, AG490, and alprostadil+AG490, respectively, the pancreatic pathological score, apoptosis, MDA, MPO, serum IL-1ß, IL-6, and TNF-alpha were significantly decreased in AP rats, while SOD levels were significantly increased. The protein levels of p-JAK2 and p-STAT3 were significantly upregulated in the AP group compared with the control group, and the protein levels of p-JAK2 and p-STAT3 after treatment with alprostadil, AG490, and alprostadil+AG490 were significantly decreased, and the effect of alprostadil+AG490 was the strongest. CONCLUSIONS Alprostadil can reduce pancreatic tissue damage, delay pancreatic cell apoptosis, and reduce inflammation and anti-oxidative stress by inhibiting the JAK2/STAT3 signal pathway, thus protecting the pancreas.


Assuntos
Alprostadil/uso terapêutico , Janus Quinase 2/metabolismo , Pancreatite/tratamento farmacológico , Pancreatite/metabolismo , Substâncias Protetoras/uso terapêutico , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais , Células Acinares/efeitos dos fármacos , Células Acinares/metabolismo , Células Acinares/patologia , Doença Aguda , Alprostadil/farmacologia , Amilases/sangue , Animais , Apoptose/efeitos dos fármacos , Arginina , Citocinas/sangue , Mediadores da Inflamação/metabolismo , Lipopolissacarídeos/sangue , Masculino , Estresse Oxidativo/efeitos dos fármacos , Pâncreas/patologia , Pancreatite/sangue , Substâncias Protetoras/farmacologia , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
7.
Acta Gastroenterol Belg ; 82(3): 397-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566327

RESUMO

BACKGROUND AND AIMS: Early prediction of severe acute pancreatitis (SAP)would be helpful for triaging patients to the appropriate level of care and intervention. The aim of this study is to compare the performance of the Change in Amylase And Body mass index (CAB) score and BISAP score for predicting SAP. PATIENTS AND METHODS: A total of 406 with AP were enrolled. The age, gender, body mass index(BMI), blood urea nitrogen determined at the time of admission and serum amylase determined on day 1 and day 2 after hospitalization were collected and analyzed statistically. RESULTS: Multivariable analysis confirmed that blood urea nitrogen (OR 1.06; 95%CI 1.03-1.09) and percentage change in amylase day 2 (OR 0.75; 95%CI 0.65-0.87) were independently associated with development of SAP. No statistically significant association was observed between BMI (OR 1.04; 95%CI 0.951.13) and severity of acute pancreatitis. The area under the receiver operating characteristic curve for Body mass index (BMI), percentage change in amylase day 2, BISAP score and CAB score were 0.57±0.05, 0.68±0.04, 0.84±0.03 and0.53±0.05, respectively. CONCLUSION: BISAP is more accurate for predicting the severity of acute pancreatitis than the CAB score.


Assuntos
Amilases/sangue , Nitrogênio da Ureia Sanguínea , Índice de Massa Corporal , Pancreatite/diagnóstico , Índice de Gravidade de Doença , Doença Aguda , Biomarcadores/sangue , Humanos , Pancreatite/classificação , Pancreatite/patologia , Admissão do Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos
8.
Ann Saudi Med ; 39(5): 354-358, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580713

RESUMO

BACKGROUND: Measuring both serum amylase and lipase in the setting of acute pancreatitis is not recommended and monitoring changes in amylase and lipase levels after diagnostic results is of little added value. The extent of the two types of superfluous amylase/lipase testing at our institution is unknown. OBJECTIVE: Explore the extent of superfluous amylase/lipase testing. DESIGN: Medical record review. SETTINGS: Tertiary care, teaching hospital. PATIENTS AND METHODS: We retrospectively reviewed all amylase and lipase tests performed over a recent 12-month period. Amylase tests were considered superfluous if they were ordered with lipase tests at the same time or if they were repeated after diagnostic amylase results. They were considered questionably superfluous if they were repeated alone after non-diagnostic amylase results. Lipase tests were considered superfluous if they were repeated after diagnostic lipase results and questionably superfluous if they were repeated after non-diagnostic lipase results. MAIN OUTCOME MEASURES: Number and percentage of lipase and amylase tests that were superfluous or questionably superfluous. SAMPLE SIZE: 23 950. RESULTS: Superfluous testing was identified in 30.6% of 23 950 amylase/lipase tests and questionably superfluous testing in 12.4%. Of the 7330 superfluous tests, 94.8% were due to simultaneous amylase/lipase testing and 5.2% to repeated lipase testing after diagnostic results. The rate of superfluous and questionably superfluous testing was significantly higher in the inpatient setting compared to emergency department or outpatient settings ( P<.0001). Of the 6483 amylase tests obtained simultaneously with non-diagnostic lipase tests, only 36 (0.6%) showed a diagnostic result. Furthermore, only 0.7% and 3.6% of amylase tests that were repeated after normal and borderline results, respectively, were diagnostic and 1.1% and 9.3% of lipase tests that were repeated after normal and borderline results, respectively, were diagnostic. CONCLUSIONS: About one third of amylase/lipase testing appears to be superfluous, mainly due to simultaneous amylase/lipase testing. Since only 0.6% of simultaneous amylase/lipase tests showed diagnostic amylase with non-diagnostic lipase levels, quality improvement initiatives should be directed at reducing this low-value practice. Repeating amylase/lipase tests following normal results is of little value. LIMITATIONS: Clinical notes and imaging studies were not reviewed. CONFLICT OF INTEREST: None.


Assuntos
Amilases/sangue , Lipase/sangue , Pancreatite/diagnóstico , Procedimentos Desnecessários/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais de Ensino , Humanos , Pancreatite/sangue , Estudos Retrospectivos , Centros de Atenção Terciária
9.
Biomed Pharmacother ; 119: 109455, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31541854

RESUMO

Severe acute pancreatitis (SAP) is an acute abdominal disease that can develop locally to the multiple organs. It is characterized by pancreatic tissue self-digestion, and the rapid release of inflammatory cytokines, which play a dominant role in local or even systemic inflammation. In this study, we investigate the protective effect of T-614 against SAP induced by cerulein plus LPS in mice. Biochemical markers associated with pancreatitis in serum such as inflammatory cytokines, amylase and lipase activities were measured. Related proteins of NLRP3 inflammasome and NF-κB signaling pathway were evaluated by western blotting. Hematoxylin-eosin staining (HE) and immunohistochemistry (IHC) were used to evaluate changes of inflammation in pancreatic tissue. T-614 significantly alleviated the elevation markers of pancreatitis and suppresses the pancreatic tissue damage, including histopathological and molecular manifestations. In conclusion, T-614 plays a protective role in experimental SAP mice model via anti-inflammatory effects.


Assuntos
Cromonas/uso terapêutico , Inflamassomos/metabolismo , NF-kappa B/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Pancreatite/tratamento farmacológico , Pancreatite/metabolismo , Transdução de Sinais , Sulfonamidas/uso terapêutico , Doença Aguda , Amilases/sangue , Animais , Cromonas/farmacologia , Ciclo-Oxigenase 2/metabolismo , Citocinas/metabolismo , Mediadores da Inflamação/metabolismo , Lipase/sangue , Masculino , Camundongos Endogâmicos C57BL , Infiltração de Neutrófilos/efeitos dos fármacos , Pâncreas/efeitos dos fármacos , Pâncreas/patologia , Pancreatite/sangue , Pancreatite/patologia , Transdução de Sinais/efeitos dos fármacos , Sulfonamidas/farmacologia
10.
Med Sci Monit ; 25: 6097-6103, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31413252

RESUMO

BACKGROUND To investigate the clinical characteristics of hypertriglyceridemia pancreatitis (HTGP) and evaluate the correlative risk factors for severe acute pancreatitis (SAP) in HTGP patients. MATERIAL AND METHODS A total of 1005 patients with acute pancreatitis (AP) admitted to Peking Union Medical College Hospital (PUMCH) from 1 Jan 2013 to 1 Aug 2018 were retrospectively reviewed. After screening, we enrolled 159 patients with HTGP and 172 with non-hypertriglyceridemia pancreatitis (NHTGP). We gathered and assessed demographic and blood biochemical information and analyzed the risk factors for SAP. RESULTS Age, serum amylase (AMY), lipase (LIP), and serum ionized calcium (Ca²âº) in the HTGP group were lower than in the NHTGP group (P<0.05), while high-sensitivity C-reactive protein (hsCRP), neutrophil-lymphocyte ratio (NLR), and body mass index (BMI) in the HTGP group were higher than in the NHTGP group (P<0.05). Among the HTGP patients, the results indicated that Ca²âº (OR=0.018, P<0.001, 95%CI: 0.002-0.129) was an independent protective factor for SAP, while higher CRP (OR=1.008, P=0.004, 95%CI: 1.003-1.013), NLR (OR=1.314, P<0.001, 95%CI: 1.161-1.488), and BMI (OR=1.597, P=0.002, 95%CI: 1.195-2.314) were independent risk factors for SAP. CONCLUSIONS Patients with HTGP had lower serum Ca²âº and higher hsCRP, NLR, and BMI, and these were associated with higher risk of developing SAP.


Assuntos
Proteína C-Reativa/metabolismo , Cálcio/sangue , Hiperlipidemias/sangue , Linfócitos/patologia , Neutrófilos/patologia , Pancreatite/sangue , Adulto , Amilases/sangue , Índice de Massa Corporal , Cálcio/metabolismo , Feminino , Humanos , Hiperlipidemias/complicações , Hipertrigliceridemia/complicações , Lipase/sangue , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Pancreatite/patologia , Estudos Retrospectivos , Fatores de Risco
11.
Int J Mol Med ; 44(4): 1563-1573, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432106

RESUMO

Acute pancreatitis (AP) is an inflammatory disease of the pancreas. Icariin (ICA), a flavonoid glycoside, has been reported to have several pharmacological effects; however, the anti­inflammatory effects of ICA against AP require further study. Therefore, we aimed to investigate the effect of ICA on cerulein­induced AP. In the present study, AP was induced by intraperitoneally administering a supramaximal concentration of cerulein (50 µg/kg/h) for 6 h. ICA was also administered intraperitoneally, and mice were sacrificed 6 h after the final cerulein injection. Blood samples were collected to determine serum amylase and lipase levels. The pancreas and lung were rapidly removed for histological examination, and the analysis of myeloperoxidase activity. In addition, reverse transcription­quantitative polymerase chain reaction was conducted to analyze the expression of inflammatory cytokines in pancreatic tissues. Our results revealed that the administration of ICA prevented an increase in the pancreas weight/body weight ratio of mice and serum digestive enzyme levels. ICA treatment also inhibited cerulein­induced histological injury and neutrophil infiltration of the pancreas and lung. In addition, ICA suppressed the production of pro­inflammatory cytokines, including interleukin (IL)­1ß, IL­6 and tumor necrosis factor­α in the pancreas. Furthermore, ICA administration was observed to inhibit p38 activation during cerulein­induced AP. Inhibition of p38 activation resulted in alleviated pancreatitis. Collectively, our results suggested that ICA exhibits anti­inflammatory effects in cerulein­induced AP via the inhibition of p38.


Assuntos
Ceruletídeo/efeitos adversos , Flavonoides/farmacologia , Pancreatite/etiologia , Pancreatite/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/antagonistas & inibidores , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Amilases/sangue , Animais , Biomarcadores , Modelos Animais de Doenças , Feminino , Lipase/sangue , Lipase/metabolismo , Camundongos , NF-kappa B/metabolismo , Pancreatite/diagnóstico , Pancreatite/tratamento farmacológico , Índice de Gravidade de Doença
12.
Clin Lab ; 65(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31307179

RESUMO

BACKGROUND: Clinical Chemistry is the backbone of medical treatment, diagnostics, and prevention. The laborato-ries are trying to improve the quality and to reduce diagnostic errors and processing time and safeguard trace-ability of all laboratory procedures to ensure patient safety. Six sigma belongs to statistical quality control and provides a new methodology for measuring and improving process performance in laboratory. METHODS: Activities of AST, ALT, CK, LDH, Amy, and γ-GT were determined by standard kinetic methods on a Vitros 5600 biochemistry analyzer. Two daily quality controls (Verifier I and Verifier II) were run over 60 days. Total percent CV was calculated from routine daily QC. Between-instrument bias was also calculated from daily QC. RESULTS: The calculated sigma metrics for AST were 6.9 and 3.8; for ALT 9.3 and 5.6; for CK 6.6 and 5.3; LDH 5.2 and 5.2; for γ-GT 4.9 and 2.7; and for amylase 8.7 and 7.1. Analytical performance for AST, ALT, CK, LDH, and Amylase is world class. On the other hand, γ-GT analytical performance is poor. CONCLUSIONS: Six Sigma benefits from earlier quality management approaches that creates new challenges for medical laboratories.


Assuntos
Química Clínica/normas , Enzimas/sangue , Laboratórios/normas , Controle de Qualidade , Alanina Transaminase/sangue , Alanina Transaminase/metabolismo , Amilases/sangue , Amilases/metabolismo , Aspartato Aminotransferases/sangue , Aspartato Aminotransferases/metabolismo , Química Clínica/métodos , Creatinina , Erros de Diagnóstico/prevenção & controle , Enzimas/metabolismo , Humanos , Cinética , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/metabolismo , Monoéster Fosfórico Hidrolases/sangue , Monoéster Fosfórico Hidrolases/metabolismo , gama-Glutamiltransferase/sangue , gama-Glutamiltransferase/metabolismo
13.
Zhonghua Er Ke Za Zhi ; 57(7): 515-519, 2019 Jul 02.
Artigo em Chinês | MEDLINE | ID: mdl-31269550

RESUMO

Objective: To analyze the clinical characteristics of chronic pancreatitis (CP) and evaluate its impact on growth of children. Methods: A retrospective study was conducted in 94 children (male 49 cases, female 45 cases) who were diagnosed with CP in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from August 2008 to July 2015. Clinical characteristics, such as features of abdominal pain, etiologies, image data, levels of serum amylase and lipase, and physical development data were extracted from electronic medical records. The comparison between groups based on etiology or with normal control was performed with student's t test. Results: The age of first episode was (8.2±3.7) years. There were 61 (65%) children diagnosed with idiopathic CP, and 25 (27%) with anatomic abnormalities. The age of onset in the group with anatomic abnormalities was lower than that in the idiopathic CP group ((6.3±3.5) vs. (8.9±3.4) years, t=3.211, P=0.002). There were 51 (54%) patients with serum amylase elevation, 41(44%) patients with lipase elevation, and 35 (37%) with elevation in both. The questionnaire showed that 28 out of 30 children had moderate to severe abdominal pain. The patients' weight standard score (SDS) was significantly lower than the overall average in normal control (-0.4±1.1 vs. 0, t=-3.308, P=0.001). Meanwhile, the mean level of insulin like growth factor-1 (IGF-1) SDS of 35 children was significantly decreased (-1.8±1.8 vs. 0, t=-6.136, P<0.01). There were 69% (37/54) patients diagnosed by magnetic resonance cholangiopancreatography (MRCP) combined with magnetic resonance imaging (MRI), higher than that diagnosed by abdominal ultrasound (29%, 27/94). Conclusions: Idiopathic CP and anatomic abnormalities were the two main etiologies. Normal level of serum amylase and lipase or negative finding of ultrasound cannot exclude CP, while MRCP and MRI should be considered to improve CP diagnostic rate. It is noteworthy that growth delay would happen in children with CP history.


Assuntos
Dor Abdominal/etiologia , Colangiopancreatografia por Ressonância Magnética/métodos , Pancreatite Crônica/diagnóstico por imagem , Amilases/sangue , Criança , China/epidemiologia , Feminino , Humanos , Lipase/sangue , Imagem por Ressonância Magnética , Masculino , Pancreatite Crônica/epidemiologia , Estudos Retrospectivos
14.
Zhonghua Wai Ke Za Zhi ; 57(7): 534-539, 2019 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-31269617

RESUMO

Objective: To investigate the prognostic factors of hyperamylasemia following pancreaticoduodenectomy (PD) . Methods: Clinical data of 359 patients were collected prospectively who underwent PD by the same group at Changhai Hospital of Navy Medical University from January 2017 to June 2018.There were 212 males and 147 females.The median age was 63 years old (range: 23 to 82 years old) .According to whether the patient's serum amylase was greater than 120 U/L at 0 or 1 day after surgery,the patients were divided into hyperamylasemia group and non-hyperamylasemia group. Univariate analysis and multivariate analysis were used to find out the prognostic factors of hyperamylasemia after PD. Results: Of the 359 patients, 238 cases (66.3%) developed hyperamylasemia.The incidence rate of clinically related pancreatic fistula (15.1% vs.2.5%, P<0.01) , grade B/C post pancreatectomy hemorrhage (8.8% vs. 2.5%, P<0.01) , and surgical site infection (9.2% vs. 3.3%, P=0.04) was significantly higher in the hyperamylasemia group.The severity of complications (CD grade≥Ⅲ: 11.3% vs.4.1%, P=0.023) and postoperative hospital stay (11 days vs. 9 days, P=0.001) were higher in the hyperamylasemia group.In the multivariate analysis, the main pancreatic duct diameter (MPD) ≤3 mm (OR=4.469, 95% CI: 2.563-7.793, P<0.01) , pathological type of disease (pancreatic cancer or pancreatitis) (OR=0.230, 95% CI: 0.122-0.436, P<0.01) and soft texture of pancreas (OR=3.297, 95%CI: 1.930-5.635, P<0.01) were independent prognostic factors for hyperamylasemia. Conclusions: Post-PD hyperamylasemia increased the incidence and severity of postoperative complications after PD.MPD≤3 mm, soft texture of pancreas and pathological type of disease were independent prognostic factors of hyperamylasemia.


Assuntos
Hiperamilassemia/etiologia , Pancreatopatias/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amilases/sangue , Feminino , Hemorragia/sangue , Hemorragia/etiologia , Humanos , Hiperamilassemia/sangue , Masculino , Pessoa de Meia-Idade , Pancreatopatias/sangue , Pancreatopatias/etiologia , Fístula Pancreática/sangue , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/métodos , Prognóstico , Fatores de Risco , Infecção da Ferida Cirúrgica/sangue , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
15.
Cell Mol Biol Lett ; 24: 43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236121

RESUMO

Background: Impairment of the blood-brain barrier (BBB) could result in secondary cerebral edema and life-threatening pancreatic encephalopathy in patients with severe acute pancreatitis (SAP). Mesenchymal stem cells (MSCs) have been widely adopted in clinical research because of their pleiotropic functions. The aim of this study was to investigate the impact of MSCs on BBB permeability in SAP and the potential mechanisms driving these effects. Methods: Sprague-Dawley rats were randomly assigned to the control, SAP and SAP+MSCs groups. Pancreatic impairment was assessed. The serum levels of amylase, TNF-α and IL-10, expression levels of claudin-5, Bax, Bcl-2 and MMP-9, and the BBB permeability were measured. Endothelial cell apoptosis was evaluated. Results: SAP rats showed BBB impairment with increased permeability and secondary cerebral edema, which was confirmed using the Evans blue assay and the calculation of the brain dry/wet ratio. Treatment with MSCs decreased the serum levels of amylase and TNF-α, increased the serum levels of IL-10, attenuated the apoptosis of brain microvascular endothelial cells, upregulated claudin-5 expression and downregulated MMP-9 expression. This treatment attenuated the increased BBB permeability in SAP rats. Conclusions: MSCs attenuated the impairment of the BBB and decreased its permeability, producing protective effects in SAP rats.


Assuntos
Barreira Hematoencefálica/metabolismo , Transplante de Células-Tronco Mesenquimais , Pancreatite/metabolismo , Pancreatite/terapia , Doença Aguda/terapia , Amilases/sangue , Animais , Apoptose , Claudina-5/sangue , Modelos Animais de Doenças , Células Endoteliais/fisiologia , Interleucina-10/sangue , Masculino , Metaloproteinase 9 da Matriz/sangue , Pancreatite/sangue , Permeabilidade , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
16.
World J Emerg Surg ; 14: 27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210778

RESUMO

Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.


Assuntos
Pancreatite/terapia , Doença Aguda/terapia , Amilases/análise , Amilases/sangue , Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Endoscopia/métodos , Guias como Assunto , Hematócrito/métodos , Humanos , Itália , Lipase/análise , Lipase/sangue , Pancreatite/classificação , Pancreatite/diagnóstico , Pró-Calcitonina/análise , Pró-Calcitonina/sangue , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
17.
Med Sci Monit ; 25: 3880-3886, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-31127077

RESUMO

BACKGROUND Acute pancreatitis is an inflammatory disease of the pancreas associated with high patient morbidity. Lycium barbarum polysaccharide (LBP), a traditional Chinese medicine with an active component extracted from the goji berry, has previously been reported to have anti-inflammatory effects. This study aimed to investigate the effects of LBP in a mouse model of cerulein-induced acute pancreatitis. MATERIAL AND METHODS Acute pancreatitis was induced by intraperitoneal injection of cerulein in C57BL/6 wild-type mice or nuclear factor erythroid-2-related factor 2 (NRF2) gene knockout mice. LBP or normal saline was administrated by gavage once daily for one week before the induction of acute pancreatitis. At 12 hours after the first intraperitoneal injection of cerulein, the mice were euthanized. Blood and pancreatic tissue were sampled for histology and for the measurement of pro-inflammatory cytokines, serum amylase, and lipase. RESULTS In the untreated mouse model of cerulein-induced acute pancreatitis, amylase and lipase levels were increased, and these levels were reduced by LBP treatment when compared with vehicle treatment. In the untreated mouse model, histology of the pancreas showed edema and inflammation, which were reduced in the LBP-treated mice. In the untreated mouse model, increased levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were found, which were reduced in the LBP-treated mice. NRF2 gene knockout mice with cerulein-induced acute pancreatitis showed reduced anti-inflammatory effects of LBP treatment. LBP increased the expression of NRF2 and heme oxygenase-1 (HO-1). CONCLUSIONS In a mouse model of cerulein-induced acute pancreatitis, LBP reduced inflammation by upregulating NRF2 and HO-1.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Pâncreas/patologia , Pancreatite/tratamento farmacológico , Doença Aguda , Amilases/sangue , Animais , Ceruletídeo/farmacologia , Citocinas/metabolismo , Modelos Animais de Doenças , Heme Oxigenase-1/metabolismo , Interleucina-6/metabolismo , Lipase/sangue , Medicina Tradicional Chinesa/métodos , Camundongos , Camundongos Endogâmicos C57BL , Fator 2 Relacionado a NF-E2/genética , Fator 2 Relacionado a NF-E2/metabolismo , NF-kappa B/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
18.
Mol Med Rep ; 19(6): 5142-5152, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31059081

RESUMO

The purpose of the present study was to investigate the effect of carbon monoxide (CO) released from CO­releasing molecule 2 (CORM­2) on mice with acute pancreatitis (AP). To perform the investigation, a mouse AP model was established using caerulein. The mice were treated with or without CORM­2. The survival rate of the mice in the different groups was analyzed, and serum amylase and lipase levels were measured to assess the degree of pancreatic injury. The severity of AP was also evaluated by histological examination, and histopathological scoring of the pancreatic damage was performed. Pancreatic cell apoptosis was analyzed using a terminal deoxynucleotidyl­transferase­mediated dUTP nick end labelling assay. The function of the lung and liver was also assessed in the present study. Furthermore, the role of CORM­2 on oxidative stress, intercellular adhesion molecule 1 (ICAM­1) and vascular cell adhesion molecule 1 (VCAM­1) expression, pro­inflammatory cytokine production, and nuclear factor (NF)­κB activation in the pancreas of AP mice was determined. The results demonstrated that CORM­2 reduced the mortality, pancreatic damage, and lung and liver injury of AP mice. CORM­2 administration also reduced systemic and localized inflammatory cell factors. Furthermore, treatment with CORM­2 inhibited the expression of ICAM­1 and VCAM­1, and the activation of NF­κB and phosphorylated inhibitor of NF­κB subunit α, in the pancreas of AP mice. These results indicated that CO released from CORM­2 exerted protective effects on AP mice, and the beneficial effects were likely due to inhibition of NF­κB pathway activation.


Assuntos
Monóxido de Carbono/metabolismo , Compostos Organometálicos/farmacologia , Pancreatite/prevenção & controle , Doença Aguda , Amilases/sangue , Animais , Ceruletídeo/toxicidade , Citocinas/metabolismo , Modelos Animais de Doenças , Molécula 1 de Adesão Intercelular/metabolismo , Lipase/sangue , Pulmão/metabolismo , Pulmão/patologia , Masculino , Malondialdeído/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Compostos Organometálicos/química , Compostos Organometálicos/uso terapêutico , Estresse Oxidativo/efeitos dos fármacos , Pâncreas/metabolismo , Pâncreas/patologia , Pancreatite/induzido quimicamente , Pancreatite/patologia , Peroxidase/metabolismo
19.
Cutan Ocul Toxicol ; 38(3): 294-297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31039622

RESUMO

Objective: The aim of this study was to analyze the effect of pentavalent antimonials used in the treatment of cutaneous leishmaniasis (CL) on hemogram and biochemical parameters. Material and methods: The study consisted of 168 patients diagnosed with CL after microscopic examination and treated with either systemic sodium stibogluconate (SSG) or meglumine antimonate (MA) 20 mg/kg/day for 14 days. The patients were divided into two groups as SSG and MA patients. Neutrophil count, leukocyte count, lymphocyte count, hemoglobin concentration, platelet count, amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen and serum creatinine levels were compared before and on the 14th day of the treatment. Results: There was a statistically significant decrease in the neutrophil, lymphocyte, leukocyte, platelet counts, and hemoglobin and blood urea nitrogen levels on the 14th day of the treatment when compared to the pre-treatment values. A statistically significant increase was found in the ALT, AST, amylase and lipase levels. No significant change was found in the serum creatinine levels. Conclusion: According to the results of our study, pentavalent antimonials given standard doses in the treatment of CL can lead to an increase in the pancreatic enzymes and transaminases and bone marrow suppression. We do not recommend any change in the treatment if these conditions are not corroborated by clinical findings.


Assuntos
Gluconato de Antimônio e Sódio/efeitos adversos , Antiprotozoários/efeitos adversos , Leishmaniose Cutânea/tratamento farmacológico , Antimoniato de Meglumina/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Amilases/sangue , Aspartato Aminotransferases/sangue , Contagem de Células Sanguíneas , Nitrogênio da Ureia Sanguínea , Criança , Pré-Escolar , Creatinina/sangue , Feminino , Humanos , Lactente , Leishmaniose Cutânea/sangue , Lipase/sangue , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(2): 215-218, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31106542

RESUMO

OBJECTIVE: To investigate the therapeutic effects of resolvin D1 (RvD1) on cerulein and lipopolysaccharide (LPS)-induced severe acute pancreatitis in mice. METHODS: The model of severe acute pancreatitis was induced by cerulein combined with LPS in mice. Mice were treated with RvD1 at a dose of 150 mg/kg for 4 h after the last injection of cerulein. Pathological changes and scores were assessed by HE staining, serum amylase and lipase levels were detected by ELISA, serum tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) levels were determined by Luminex Assay. RESULTS: Cerulein combined with LPS successfully induced severe acute pancreatitis model in mice. RvD1 reduced the pathological changes of pancreas in severe acute pancreatitis mice, decreased the serum levels of amylase and lipase, as well as attenuated the serum levels of TNF-α and IL-6. CONCLUSION: RvD1 can reduce the severity of severe acute pancreatitis induced by cerulein and LPS in mice.


Assuntos
Ácidos Docosa-Hexaenoicos/farmacologia , Pancreatite/tratamento farmacológico , Doença Aguda , Amilases/sangue , Animais , Ceruletídeo , Interleucina-6/sangue , Lipase/sangue , Lipopolissacarídeos , Camundongos , Pâncreas , Pancreatite/induzido quimicamente , Fator de Necrose Tumoral alfa
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