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1.
Wiad Lek ; 74(8): 1794-1799, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34537722

RESUMO

OBJECTIVE: The aim: Improve the treatment outcomes of patients with fl uid collections following acute pancreatitis using an ultrasound-guided puncture and catheter drainage methods. PATIENTS AND METHODS: Materials and methods: 67 patients with acute pancreatitis complicated by fl uid collections were divided into two groups. The fi rst group (comparison group) consisted of 32 patients who underwent percutaneous ultrasound-guided puncture and catheter drainage interventions in addition to conservative therapy. The second group (control group) consisted of 35 patients receiving conservative therapy. The age of patients was from 18 to 77 years. In the comparison group among 32 patients there were 19 women and 13 men, the average age consisted 48.2 ± 2.2 years. In the control group among 35 patients there were 21 women and 14 men, the average age of patients consisted 47.1 ± 2.3 years. RESULTS: Results: The mortality rate in the comparison group was 2 (6.2%) cases, in the control group - 4 (11.4%) cases (p <0.05). Infection of fl uid collections developed in 2 (6.2%) patients of the comparison group and in 5 (14.3%) patients of the control group. The average length of stay in the hospital of patients in the comparison group was 24.13 ± 2.17 days, in the control group 28.11 ± 1.05 days (p <0.05). Also in the comparison group there was a faster normalization of clinical and laboratory indicators (level of leukocytes, serum amylase, C-reactive protein) (p <0,05). CONCLUSION: Conclusions: the use of percutaneous ultrasound-guided puncture and catheter drainage methods has reduced mortality and improved treatment outcomes in patients with acute pancreatitis complicated by fluid collections.


Assuntos
Pancreatite , Doença Aguda , Adolescente , Adulto , Idoso , Cateteres , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/terapia , Punções , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto Jovem
2.
World J Gastroenterol ; 27(30): 5019-5036, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34497432

RESUMO

The gut microbiome is a complex microbial community, recognized for its potential role in physiology, health, and disease. The available evidence supports the role of gut dysbiosis in pancreatic disorders, including acute pancreatitis (AP). In AP, the presence of gut barrier damage resulting in increased mucosal permeability may lead to translocation of intestinal bacteria, necrosis of pancreatic and peripancreatic tissue, and infection, often accompanied by multiple organ dysfunction syndrome. Preserving gut microbial homeostasis may reduce the systemic effects of AP. A growing body of evidence suggests the possible involvement of the gut microbiome in various pancreatic diseases, including AP. This review discusses the possible role of the gut microbiome in AP. It highlights AP treatment and supplementation with prebiotics, synbiotics, and probiotics to maintain gastrointestinal microbial balance and effectively reduce hospitalization, morbidity and mortality in an early phase. It also addresses novel therapeutic areas in the gut microbiome, personalized treatment, and provides a roadmap of human microbial contributions to AP that have potential clinical benefit.


Assuntos
Microbioma Gastrointestinal , Pancreatite , Probióticos , Doença Aguda , Disbiose , Humanos , Pancreatite/terapia , Prebióticos , Probióticos/uso terapêutico
3.
Harefuah ; 160(8): 508-513, 2021 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-34396726

RESUMO

BACKGROUND: Previous studies have shown a correlation between acute pancreatitis and several different risk factors that vary in different countries and ethnic groups. The aims of this study are to examine the clinical characteristics and outcomes of acute pancreatitis in patients of Jewish and Bedouin origin. METHODS: We performed a retrospective cohort study of patients hospitalized with acute pancreatitis in the Soroka University Medical Center between the years 2012 and 2016 and compared two groups of patients: patients of Jewish and Bedouin origin. The primary outcome was a composite outcome consisting of 30-days mortality, ICU admission, complications (defined as necrotizing pancreatitis or pseudocyst formation), surgery due to these complications and 30-days re-admission due to pancreatitis. RESULTS: A total of 560 patients were included, 483 patients (86.3%) of Jewish origin and 77 patients (13.7%) of Bedouin origin. The most common cause in both groups was biliary pancreatitis: 49.7% among Jewish, 61% among Bedouin. In our study alcohol consumption, the most common worldwide risk factor of pancreatitis, accounts for only a small percentage of the disease in the Jewish population (5.6%) and does not exist in the Bedouin population. We found no significant differences in outcomes between the two groups. CONCLUSIONS: Biliary pancreatitis was the most common cause in both groups of patients. The important finding of our study is that alcohol use is a minor cause of acute pancreatitis in the Negev. Moreover, it is uncommon in the Jewish population and is completely non-existent among Bedouins. No differences were found in the primary outcomes between the two groups.


Assuntos
Pancreatite , Doença Aguda , Árabes , Humanos , Israel/epidemiologia , Judeus , Pancreatite/epidemiologia , Pancreatite/terapia , Estudos Retrospectivos
4.
BMJ Open ; 11(8): e045031, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373293

RESUMO

OBJECTIVES: To conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional 'step-up' strategy based on percutaneous catheter drainage (PCD). DESIGN: Systematic review and meta-analysis. METHODS: PubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional 'step-up' strategy based on PCD were included. OUTCOMES: The primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay. RESULTS: Five cohort studies and three RCTs were included in the analysis. Compared with the conventional 'step-up' method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) -0.31, 95% CI -0.53 to -0.10 and p=0.005; RCTs: SMD -0.45, 95% CI -0.64 to -0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD -2.49, 95% CI -4.46 to -0.51 and p<0.001; RCTs: SMD -0.67, 95% CI -0.89 to -0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04). CONCLUSIONS: The findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the 'step-up' strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials. PROSPERO REGISTRATION NUMBER: CRD42020168537.


Assuntos
Pancreatite , Paracentese , Drenagem , Hospitalização , Humanos , Tempo de Internação , Pancreatite/terapia , Paracentese/efeitos adversos
5.
Zhonghua Yi Xue Za Zhi ; 101(30): 2356-2359, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34404126

RESUMO

Fluid resuscitation is the cornerstone in the early treatment of severe acute pancreatitis(SAP). The endpoints of fluid therapy should be closely monitored early in the disease course by different methods, such as clinical status, pressure indicators, volume indicators, the maintain of microcirculation and the tissue oxygenation. To avoid volume overload that may lead to complications such as pulmonary edema and abdominal hypertension, it is critical to adjust the ratio of crystalloid-colloid and the speed of the liquid timely according to the dynamically assessment of fluid responsiveness and tolerance, the perfusion of macrocirculation and microcirculation and the stage of the fluid resuscitation, so as to improve the efficacy and safety of early fluid resuscitation in the treatment of SAP.


Assuntos
Pancreatite , Edema Pulmonar , Doença Aguda , Hidratação , Humanos , Monitorização Fisiológica , Pancreatite/terapia , Ressuscitação
6.
Zhonghua Wai Ke Za Zhi ; 59(7): 578-587, 2021 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-34256457

RESUMO

Acute pancreatitis is a common acute abdomen of the digestive system. In recent years,great progress has been made in the diagnosis and treatment concepts,methods and strategies of acute pancreatitis,which plays an important role in promoting the standardization of acute pancreatitis management and improving the level of patient treatment. Based on the previous guidelines and expert consensus,this guideline adopts an evidence-based and problem-oriented presentation in a way. Comprehensive analysis of the data of important domestic and foreign clinical research in the past 5 years,29 recommendations are formed after multi-disciplinary expert discussion which including diagnosis,treatments and follow-up,with the expectation of providing evidence support for clinical practice of acute pancreatitis in China.


Assuntos
Pancreatite , Doença Aguda , China , Consenso , Humanos , Pancreatite/diagnóstico , Pancreatite/terapia
7.
Nat Commun ; 12(1): 4136, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230486

RESUMO

Acute pancreatitis is a disease associated with suffering and high lethality. Although the disease mechanism is unclear, phospholipase A2 (PLA2) produced by pancreatic acinar cells is a known pathogenic trigger. Here, we show macrophage membrane-coated nanoparticles with a built-in 'lure and kill' mechanism (denoted 'MΦ-NP(L&K)') for the treatment of acute pancreatitis. MΦ-NP(L&K) are made with polymeric cores wrapped with natural macrophage membrane doped with melittin and MJ-33. The membrane incorporated melittin and MJ-33 function as a PLA2 attractant and a PLA2 inhibitor, respectively. These molecules, together with membrane lipids, work synergistically to lure and kill PLA2 enzymes. These nanoparticles can neutralize PLA2 activity in the sera of mice and human patients with acute pancreatitis in a dose-dependent manner and suppress PLA2-induced inflammatory response accordingly. In mouse models of both mild and severe acute pancreatitis, MΦ-NP(L&K) confer effective protection against disease-associated inflammation, tissue damage and lethality. Overall, this biomimetic nanotherapeutic strategy offers an anti-PLA2 treatment option that might be applicable to a wide range of PLA2-mediated inflammatory disorders.


Assuntos
Doença Aguda/terapia , Macrófagos , Nanopartículas/uso terapêutico , Pancreatite/terapia , Animais , Citocinas , Modelos Animais de Doenças , Feminino , Humanos , Inflamação , Meliteno , Camundongos , Fosfolipases A2/sangue , Células THP-1
8.
J Investig Med High Impact Case Rep ; 9: 23247096211024773, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34130536

RESUMO

The gastrointestinal (GI) involvement, including acute pancreatitis (AP) from the novel coronavirus disease-2019 (COVID-19), is increasingly being reported. Recent evidence suggests that the pathogenesis of COVID-19 is mediated by the angiotensin-converting enzyme 2 (ACE-2) receptors and transmembrane protease serine 2 (TMPRSS2) for "priming," which is highly expressed in the pancreas. To our knowledge, there is no other reported case of AP associated with COVID-19 after the respiratory symptoms are resolved. In this article, we present a patient with COVID-19, who came with intractable epigastric pain and resolved respiratory symptoms. A diagnosis of AP complicated with COVID-19 was made after laboratory and imaging workup, which was successfully managed conservatively.


Assuntos
COVID-19/diagnóstico , Pancreatite/diagnóstico , Dor Abdominal/etiologia , Antibacterianos/uso terapêutico , Humanos , Leucocitose/etiologia , Lipase/sangue , Masculino , Pancreatite/terapia , Combinação Piperacilina e Tazobactam/uso terapêutico , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Stem Cell Res Ther ; 12(1): 337, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112260

RESUMO

BACKGROUND: Mesenchymal stem cells (MSCs) hold promising potential to treat systemic inflammatory diseases including severe acute pancreatitis (SAP). In our previous study, placental chorionic plate-derived MSCs (CP-MSCs) were found to possess superior immunoregulatory capability. However, the therapeutic efficacy of CP-MSCs on SAP and their underlying mechanism remain unclear. METHODS: The survival and colonization of exogenous CP-MSCs were observed by bioluminescence imaging and CM-Dil labeling in rodent animal models of SAP. The therapeutic efficacy of CP-MSCs on SAP rats was evaluated by pathology scores, the levels of pancreatitis biomarkers as well as the levels of inflammatory factors in the pancreas and serum. The potential protective mechanism of CP-MSCs in SAP rats was explored by selectively depleting M1 or M2 phenotype macrophages and knocking down the expression of TSG-6. RESULTS: Exogenous CP-MSCs could survive and colonize in the injured tissue of SAP such as the lung, pancreas, intestine, and liver. Meanwhile, we found that CP-MSCs alleviated pancreatic injury and systemic inflammation by inducing macrophages to polarize from M1 to M2 in SAP rats. Furthermore, our data suggested that CP-MSCs induced M2 polarization of macrophages by secreting TSG-6, and TSG-6 played a vital role in alleviating pancreatic injury and systemic inflammation in SAP rats. Notably, we found that a high inflammation environment could stimulate CP-MSCs to secrete TSG-6. CONCLUSION: Exogenous CP-MSCs tended to colonize in the injured tissue and reduced pancreatic injury and systemic inflammation in SAP rats through inducing M2 polarization of macrophages by secreting TSG-6. Our study provides a new treatment strategy for SAP and initially explains the potential protective mechanism of CP-MSCs on SAP rats.


Assuntos
Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Pancreatite , Doença Aguda , Animais , Modelos Animais de Doenças , Feminino , Macrófagos , Pancreatite/terapia , Placenta , Gravidez , Ratos
10.
Medicine (Baltimore) ; 100(18): e25614, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950939

RESUMO

BACKGROUND: Patients with severe acute pancreatitis (SAP) have gastrointestinal dysfunction, and enteral nutrition intolerance is easy to occur during the implementation of enteral nutrition, which leads to the suspension or termination of enteral nutrition. Enteral nutrition cannot tolerate the influence of many factors. At present, there is a lack of analysis on the influencing factors of enteral nutrition intolerance in patients with SAP. Therefore, this study analyzed the factors of enteral nutrition intolerance in patients with SAP by meta-analysis, to provide a basis for the protection of enteral nutrition in patients with SAP. METHODS: Databases (PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) were searched using index words to find relevant studies published before March 2021. Meta-analyses of relative risk were performed for the identification of risk factors. RESULTS: We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSION: This study systematically reviewed the existing evidence and determined the incidence and predictors of enteral nutrition intolerance in patients with SAP.


Assuntos
Nutrição Enteral/efeitos adversos , Intolerância Alimentar/epidemiologia , Pancreatite/terapia , Intolerância Alimentar/etiologia , Humanos , Metanálise como Assunto , Pancreatite/complicações , Pancreatite/diagnóstico , Fatores de Risco , Índice de Gravidade de Doença , Revisões Sistemáticas como Assunto
11.
Radiologe ; 61(6): 548-554, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-33931791

RESUMO

BACKGROUND: There is currently no S3 guideline that contains statements on the diagnosis and treatment of acute, chronic and autoimmune pancreatitis in a single guideline. OBJECTIVES: This article presents the most relevant recommendations relating to radiological imaging from the new "S3 guideline for pancreatitis". MATERIALS AND METHODS: The guideline was developed by the DGVS (German Society for Digestive and Metabolic Diseases). After an online-based Delphi survey, the statements were discussed by an interdisciplinary expert team at a 3-day consensus conference and then agreed upon. The level of evidence scheme (version 2) of the Oxford Centre for Evidence-based Medicine was used. RESULTS: The new German "S3 guideline pancreatitis" comprises for the first time all entities of pancreatitis, acute, chronic and autoimmune pancreatitis and contains a large number of innovations with regard to diagnostic imaging and therapy. In addition to the evidence-based recommendations for diagnosis and therapy, a German-language glossary of the revised Atlanta classification on acute pancreatitis was adopted by consensus of the interdisciplinary guideline expert team. Furthermore, protocol recommendations for the performance of computed tomography (CT) are provided for the first time. In this article we introduce the key recommendations and innovations in the field of diagnostic radiologic imaging for acute, chronic and autoimmune pancreatitis. CONCLUSIONS: In the future, every radiologist should have deep knowledge of the recommended time intervals for radiological imaging in acute pancreatitis and know the German terms for the description of acute pancreatitis; furthermore they should be able to classify the morphologies to the appropriate stages.


Assuntos
Pancreatite , Doença Aguda , Medicina Baseada em Evidências , Humanos , Pancreatite/diagnóstico por imagem , Pancreatite/terapia , Tomografia Computadorizada por Raios X
12.
Zhen Ci Yan Jiu ; 46(4): 312-7, 2021 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-33931997

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) of Zusanli(ST36) and Zhongwan (CV12) on intestinal nutritional feeding intolerance in patients with severe acute pancreatitis (SAP). METHODS: A total of 68 SAP patients (hospitalized from January of 2018 to December of 2019 in Cangzhou Hospital of Integrated Medicine) were randomly divided into control and EA groups (n=34 cases in each group). All patients of the two groups received the same early enteral nutrition treatment through nasojejunal tube. EA (5-15 Hz, 1-5 mA) was applied to bilateral ST36 and CV12 for 20 min, twice a day for 7 days. The incidence of feeding intolerance (abdominal distension, vomiting, diarrhea, constipation, gastrointestinal bleeding), time to reach energy target, intraperitoneal pressure and the number of borborygmus in 1 min were recorded. The contents of plasma high sensitivity -C reactive protein (hs-CRP), IL-6 and endotoxin were measured using Latex immunoturbidimetric method, chemiluminescence and Tachypiens Amebocyte Lysate Azo substrate color development method, respectively, and the contents of urinary lactulose and mannitol detected using high-performance liquid chromatography. The total protein and albumin levels in the blood were measured for assessing the patients' nutrition status, and acute physiology and chronic health evaluation scoring system (APACHE-Ⅱ) score was determined for assessing the severity of disease. RESULTS: Compared with the control group, the incidence of abdominal distension, vomiting and constipation, intolerance rate to feeding, time to reach the energy target, intraperitoneal pressure on day 7, inflammatory indexes, hs-CRP, IL-6, endotoxin, urine L/M on day 4 and 7, and the APACHE Ⅱ score on day 7 were significantly lower (P<0.01), and the number of borborygmus in 1 min on day 4 and 7 after the treatment was significantly higher in the EA group (P<0.01). In comparison with pretreatment, the abdominal pressure and plasma endotoxin level on day 4 and 7, hs-CRP, IL-6 and L/M ratio on day 1, 4 and 7, as well as APACHE Ⅱ score on day 7 after the treatment were significantly decreased in the two groups (P<0.01), and the number of borborygmus on day 4 and 7, and the total protein and albumin on day 7 significantly increased in both the control and EA groups (P<0.01). CONCLUSION: EA of ST36 and CV12 can shorten the time to reach the energy target, reduce inflammatory response, improve the intestinal mucosal barrier function, and thus reduce the incidence of feeding intolerance in SAP patients.


Assuntos
Eletroacupuntura , Pancreatite , Pontos de Acupuntura , Doença Aguda , Humanos , Recém-Nascido , Mucosa Intestinal , Pancreatite/terapia
14.
ANZ J Surg ; 91(7-8): 1558-1562, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33825324

RESUMO

BACKGROUND: Previous studies have demonstrated a high incidence of acute pancreatitis (AP) in New Zealand, with Maori having the highest reported incidence worldwide. It is possible that barriers to healthcare exist for rural and Maori patients, leading to poorer outcomes. The aim of this study is to compare differences in severity and outcomes in patients with AP with regards to rurality and ethnicity. METHODS: Multicentre retrospective study of all adults aged >16 years who were admitted to any hospital with AP in Northland between 1 January 2014 and 31 December 2018 was performed. Pancreatitis severity was classified using the Revised Atlanta classification. The primary outcome of interest was the difference in severity of pancreatitis with regards to rurality and ethnicity. Secondary outcomes of interest included clinical outcomes, aetiology of AP and re-presentation rates. RESULTS: A total of 468 patients were included. There was no difference found between rural and urban or Maori and non-Maori patients with regards to disease severity, length of stay, mortality or intensive care unit admission rate. A significant difference in aetiology was found between Maori and non-Maori patients, with a higher rate of gallstone pancreatitis in Maori. There was no difference in local complications or number of re-presentations between groups. CONCLUSION: This study showed no difference in the severity or outcomes of AP across rural and urban patients in the Northland region of New Zealand. Secondary outcomes were broadly comparable between groups, with a higher rate of gallstone pancreatitis found in Maori compared to non-Maori.


Assuntos
Grupos Étnicos , Pancreatite , Doença Aguda , Adulto , Humanos , Pancreatite/epidemiologia , Pancreatite/terapia , Estudos Retrospectivos , População Rural , Índice de Gravidade de Doença
15.
Ann Palliat Med ; 10(3): 3445-3451, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33849128

RESUMO

To investigate the role played by gut microbiota in the development and treatment of acute pancreatitis. Gut microbiota is the largest micro-ecosystem in the human body, and is related to various system diseases. Acute pancreatitis is one of the common acute critical diseases in clinical practice, and there are various causative factors for the occurrence of this disease, such as alcohol, infection, obstruction and intestinal microecological factors. The dysbiosis of gut microbiota may play an important role in the pathogenesis of acute pancreatitis and affect prognoses, including gut microbiota structure disorder and bacterial translocation. It can also affect host metabolism and increase the production of toxic metabolites and affect the treatment of acute pancreatitis. Probiotics are live microorganisms that can give health benefits to the host when applied in sufficient quantities, which can effectively stimulate the growth and reproduction of the normal flora of the body, inhibit the overgrowth of pathogenic bacteria, and have a protective effect on the intestinal barrier function. A search of electronic databases (PubMed, EMBASE, Cochrane) has been realized to summarize the information. The paper briefly describes the concept of gut microbiota and acute pancreatitis, examines the role of gut microbiota in the development and treatment of acute pancreatitis, concludes the investigations of the therapeutic effect of probiotics for dysbiosis of gut microbiota in acute pancreatitis in order to provide a valid reference for the development of subsequent clinical strategies.


Assuntos
Microbioma Gastrointestinal , Pancreatite , Doença Aguda , Disbiose/terapia , Ecossistema , Humanos , Pancreatite/terapia
16.
Arq Gastroenterol ; 58(1): 17-25, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909792

RESUMO

BACKGROUND: New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012. OBJECTIVE: The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices. METHODS: A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: "Acute pancreatitis" AND "Atlanta". Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study. RESULTS: Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification. CONCLUSION: Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn't enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.


Assuntos
Pancreatite , Doença Aguda , Humanos , Pancreatite/terapia , Prognóstico , Índice de Gravidade de Doença
17.
World J Gastroenterol ; 27(9): 815-834, 2021 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-33727772

RESUMO

BACKGROUND: Our previous studies confirmed that abdominal paracentesis drainage (APD) attenuates intestinal mucosal injury in rats with severe acute pancreatitis (SAP), and improves administration of enteral nutrition in patients with acute pancreatitis (AP). However, the underlying mechanisms of the beneficial effects of APD remain poorly understood. AIM: To evaluate the effect of APD on intestinal inflammation and accompanying apoptosis induced by SAP in rats, and its potential mechanisms. METHODS: SAP was induced in male adult Sprague-Dawley rats by 5% sodium taurocholate. Mild AP was induced by intraperitoneal injections of cerulein (20 µg/kg body weight, six consecutive injections). Following SAP induction, a drainage tube connected to a vacuum ball was placed into the lower right abdomen of the rats to build APD. Morphological changes, serum inflammatory mediators, serum and ascites high mobility group box protein 1 (HMGB1), intestinal barrier function indices, apoptosis and associated proteins, and toll-like receptor 4 (TLR4) signaling molecules in intestinal tissue were assessed. RESULTS: APD significantly alleviated intestinal mucosal injury induced by SAP, as demonstrated by decreased pathological scores, serum levels of D-lactate, diamine oxidase and endotoxin. APD reduced intestinal inflammation and accompanying apoptosis of mucosal cells, and normalized the expression of apoptosis-associated proteins in intestinal tissues. APD significantly suppressed activation of the intestinal TLR4 signaling pathway mediated by HMGB1, thus exerting protective effects against SAP-associated intestinal injury. CONCLUSION: APD improved intestinal barrier function, intestinal inflammatory response and accompanying mucosal cell apoptosis in SAP rats. The beneficial effects are potentially due to inhibition of HMGB1-mediated TLR4 signaling.


Assuntos
Proteína HMGB1 , Pancreatite , Doença Aguda , Animais , Ascite , Drenagem , Humanos , Inflamação , Masculino , Pancreatite/induzido quimicamente , Pancreatite/terapia , Paracentese , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Receptor 4 Toll-Like
18.
Lakartidningen ; 1182021 03 02.
Artigo em Sueco | MEDLINE | ID: mdl-33650097

RESUMO

This is a short report of the recently published Swedish guidelines for acute pancreatitis, which are based on international guidelines as well as original publications. The report covers diagnosis, classification, treatment and follow up for patients with acute pancreatitis. Early rehydration and goal-based fluid therapy is recommended as well as oral intake of food on demand. Risk factors for development of severe disease and organ failure should be considered already in the emergency unit. Abdominal computer tomography is generally not recommended the first 5-7 days from onset of symptoms. Antibiotic therapy is only recommended when there is suspicion of or a confirmed infection. If intervention is needed for patients with moderate or severe disease a minimal-invasive step-up approach is recommended. Endoscopic Retrograde Cholangiography is generally not recommended as a treatment in the acute phase of the disease. Identification and treatment of the etiology causing acute pancreatitis is essential to prevent new episodes of the disease.


Assuntos
Laparoscopia , Pancreatite , Doença Aguda , Hidratação , Humanos , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite/terapia , Suécia
19.
Orv Hetil ; 162(11): 413-418, 2021 03 14.
Artigo em Húngaro | MEDLINE | ID: mdl-33714939

RESUMO

Összefoglaló. Bevezetés: Az akut pancreatitis az egyik leggyakoribb kórházi felvételt igénylo gastrointestinalis kórkép. A korai visszavételi arány egyrészt az ellátást jellemzo minoségi mutató, másrészt az akut pancreatitis 1 éves mortalitásának legerosebb prognosztikai faktora. Célkituzés: A korai visszavétel arányának, illetve okainak vizsgálata klinikánkon akut pancreatitis diagnózisával kezelt betegek körében. Módszerek: Retrospektív vizsgálatunkat azon 18 év feletti betegek körében végeztük, akiket a 2010. január és 2018. december közötti idoszakban akut pancreatitis diagnózisával kezeltünk klinikánkon, és az elso emissziótól számítva 30 napon belül újból felvételre kerültek. A betegek adatait az Akut Pancreatitis Regiszter és a betegnyilvántartó rendszer (MedSol ) segítségével gyujtöttük össze. A biliaris, illetve nem biliaris akut pancreatitises eseteket hasonlítottuk össze az epidemiológiai adatok, a visszavétel oka, a visszavételig eltelt átlagos idotartam, és a visszavétel idotartama, valamint kimenetele vonatkozásában. Eredmények: Akut pancreatitis diagnózisával 647 beteg került felvételre. Közülük 28 beteg került újrafelvételre. A leggyakoribb okok között 1) peripancreaticus szövodmények, 2) epés panaszok és 3) az akut pancreatitis kiújulása szerepel. A biliaris és a nem biliaris pancreatitises eseteket összehasonlítva, a visszavétel oka epés panasz volt az elobbi csoport 65,5%-ában és az utóbbi 15%-ában. A középsúlyos pancreatitises esetek száma szignifikánsan magasabbnak adódott a nem biliaris csoportban. Következtetés: A középsúlyos/súlyos pancreatitises esetek aránya magasabb volt a nem biliaris pancreatitises csoportban. Biliaris pancreatitis esetén javasolt index-cholecystectomia végzése. Orv Hetil. 2021; 162(11): 413-418. INTRODUCTION: Acute pancreatitis is the leading cause of hospitalization among gastrointestinal diseases. The early readmission rate is a quality marker and the strongest prognostical factor of 1-year mortality of acute pancreatitis. OBJECTIVE: To investigate the rate and cause of early readmission among patients treated with acute pancreatitis at our clinic. METHODS: Our retrospective study was conducted among patients (>18 years) treated with acute pancreatitis between January 2010 and December 2018 at our clinic, by whom unplanned readmission happened <30 days from emission. Personal data were collected from the Hungarian Pancreas Registry. Data of biliary and non-biliary acute pancreatitis cases were compared concerning epidemiological data, cause of readmission, mean time elapsed until readmission, its duration and outcome. RESULTS: 647 patients were diagnosed with acute pancreatitis. Of them, 28 patients had early readmission. The most common causes were 1) local pancreatic complications, 2) biliary and 3) recurrence of acute pancreatitis. By investigating the biliary and non-biliary pancreatitis cases separately, the cause of readmission was biliary in 65.5% and 15%, respectively. The number of moderately severe pancreatitis cases was significantly higher in the non-biliary group. CONCLUSION: The proportion of moderate/severe diseases was higher in the non-biliary pancreatitis group. In the case of biliary pancreatitis, it is suggested to perform index cholecystectomy. Orv Hetil. 2021; 162(11): 413-418.


Assuntos
Pancreatite , Readmissão do Paciente , Indicadores de Qualidade em Assistência à Saúde , Doença Aguda , Adulto , Humanos , Hungria , Pancreatite/terapia , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos
20.
Theranostics ; 11(7): 3213-3228, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33537083

RESUMO

Rationale: Acute pancreatitis (AP) is a serious acute condition affecting the abdomen and shows high morbidity and mortality rates. Its global incidence has increased in recent years. Inflammation and oxidative stress are potential therapeutic targets for AP. This study was conducted to investigate the intrinsic anti-oxidative and anti-inflammatory effects of Prussian blue nanozyme (PBzyme) on AP, along with its underlying mechanism. Methods: Prussian blue nanozymes were prepared by polyvinylpyrrolidone modification method. The effect of PBzyme on inhibiting inflammation and scavenging reactive oxygen species was verified at the cellular level. The efficacy and mechanism of PBzyme for prophylactically treating AP were evaluated using the following methods: serum testing in vivo, histological scoring following hematoxylin and eosin staining, terminal deoxynucleotidyl transferase dUTP nick end labeling fluorescence staining, polymerase chain reaction array, Kyoto Encyclopedia of Genes and Genomes analysis and Western blotting analysis. Results: The synthetic PBzyme showed potent anti-oxidative and anti-inflammatory effects in reducing oxidative stress and alleviating inflammation both in vitro and in vivo in the prophylactic treatment of AP. The prophylactic therapeutic efficacy of PBzyme on AP may involve inhibition of the toll-like receptor/nuclear factor-κB signaling pathway and reactive oxygen species scavenging. Conclusion: The single-component, gram-level mass production, stable intrinsic biological activity, biosafety, and good therapeutic efficacy suggest the potential of PBzyme in the preventive treatment of AP. This study provides a foundation for the clinical application of PBzyme.


Assuntos
Terapia Enzimática/métodos , Nanotecnologia/métodos , Pancreatite/terapia , Transdução de Sinais/efeitos dos fármacos , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular Tumoral , China , Citocinas/metabolismo , Enzimas/metabolismo , Enzimas/farmacologia , Ferricianetos/química , Ferricianetos/uso terapêutico , Ferrocianetos/química , Ferrocianetos/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Inflamação/patologia , Masculino , Camundongos Endogâmicos BALB C , NF-kappa B/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Pancreatite/metabolismo , Povidona/química , Povidona/uso terapêutico , Reação do Azul da Prússia/métodos , Espécies Reativas de Oxigênio/metabolismo , Receptores Toll-Like/efeitos dos fármacos
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