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1.
Can J Gastroenterol Hepatol ; 2022: 2372257, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35910039

RESUMO

Background and Aims: While endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC), there is conflicting data on associated adverse events. The aims of this systematic review and meta-analysis are to (1) compare ERCP-related adverse events in patients with and without PSC and (2) determine risk factors for ERCP-related adverse events in PSC. Methods: Embase, PubMed, and CENTRAL were searched between January 1, 2000, and May 12, 2021. Eligible studies included adults with PSC undergoing ERCP and reported at least one ERCP-related adverse event (cholangitis, pancreatitis, bleeding, and perforation) or an associated risk factor. The risk of bias was assessed with the Newcastle-Ottawa scale and Cochrane Risk of Bias 2. Raw event rates were used to calculate odds ratios (ORs) and then pooled using random-effects models. Results: Twenty studies met eligibility criteria, of which four were included in a meta-analysis comparing post-ERCP adverse events in patients with PSC (n = 715) to those without PSC (n = 9979). We found a significant threefold increase in the 30-day odds of cholangitis in PSC compared to those without (OR 3.263, 95% CI 1.076-9.896; p=0.037). However, there were no significant differences in post-ERCP pancreatitis (PEP), bleeding, or perforation. Due to limitations in primary data, only risk factors contributing to PEP could be analyzed. Accidental passage of the guidewire into the pancreatic duct (OR 7.444, 95% CI 3.328-16.651; p < 0.001; I 2 = 65.0%) and biliary sphincterotomy (OR 4.802, 95% CI 1.916-12.033; p=0.001; I 2 = 73.1%) were associated with higher odds of PEP in a second meta-analysis including five studies. Conclusions: In the context of limited comparative data and heterogeneity, PSC patients undergoing ERCP have higher odds of cholangitis despite the majority receiving antibiotics. Additionally, accidental wire passage and biliary sphincterotomy increased the odds of PEP. Future studies on ERCP-related risks and preventive strategies are needed.


Assuntos
Colangite Esclerosante , Colangite , Pancreatite , Adulto , Cateterismo/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangite/epidemiologia , Colangite/etiologia , Humanos , Pancreatite/epidemiologia , Pancreatite/etiologia
2.
Front Endocrinol (Lausanne) ; 13: 874608, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35923617

RESUMO

Background: Type I hyperlipoproteinemia, characterized by severe hypertriglyceridemia, is caused mainly by loss-of-function mutation of the lipoprotein lipase (LPL) gene. To date, more than 200 mutations in the LPL gene have been reported, while only a limited number of mutations have been evaluated for pathogenesis. Objective: This study aims to explore the molecular mechanisms underlying lipoprotein lipase deficiency in two pedigrees with type 1 hyperlipoproteinemia. Methods: We conducted a systematic clinical and genetic analysis of two pedigrees with type 1 hyperlipoproteinemia. Postheparin plasma of all the members was used for the LPL activity analysis. In vitro studies were performed in HEK-293T cells that were transiently transfected with wild-type or variant LPL plasmids. Furthermore, the production and activity of LPL were analyzed in cell lysates or culture medium. Results: Proband 1 developed acute pancreatitis in youth, and her serum triglycerides (TGs) continued to be at an ultrahigh level, despite the application of various lipid-lowering drugs. Proband 2 was diagnosed with type 1 hyperlipoproteinemia at 9 months of age, and his serum TG levels were mildly elevated with treatment. Two novel compound heterozygous variants of LPL (c.3G>C, p. M1? and c.835_836delCT, p. L279Vfs*3, c.188C>T, p. Ser63Phe and c.662T>C, p. Ile221Thr) were identified in the two probands. The postheparin LPL activity of probands 1 and 2 showed decreases of 72.22 ± 9.46% (p<0.01) and 54.60 ± 9.03% (p<0.01), respectively, compared with the control. In vitro studies showed a substantial reduction in the expression or enzyme activity of LPL in the LPL variants. Conclusions: Two novel compound heterozygous variants of LPL induced defects in the expression and function of LPL and caused type I hyperlipoproteinemia. The functional characterization of these variants was in keeping with the postulated LPL mutant activity.


Assuntos
Hiperlipoproteinemia Tipo I , Pancreatite , Doença Aguda , Adolescente , Feminino , Humanos , Hiperlipoproteinemia Tipo I/tratamento farmacológico , Hiperlipoproteinemia Tipo I/genética , Lipase Lipoproteica/genética , Lipase Lipoproteica/metabolismo , Pancreatite/genética , Linhagem
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 34(6): 630-634, 2022 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-35924520

RESUMO

OBJECTIVE: To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP). METHODS: The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed. RESULTS: The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×109/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (µg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH2O, 1 cmH2O ≈ 0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY (r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant (P < 0.05). CONCLUSIONS: IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.


Assuntos
Nutrição Enteral , Pancreatite , Doença Aguda , Humanos , Pancreatite/terapia
4.
Curr Opin Gastroenterol ; 38(5): 482-486, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35916322

RESUMO

PURPOSE OF REVIEW: Drug-induced pancreatitis is one of the top three causes of acute pancreatitis. A drug exposure is traditionally determined to be the cause of pancreatitis only after other possible and common causes of pancreatitis have been excluded. RECENT FINDINGS: In this review, we challenge this traditional notion of drug-induced pancreatitis as a diagnosis of exclusion. Instead, we propose to shift the paradigm of conceptualizing what we term drug-associated pancreatic injury (DAPI); as a continuum of pancreatic injury that can be concomitant with other risk factors. The aims of this targeted review are to harness recent literature to build a foundation for conceptualizing DAPI, to highlight specific drugs associated with DAPI, and to describe a framework for future studies of DAPI. SUMMARY: Our hope is that probing and characterizing the mechanisms underlying the various types of DAPI will lead to safer use of the DAPI-inducing drugs by minimizing the adverse event of pancreatitis.


Assuntos
Pancreatite , Doença Aguda , Humanos , Pancreatite/induzido quimicamente , Pancreatite/diagnóstico , Fatores de Risco
5.
Front Immunol ; 13: 840620, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35911709

RESUMO

Acute pancreatitis (AP) is pancreatic or systemic inflammation without or with motion organ dysfunction. Severe acute pancreatitis (SAP) is the main cause of death for patients with AP. A pro-/anti-inflammatory imbalance is considered the key regulation of disease severity. However, the real mechanism of SAP remains unclear. This study aimed to identify the frequency and specific roll of myeloid-derived suppressor cell (MDSC) in AP. We evaluated MDSC frequency and disease severity by analyzing MDSCs in the peripheral blood of healthy controls (HCs) and patients with mild acute pancreatitis (MAP) and SAP by flow cytometry. We also compared the frequency and inhibitory ability of MDSCs from HCs and SAP, and finally detected the reason for the difference in inhibitory ability. AP was marked by expansion of MDSCs as well as its subsets, granulocytic MDSCs (G-MDSCs) and monocytic MDSCs (M-MDSCs). The proportion of MDSC in the peripheral blood mononuclear cells of patients with AP was increased and positively correlated with AP severity. The frequency of MDSC was decreased after treatment compared with pre-treatment. CD3+ T cells were remarkably inhibited by MDSC derived from the patients with SAP. In the expression of arginase-1 (Arg-1) and reactive oxygen species (ROS), the MDSCs from patients with SAP increased. These findings demonstrated that MDSCs expanded in the peripheral blood in patients with AP, especially in those with SAP. Moreover, the inhibitory ability of MDSCs was increased in the patients with SAP compared with that in the HCs. The enhanced suppressive function was possibly caused by an overexpression of Arg-1 and ROS.


Assuntos
Células Supressoras Mieloides , Pancreatite , Doença Aguda , Humanos , Leucócitos Mononucleares/metabolismo , Células Supressoras Mieloides/metabolismo , Pancreatite/metabolismo , Espécies Reativas de Oxigênio/metabolismo
6.
Front Immunol ; 13: 869207, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35911777

RESUMO

Acute pancreatitis (AP) is a common cause of a clinically acute abdomen. Crosstalk between acinar cells and leukocytes (especially macrophages) plays an important role in the development of AP. However, the mechanism mediating the interaction between acinar cells and macrophages is still unclear. This study was performed to explore the role of acinar cell extracellular vesicles (EVs) in the crosstalk between acinar cells and macrophages involved in the pathogenesis of AP. EVs derived from caerulein-treated acinar cells induced macrophage infiltration and aggravated pancreatitis in an AP rat model. Further research showed that acinar cell-derived EV miR-183-5p led to M1 macrophage polarization by downregulating forkhead box protein O1 (FoxO1), and a dual-luciferase reporter assay confirmed that FoxO1 was directly inhibited by miR-183-5p. In addition, acinar cell-derived EV miR-183-5p reduced macrophage phagocytosis. Acinar cell-derived EV miR-183-5p promoted the pancreatic infiltration of M1 macrophages and increased local and systemic damage in vivo. Subsequently, miR-183-5p overexpression in macrophages induced acinar cell damage and trypsin activation, thus further exacerbating the disease. In clinical samples, elevated miR-183-5p levels were detected in serum EVs and positively correlated with the severity of AP. EV miR-183-5p might play an important role in the development of AP by facilitating M1 macrophage polarization, providing a new insight into the diagnosis and targeted management of pancreatitis. Graphical abstract of the present study. In our caerulein-induced AP model, miR-183-5p was upregulated in injured acinar cells and transported by EVs to macrophages. miR-183-5p could induce M1 macrophage polarization through downregulation of FoxO1 and the release of inflammatory cytokines, which could aggravate AP-related injuries. Therefore, a vicious cycle might exist between injured ACs and M1 macrophage polarization, which is fulfilled by EV-transported miR-183-5p, leading to sustainable and progressive AP-related injuries.


Assuntos
Vesículas Extracelulares , MicroRNAs , Pancreatite , Células Acinares/metabolismo , Doença Aguda , Animais , Ceruletídeo/toxicidade , Regulação para Baixo , Vesículas Extracelulares/genética , Vesículas Extracelulares/metabolismo , Macrófagos/metabolismo , MicroRNAs/genética , MicroRNAs/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Pancreatite/genética , Pancreatite/metabolismo , Ratos
7.
BMC Complement Med Ther ; 22(1): 208, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927726

RESUMO

AIM: Acute pancreatitis is a common and potentially serious condition. However, a specific treatment for this condition is still lacking. Genistein, with its anti-oxidant and anti-inflammatory effects, could possibly be used to tackle the underlying pathophysiology of acute pancreatitis. Therefore, the aim of this study was to investigate the effects of genistein on oxidative stress, inflammation, and apoptosis in acute pancreatitis induced by L-arginine in mice. METHODS: Twenty-four male ICR mice were equally divided into 4 groups: Control (Con); Acute pancreatitis (AP) group: Two doses of i.p. 350 mg/100 g body weight (BW) of L-arginine were administered 1 h apart; AP and low-dose genistein (LG) group: mice were given i.p. injection of 10 mg/kg genistein 2 h prior to L-arginine injection followed by once-daily dosing for 3 days; and AP and high-dose genistein (HG) group: mice were given 100 mg/kg genistein with the similar protocol as the LG group. Pancreatic tissue was evaluated for histopathological changes and acinar cell apoptosis, malondialdehyde (MDA) levels, immunohistochemical staining for myeloperoxidase (MPO), nuclear factor-kappa beta (NF-kB), and 4-hydroxynonenal (4-HNE). Serum levels of amylase (AMY), c-reactive protein (CRP), and interleukin (IL)-6 were measured. RESULTS: Significant increases in the degree of acinar cell apoptosis, pancreatic MDA, serum IL-6 and amylase, MPO, NF-kB and 4-HNE positivity were observed in the AP group. All these parameters declined after low- and high-dose genistein treatment. Severe pancreatic inflammation, edema, and acinar cell necrosis were observed in the AP group. Significant improvement of histopathological changes was seen in both low- and high-dose genistein groups. There were no significant differences in any parameters between low and high doses of genistein. CONCLUSION: Genistein could attenuate the severity of histopathological changes in acute pancreatitis through its anti-oxidant, anti-inflammatory, and anti-apoptotic properties.


Assuntos
Pancreatite , Doença Aguda , Amilases/metabolismo , Amilases/farmacologia , Animais , Anti-Inflamatórios/farmacologia , Antioxidantes/metabolismo , Apoptose , Arginina/metabolismo , Arginina/farmacologia , Arginina/uso terapêutico , Genisteína/farmacologia , Inflamação/tratamento farmacológico , Interleucina-6/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos ICR , NF-kappa B/metabolismo , Estresse Oxidativo , Pancreatite/induzido quimicamente , Pancreatite/tratamento farmacológico , Pancreatite/patologia
8.
Oxid Med Cell Longev ; 2022: 4499219, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35927992

RESUMO

Acute pancreatitis (AP) is an inflammatory disease that is associated with trypsinogen activation, mitochondrial dysfunction, cell death, and inflammation. Dopamine D2 receptor (DRD2) plays an essential role in alleviating AP, while it is unclear whether it is involved in regulating acinar cell necroptosis. Here, we found that DRD2 agonist quinpirole alleviated acinar cell necroptosis via inhibiting cathepsin B (CTSB). Moreover, CTSB inhibition by CA-074Me ameliorated AP severity by reducing necroptosis. Notably, knockdown of TFAM reversed the therapeutic effect of either quinpirole or CA-074Me. We identified a new mechanism that DRD2 signaling inhibited CTSB and promoted the expression of mitochondrial transcription factor A(TFAM), leading to reduction of ROS production in AP, which attenuated acinar cell necroptosis ultimately. Collectively, our findings provide new evidence that DRD2 agonist could be a new potential therapeutic strategy for AP treatment.


Assuntos
Pancreatite , Células Acinares/metabolismo , Doença Aguda , Animais , Catepsina B/metabolismo , Proteínas de Ligação a DNA , Proteínas de Grupo de Alta Mobilidade , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Mitocondriais , Necroptose , Pancreatite/tratamento farmacológico , Pancreatite/metabolismo , Quimpirol , Espécies Reativas de Oxigênio , Receptores de Dopamina D2/metabolismo , Fatores de Transcrição
9.
Biomed Res Int ; 2022: 4942697, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35789642

RESUMO

Background: Hyperamylasemia (HA) is an inconspicuous manifestation of hemorrhagic fever with renal syndrome (HFRS) in Baoji city, West China. Hantaan virus (HTNV) is the only pathogen-caused HFRS in this region, but the knowledge about HA in the local HFRS patients has been limited. The aim of this study was to investigate the characteristics of HA and its predictive risk factors for doctors to engage in timely monitoring and dealing with the possible serious changes prewarned by HA in the early stages of the disease to improve the final outcome. Methods: All HFRS patients with and without HA (HA and nHA groups, respectively) were treated in Baoji People's Hospital. The clinical characteristics between the two groups were compared by Student's t-test or Chi-square test. The risk factors for prognosis were measured by the logistic regression analysis. The predictive effects of prognosis in clinical and laboratory parameters were analyzed by the receiver operating characteristic curves. Results: 46.53% of the patients demonstrated HA, among which 71.7% were severe and critical types of HFRS, greater than that in the nHA group (19.57%, P < 0.001). The hospitalization day and the general incidence of acute pancreatitis (AP) were longer or greater in the HA group than in the nHA group (P < 0.01). Age and the time from the onset of the first symptom to the patient being admitted to hospital (T OA) were the predictive risk factors for HA. The best cut-off values were the age of 54 years and T OA of 5.5 days. Conclusion: HTNV-induced HA is a common clinical presentation of HFRS patients in West China. It can increase the severity, the hospitalization days of patients, and the incidence of AP in HFRS. Age and T OA constituted independent risk factors for HA caused by HTNV.


Assuntos
Vírus Hantaan , Febre Hemorrágica com Síndrome Renal , Hiperamilassemia , Pancreatite , Doença Aguda , China/epidemiologia , Febre Hemorrágica com Síndrome Renal/complicações , Febre Hemorrágica com Síndrome Renal/diagnóstico , Febre Hemorrágica com Síndrome Renal/epidemiologia , Humanos , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Estudos Retrospectivos
10.
Oxid Med Cell Longev ; 2022: 3771610, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35795856

RESUMO

Background: Acute pancreatitis (AP) is a common surgical acute abdomen. Different kinds of pancreatitis may have different pathophysiological characteristics each other. The objective of this research was to investigate the early clinical features and complications of different types of acute pancreatitis. Methods: 787 AP patients admitted in the Huadu District People's Hospital of Guangzhou during January 2009 and December 2019 were analyzed retrospectively. Among 787 AP patients, 520 (66.1%) were biliary AP (group I), 69 (8.7%) were alcoholic AP (group II), and 198 (25.2%) were hypertriglyceridemic AP (group III). According to the local and systemic complications and mortality in the early stage, we compared and analyzed the clinical characteristics and prognosis of different types of pancreatitis. Results: Mild acute pancreatitis accounted for the highest proportion (79.4%) in group I, while moderately severe acute pancreatitis in group II (36.2%) and severe acute pancreatitis in group III (62.6%). In terms of severity score of the pancreatitis, the average scores of BISAP, Ranson, APACHE-II, and MCTSI of the patients in group III were the highest (p < 0.01). The incidence of acute peripancreatic fluid collection and infectious pancreatic necrosis was the highest in group III. The incidences of acute necrotic collection, pancreatic pseudocyst, and walled-off necrosis in group III were significantly higher than those in the other two groups (p < 0.01). The incidences of systemic inflammatory response syndrome, sepsis, multiple organ failure, intra-abdominal hypertension, and mortality were highest in group III. Conclusions: There is an upward trend of the incidence rate of hypertriglyceridemic AP in recent years; it has been gradually developed into the second type of acute pancreatitis which is second only to the acute biliary pancreatitis. It is worthy to pay more and more attentions to it due to the feature of its younger onset, high incidence of complications, and high mortality.


Assuntos
Pancreatite , APACHE , Doença Aguda , Humanos , Pancreatite/complicações , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
BMC Gastroenterol ; 22(1): 327, 2022 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-35780108

RESUMO

BACKGROUND: The importance of enteral nutrition (EN) in acute pancreatitis (AP) has been emphasised. Nasogastric (NG) feeding has been the preferred route for EN delivery in most AP patients intolerant to oral intake. However, gastric feeding intolerance (GFI) was frequently reported, especially in patients with more severe diseases. This study aimed to investigate the incidence and risk factors for GFI in moderately-severe to severe AP. METHODS: This is a single-centre, retrospective study. All the data were extracted from an electronic database from April 2020 to May 2021. Data were prospectively collected during hospitalisation. Patients diagnosed with moderately-severe to severe AP and admitted within seven days from the onset of abdominal pain were assessed for eligibility. Patients who showed signs of intolerance to gastric feeding and required switching to nasojejunal (NJ) feeding were deemed GFI. Multivariable logistic regression was performed to assess potential risk factors of GFI. RESULTS: A total of 93 patients were analysed, of whom 24 were deemed GFI (25.8%), and the rest tolerated NG feeding well (n = 69). In patients with GFI, the median time of switching to NJ feeding was five days (interquartile range: 4-7 days) after admission. The multivariable analysis showed that respiratory failure (odds ratio = 3.135, 95% CI: 1.111-8.848, P = 0.031) was an independent risk factor for GFI.The mean daily energy delivery in the following three days after switching to NJ feeding was significantly higher than the first three days after initiation of NG feeding in patients with GFI [920.83 (493.33-1326) vs. 465 (252.25-556.67) kcal, P < 0.001]. CONCLUSION: GFI is common in moderately-severe to severe AP patients with an incidence of 25.8%, and the presence of respiratory failure may increase the risk of GFI.


Assuntos
Pancreatite , Insuficiência Respiratória , Doença Aguda , Humanos , Incidência , Recém-Nascido , Pancreatite/diagnóstico , Pancreatite/epidemiologia , Pancreatite/etiologia , Estudos Retrospectivos , Fatores de Risco
12.
Nutrients ; 14(13)2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35807771

RESUMO

Acute pancreatitis (AP) is one of the most common causes of hospitalization for gastrointestinal diseases, with high morbidity and mortality. Endoplasmic reticulum stress (ERS) and Gasdermin D (GSDMD) mediate AP, but little is known about their mutual influence on AP. Diosgenin has excellent anti-inflammatory and antioxidant effects. This study investigated whether Diosgenin derivative D (Drug D) inhibits L-arginine-induced acute pancreatitis through meditating GSDMD in the endoplasmic reticulum (ER). Our studies were conducted in a mouse model of L-arginine-induced AP as well as in an in vitro model on mouse pancreatic acinar cells. The GSDMD accumulation in ER was found in this study, which caused ERS of acinar cells. GSDMD inhibitor Disulfiram (DSF) notably decreased the expression of GSDMD in ER and TXNIP/HIF-1α signaling. The molecular docking study indicated that there was a potential interaction between Drug D and GSDMD. Our results showed that Drug D significantly inhibited necrosis of acinar cells dose-dependently, and we also found that Drug D alleviated pancreatic necrosis and systemic inflammation by inhibiting the GSDMD accumulation in the ER of acinar cells via the TXNIP/HIF-1α pathway. Furthermore, the level of p-IRE1α (a marker of ERS) was also down-regulated by Drug D in a dose-dependent manner in AP. We also found that Drug D alleviated TXNIP up-regulation and oxidative stress in AP. Moreover, our results revealed that GSDMD-/- mitigated AP by inhibiting TXNIP/HIF-1α. Therefore, Drug D, which is extracted from Dioscorea zingiberensis, may inhibit L-arginine-induced AP by meditating GSDMD in the ER by the TXNIP /HIF-1α pathway.


Assuntos
Diosgenina , Pancreatite , Doença Aguda , Animais , Apoptose , Arginina/farmacologia , Proteínas de Transporte , Diosgenina/efeitos adversos , Retículo Endoplasmático/metabolismo , Estresse do Retículo Endoplasmático , Endorribonucleases/metabolismo , Camundongos , Simulação de Acoplamento Molecular , Pancreatite/induzido quimicamente , Pancreatite/tratamento farmacológico , Pancreatite/metabolismo , Proteínas Serina-Treonina Quinases , Tiorredoxinas/metabolismo
13.
BMC Complement Med Ther ; 22(1): 189, 2022 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-35842665

RESUMO

BACKGROUND: hyperlipidemia acute pancreatitis (HTG-AP) is a major hidden danger affecting human health, however, whether there is a protective effect of resveratrol on HTG-AP is unclear. Therefore our study was aimed to investigate the preventive effect and the underlying mechanism of resveratrol in the HTG-AP mice model. METHODS: This research was divided into two parts. In the first part, mice were adaptively fed with normal chow or HFD for 6 weeks. From the second week, resveratrol-treated mice were in intragastric administration with resveratrol (45 mg/kg/d) for 4 weeks. In the second part, the procedures were the same as the first part. After the last intragastric administration with resveratrol, all mice were intraperitoneal injections of cerulean. RESULTS: We found resveratrol effectively inhibited pancreatic pathological injury in the HFD, AP, and HTG-AP mice. Resveratrol reduced the LPS, IL-6, TNF-α, and MCP-1 expressions in the HFD mice. Resveratrol also reduced TNF-α, MDA, and MCP-1 expressions and increased SOD and T-AOC expressions in the AP and HTG-AP mice. Furthermore, resveratrol suppressed the NF-κB pro-inflammatory signaling pathway in pancreatic tissues in the AP and HTG-AP mice. Moreover, resveratrol improved the gut microbiota in the HFD mice. CONCLUSION: The resveratrol pre-treatment could attenuate pancreas injury, inflammation, and oxidative stress in the HTG-AP mice, via restraining the NF-κB signaling pathway and regulating gut microbiota. Therefore, Our study proved that the resveratrol pre-treatment had a preventive effect on HTG-AP.


Assuntos
Microbioma Gastrointestinal , Pancreatite , Doença Aguda , Animais , Ceruletídeo/efeitos adversos , Dieta Hiperlipídica/efeitos adversos , Humanos , Camundongos , NF-kappa B/metabolismo , Pancreatite/induzido quimicamente , Pancreatite/tratamento farmacológico , Pancreatite/metabolismo , Resveratrol/efeitos adversos , Transdução de Sinais , Fator de Necrose Tumoral alfa/metabolismo
14.
BMJ Case Rep ; 15(7)2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35787501

RESUMO

We report a case of a 4-year-old girl with limited financial resources, a background history marked by chronic abdominal discomfort and a positive Helicobacter pylori stool antigen test. The child presented with pallor, striking epigastric pain, nausea and vomiting. Blood tests reported high serum lipase levels. Investigations showed proof of nodular gastritis, intussusception and mild acute pancreatitis. The surgical procedure revealed Rapunzel syndrome complicated with intussusception and intestinal perforation, successfully treated. The postoperative course went uncomplicated.


Assuntos
Bezoares , Perfuração Intestinal , Intussuscepção , Pancreatite , Doença Aguda , Bezoares/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Intussuscepção/complicações , Intussuscepção/diagnóstico , Pancreatite/complicações , Síndrome
15.
Contrast Media Mol Imaging ; 2022: 4829467, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35854780

RESUMO

Objective: The paper aimed to analyze the clinical, serological, and imaging features of autoimmune pancreatitis (AIP) and the prognostic factors affecting hormone therapy. Methods: A total of 106 patients with AIP enrolled in our hospital from March 2016 to August 2018 were treated with the hormone. The curative effect and recurrence were followed up. The patients were divided into relapse group (n = 42) and nonrelapse group (n = 64) according to the recurrence within 3 years after initial hormone therapy. The symptoms and signs, laboratory examination, and treatment were compared, and binary logistic regression was employed to explore the risk factors of AIP recurrence. Results: Among the 106 patients included in this study, there were 78 males and 28 females, with a male-to-female ratio of 3:1. The average age of onset was 56.25 ± 8.87 years; the minimum age was 39 years; and the maximum age was 7 years. The main clinical symptoms were jaundice (67.92%), abdominal pain (48.11%), and abdominal distension (33.96%). In addition, there were symptoms of weight loss, nausea, vomiting, itching, and gray stool. Previous complications included 27.35% diabetes (29/106), 22.64% hypertension (24/106), 35.84% smoking (38/106), and 28.30% alcohol consumption (30/106). The serological characteristics were mainly the increase in serum IgG4 level; 92.45% (98/106) level was higher compared to the upper limit of normal value; the median level was 11.65 g/L; and the highest level was 35.79 g/L. A total of 88.67% (94/106) had an abnormal liver function. The results of imaging examination indicated that 58.49% (62/106) of extrapancreatic organs were involved, of which 46.22% (49/106) were the most common bile duct involvement. All the patients in the group reached a state of remission after hormone treatment. After the disease was relieved, the patients were followed up for 3 years. The recurrence rate was 39.62% (42/106), and the median time of recurrence (month) was 9 (range 2-36). The recurrence rates within 1, 2, and 3 years were 20.75%, 31.13%, and 39.62%, respectively. Among the recurrent patients, 52.38% (22/42) relapsed within 1 year, 78.57% (33/42) within 2 years, and 100.00% (42/42) within 3 years. Multivariate analysis showed that the short duration of glucocorticoid therapy and involvement of extrapancreatic organs were risk factors for relapse after glucocorticoid therapy in patients with type I AIP. Conclusion: Type 1 AIP is more common in middle-aged and elderly men. The clinical symptoms of jaundice, abdominal pain, and abdominal distension are common, often accompanied by involvement of extrapancreatic organs, of which bile duct involvement is the most common. Type 1 AIP glucocorticoid treatment acceptance and disease remission are better, but the recurrence rate is higher after glucocorticoid treatment. Patients with a short time of glucocorticoid treatment and involvement of extrapancreatic organs may have a higher risk of recurrence.


Assuntos
Doenças Autoimunes , Pancreatite Autoimune , Pancreatite , Dor Abdominal/complicações , Adulto , Idoso , Doenças Autoimunes/diagnóstico por imagem , Doenças Autoimunes/tratamento farmacológico , Pancreatite Autoimune/diagnóstico por imagem , Pancreatite Autoimune/tratamento farmacológico , Estudos de Casos e Controles , Criança , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/diagnóstico por imagem , Pancreatite/tratamento farmacológico , Prognóstico , Recidiva
16.
J Invest Surg ; 35(8): 1613-1620, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35855674

RESUMO

OBJECTIVES: The inflammatory response is critically important in acute pancreatitis (AP). Systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI), which are novel inflammatory markers, have been linked to determining outcomes in various diseases. The goal of the current study was to examine the relation of the SII index and SIRI with disease severity and acute kidney injury (AKI) in subjects with AP. METHODS: A total of 332 subjects with AP were analyzed retrospectively. SII index was calculated using the formula; platelet (P)×neutrophil (N)/lymphocyte (L), while SIRI was calculated as N × monocyte (M)/L count. Multivariate regression (MR) was done to determine the independent risk factors for AKI and severe AP (SAP). RESULTS: Statistical analyses showed that both median SII index and median SIRI increased gradually with higher AP severity (p < 0.001). Both SII index and SIRI were higher in subjects with AKI compared to controls (p < 0.001). Using MR analysis, the SII index was found to independently predict both SAP (OR = 1.004, 95% CI: 1.001-1.008, p = 0.018) and AKI (OR = 1.005, 95% CI: 1.003-1.008, p < 0.001). ROC analysis showed that the SII index could accurately differentiate SAP (AUC = 0.809, p < 0.001) and AKI (AUC = 0.820, p = 0.001) in patients with acute pancreatitis. ROC analysis also showed that SIRI could also accurately differentiate SAP (0.782, p < 0.001) and AKI (AUC = 0.776, p = 0.001). CONCLUSIONS: SIRI and the SII indexes can be used as potential biomarkers in predicting both disease severity and AKI development in subjects with AP.


Assuntos
Injúria Renal Aguda , Pancreatite , Doença Aguda , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Biomarcadores , Humanos , Inflamação/diagnóstico , Pancreatite/complicações , Pancreatite/diagnóstico , Estudos Retrospectivos
17.
Med Sci Monit ; 28: e937016, 2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35794808

RESUMO

BACKGROUND We analyzed the outcomes of early biliary decompression by a minimally invasive approach in acute biliary pancreatitis (ABP). MATERIAL AND METHODS A retrospective study was conducted on 143 patients with ABP who underwent biliary decompression by laparoscopic or endoscopic approach between January 2015 and March 2022. Data from the observation sheets and surgical protocols were analyzed in terms of demographic characteristics, clinical and paraclinical features at admission, comorbidities, therapeutic management, and outcomes. RESULTS The mean patient age was 62.3±11.4 years. Mild ABP had a higher frequency in men (75.5%) and urban areas (70.4%). The comorbidities associated with a higher risk of severe forms were diabetes mellitus (odds ratio [OR]: 11.250), chronic bronchopneumopathy (OR: 29.297), and ischemic coronary disease (OR: 2.784). The mean hospital stay was 7.6±3.8 days and was significantly higher in severe forms (10±2.4 days, P<0.001). The time from onset to presentation was significantly higher in severe vs mild forms (5.6 vs 1.8 days, P<0.001) and was associated with systemic and local complications. Creatinine over 2 mg/dL (OR: 4.821) and leukocytes >15 000/mmc at admission (OR: 3.533) were risk factors for systemic complications, while obesity was associated with increased local complications (OR: 5.179). None of the patients with an early presentation developed severe ABP. CONCLUSIONS Early biliary decompression, as soon as possible after onset, either by an endoscopic or minimally invasive approach, is a safe and effective procedure in ABP. The type of procedure and optimal timing should be individualized, according to the patient's local and general features.


Assuntos
Laparoscopia , Pancreatite , Idoso , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Pancreatite/cirurgia , Estudos Retrospectivos , Fatores de Risco
18.
Front Cell Infect Microbiol ; 12: 838340, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35811665

RESUMO

Impaired intestinal barrier function and gut microbiota dysbiosis are believed to be related to exacerbation of acute pancreatitis (AP). As a bacterial cell wall peptidoglycan component, diaminopimelic acid (DAP) is a specific ligand of NOD1 that regulates the NOD1/RIP2/NF-kB signaling pathway. Here, we investigated the role of DAP in the crosstalk between the gut microbiota and pancreas during the occurrence of AP. Upregulation of NOD1/RIP2/NF-kB and elevated serum DAP levels were found in severe AP (SAP) model rats. The accumulation of DAP in SAP patients corroborated its ability to serve as an indicator of disease severity. Subsequently, SAP rats were treated with oral administration of the traditional Chinese medicine Qingyi Keli (QYKL) as well as neomycin, which can widely eliminate DAP-containing bacteria. Both QYKL and neomycin intervention ameliorated intestinal and pancreatic damage and systemic inflammation in SAP rats. Through 16S rDNA sequencing, we found that QYKL could rehabilitate the gut microbiota structure and selectively inhibit the overgrowth of enteric bacteria, such as Helicobacter and Lactobacillus, in SAP rats without affecting some protective strains, including Romboutsia and Allobaculum. Interestingly, we demonstrated that the decrease in serum DAP was accompanied by suppression of the NOD1/RIP2/NF-kB signaling pathway in both the intestine and pancreas of the two intervention groups. Taken together, these results suggested that the gut microbiota-DAP-NOD1/RIP2 signaling pathway might play a critical role in the progression of AP and that SAP could be alleviated via intervention in the signaling pathway. Our work provides new potential early warning indicators of SAP and targets for intervention.


Assuntos
Microbioma Gastrointestinal , Pancreatite , Doença Aguda , Animais , Ácido Diaminopimélico/química , Ácido Diaminopimélico/metabolismo , Ácido Diaminopimélico/farmacologia , Microbioma Gastrointestinal/fisiologia , NF-kappa B/metabolismo , Neomicina , Proteína Adaptadora de Sinalização NOD1/genética , Proteína Adaptadora de Sinalização NOD1/metabolismo , Ratos , Transdução de Sinais
19.
Medicine (Baltimore) ; 101(26): e29822, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35777067

RESUMO

BACKGROUND: Cannabis use has been steadily rising in the United States and can have multiple adverse effects, including cannabis-induced acute pancreatitis. This study aims to collate and highlight the significant demographics, clinical presentation, and outcomes in patients with cannabis-induced acute pancreatitis. METHOD: A systematic literature search of electronic databases for peer-reviewed articles was conducted. After an initial search, we found 792 articles through different electronic databases. After manually removing duplicates and articles that did not meet the criteria, 25 articles were included in our review. RESULTS: A total of 45 patients were studied, 35 (78%) cases were male and 10 (22%) cases were female, showing male predominance. The mean age of all participants was 29.2 ± 10.3 years. The most common presenting symptoms were abdominal pain 21 of 21 (100%), nausea 17 of 21 (81%), and vomiting 12 of 20 (60%). Ultrasound was normal in the majority of patients, with findings of mild pancreatitis. Computerized tomography scans revealed pancreatic edema and inflammation in 7 of 20 (35%) patients, and findings of necrotizing pancreatitis and complex fluid collection were visualized in 3 of 20 (15%) patients. Dilatation of intrahepatic or extrahepatic biliary ducts was not seen in any patients. The overall prognosis was good, with reported full recovery. CONCLUSIONS: Cannabis should be included in the differential diagnosis for the etiology of acute pancreatitis, which would help in early intervention and treatment for the mitigation of the rapidly progressive disease.


Assuntos
Cannabis , Alucinógenos , Pancreatite , Doença Aguda , Adolescente , Adulto , Analgésicos/efeitos adversos , Agonistas de Receptores de Canabinoides , Cannabis/efeitos adversos , Feminino , Alucinógenos/efeitos adversos , Humanos , Masculino , Pancreatite/induzido quimicamente , Adulto Jovem
20.
Nan Fang Yi Ke Da Xue Xue Bao ; 42(7): 1006-1012, 2022 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-35869762

RESUMO

OBJECTIVE: To explore the correlation of coagulation function with the severity and prognosis of acute pancreatitis (AP) and identify the laboratory markers for early prediction and dynamic monitoring of the prognosis of AP. METHODS: We retrospectively analyzed the clinical data of patients with AP admitted less than 72 h after onset to our hospital from December 1, 2017 to November 30, 2018. The correlation of coagulation function-related markers at admission and their changes during hospitalization with the prognosis of the patients was analyzed. RESULTS: We screened the data of a total of 1260 patients with AP against the inclusion and exclusion criteria, and eventually 175 patients were enrolled in this analysis, among whom 52 patients had severe AP (SAP) and 12 patients died. Logistic regression analysis identified vWF: Ag, PT, PC, AT Ⅲ and D-dimer markers at admission as independent risk factors for predicting SAP and death. Dynamic monitoring of the changes in coagulation function-related markers in the disease course had greater predictive value of the patients' prognosis, and the indicators including vWF: Agmax, PTmax, APTTmax, TTmax, FIBmin, D-dimermax, PLTmin, PCmin, PLGmin, AT Ⅲmin, and their variations were all independent risk factors for predicting SAP and death. ROC analysis suggested that dynamic monitoring of the changes in the indicators, especially those of △vWF: Ag, △PT, △APTT, △FIB, △TT, △D-dimer, △PLT, △PC, △AT Ⅲ, △PLG, could effectively predict SAP and death in these patients (with AUC range of 0.63-0.84). CONCLUSION: Patients with AP have vascular endothelial injuries and coagulation disorders. The markers including vWF: Ag, PT, PC, AT Ⅲ and D-dimer at admission are independent risk factors for predicting SAP and death, and dynamic monitoring of the changes in vWF: Ag、PT、APTT、TT、FIB、D-dimer、PLT、PC、AT Ⅲ and PLG can further increase the predictive value.


Assuntos
Pancreatite , Doença Aguda , Biomarcadores , Humanos , Pancreatite/complicações , Pancreatite/diagnóstico , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Fator de von Willebrand
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