Assessing Quality of Precut Sphincterotomy in Patients With Difficult Biliary Access: An Updated Meta-analysis of Randomized Controlled Trials.

BACKGROUND: It is generally accepted that precut sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of pancreatitis. However, patients with difficult biliary access may be different. We implemented a meta-analysis to explore the effects of early and delayed precut sphincterotomy on post-ERCP pancreatitis in patients with difficult biliary access. METHODS: We searched studies in PubMed, EMBASE, and the Cochrane Central Register of Randomized Controlled Trials for meeting requirement in which precut sphincterotomy was compared with persistent standard cannulation during ERCP. The primary outcomes included the overall cannulation success rate and the incidence of post-ERCP pancreatitis. The secondary outcomes included primary cannulation success and the overall complication rate. RESULTS: Six studies (898 patients) were included. The present meta-analysis found no significant difference in overall cannulation success rate and overall complication rate between early precut sphincterotomy and persistent standard cannulation. However, early precut sphincterotomy not only increased the primary cannulation success rate [Mantel Haenszel test relative risk, 1.87; 95% confidence interval (CI), 1.15-3.04] but also decreased the overall risk of pancreatitis (Peto odds ratio, 0.49; 95% CI, 0.30-0.80). For persistent standard cannulation, no significant difference was observed in the pancreatitis rate between no salvage precut and delayed salvage precut sphincterotomy (Peto odds ratio, 0.96; 95% CI, 0.49-1.85). CONCLUSIONS: Compared with persistent standard cannulation, an early precut sphincterotomy exhibited a reduced risk of pancreatitis. In addition, a delayed precut sphincterotomy after persistent attempts did not increase the occurrence of pancreatitis and this is the first meta-analysis to present this conclusion.

Comparative transcriptomic analysis reveals the molecular changes of acute pancreatitis in experimental models.

BACKGROUND: Acute pancreatitis (AP) encompasses a spectrum of pancreatic inflammatory conditions, ranging from mild inflammation to severe pancreatic necrosis and multisystem organ failure. Given the challenges associated with obtaining human pancreatic samples, research on AP predominantly relies on animal models. In this study, we aimed to elucidate the fundamental molecular mechanisms underlying AP using various AP models. AIM: To investigate the shared molecular changes underlying the development of AP across varying severity levels. METHODS: AP was induced in animal models through treatment with caerulein alone or in combination with lipopolysaccharide (LPS). Additionally, using Ptf1α to drive the specific expression of the hM3 promoter in pancreatic acinar cells transgenic C57BL/6J- hM3/Ptf1α(cre) mice were administered Clozapine N-oxide to induce AP. Subsequently, we conducted RNA sequencing of pancreatic tissues and validated the expression of significantly different genes using the Gene Expression Omnibus (GEO) database. RESULTS: Caerulein-induced AP showed severe inflammation and edema, which were exacerbated when combined with LPS and accompanied by partial pancreatic tissue necrosis. Compared with the control group, RNA sequencing analysis revealed 880 significantly differentially expressed genes in the caerulein model and 885 in the caerulein combined with the LPS model. Kyoto Encyclopedia of Genes and Genomes enrichment analysis and Gene Set Enrichment Analysis indicated substantial enrichment of the TLR and NOD-like receptor signaling pathway, TLR signaling pathway, and NF-κB signaling pathway, alongside elevated levels of apoptosis-related pathways, such as apoptosis, P53 pathway, and phagosome pathway. The significantly elevated genes in the TLR and NOD-like receptor signaling pathways, as well as in the apoptosis pathway, were validated through quantitative real-time PCR experiments in animal models. Validation from the GEO database revealed that only MYD88 concurred in both mouse pancreatic tissue and human AP peripheral blood, while TLR1, TLR7, RIPK3, and OAS2 genes exhibited marked elevation in human AP. The genes TUBA1A and GADD45A played significant roles in apoptosis within human AP. The transgenic mouse model hM3/Ptf1α(cre) successfully validated significant differential genes in the TLR and NOD-like receptor signaling pathways as well as the apoptosis pathway, indicating that these pathways represent shared pathological processes in AP across different models. CONCLUSION: The TLR and NOD receptor signaling pathways play crucial roles in the inflammatory progression of AP, notably the MYD88 gene. Apoptosis holds a central position in the necrotic processes of AP, with TUBA1A and GADD45A genes exhibiting prominence in human AP.

DNA-damaging drug-induced apoptosis sensitized by N-myc in neuroblastoma cells.

Neuroblastoma is one of the most common solid tumours in children (8-10% of all malignancies). Over 22% of cases have N-myc amplification associated with aggressively growing neuroblastomas. Oncogene-induced sensitization of cells to apoptosis is an important mechanism for suppression of tumorigenesis. Tumour suppressors often play a critical role in linking oncogenes to apoptotic machinery. For example, activated p53 then targets both intrinsic and extrinsic pathways to promote apoptosis through transcription-dependent and -independent mechanisms. Understanding of the involved mechanisms has important clinical implications. We have employed DNA-damaging drug-induced apoptosis sensitized by oncogene N-myc as a model. DNA damaging drugs trigger high levels of p53, leading to caspase-9 activation in neuroblastoma cells. Inactivation of p53 protects cells from drug-triggered apoptosis sensitized by N-myc. These findings thus define a molecular pathway for mediating DNA-damaging drug-induced apoptosis sensitized by oncogene, and suggest that inactivation of p53 or other components of this apoptotic pathway may confer drug resistance in neuroblastoma cells. The data also suggests that inactivation of apoptotic pathways through co-operating oncogenes may be necessary for the pathogenesis of neuroblastoma with N-myc amplification.

Multiple roles for cholinergic signaling in pancreatic diseases.

Cholinergic nerves are widely distributed throughout the human body and participate in various physiological activities, including sensory, motor, and visceral activities, through cholinergic signaling. Cholinergic signaling plays an important role in pancreatic exocrine secretion. A large number of studies have found that cholinergic signaling overstimulates pancreatic acinar cells through muscarinic receptors, participates in the onset of pancreatic diseases such as acute pancreatitis and chronic pancreatitis, and can also inhibit the progression of pancreatic cancer. However, cholinergic signaling plays a role in reducing pain and inflammation through nicotinic receptors, but enhances the proliferation and invasion of pancreatic tumor cells. This review focuses on the progression of cholinergic signaling and pancreatic diseases in recent years and reveals the role of cholinergic signaling in pancreatic diseases.

Pancreatic necrosis and severity are independent risk factors for pancreatic endocrine insufficiency after acute pancreatitis: A long-term follow-up study.

BACKGROUND: Pancreatic endocrine insufficiency after acute pancreatitis (AP) has drawn increasing attention in recent years. AIM: To assess the impact of risk factors on the development of pancreatic endocrine insufficiency after AP. METHODS: This retrospective observational long-term follow-up study was conducted in a tertiary hospital. Endocrine function was evaluated by the oral glucose tolerance test. The data, including age, sex, body mass index, APACHE II score, history of smoking and drinking, organ failure, pancreatic necrosis, debridement of necrosis (minimally invasive and/or open surgery), and time interval, were collected from the record database. RESULTS: A total of 361 patients were included in the study from January 1, 2012 to December 30, 2018. A total of 150 (41.6%) patients were diagnosed with dysglycemia (including diabetes mellitus and impaired glucose tolerance), while 211 (58.4%) patients had normal endocrine function. The time intervals (mo) of the above two groups were 18.73 ± 19.10 mo and 31.53 ± 27.27 mo, respectively (P = 0.001). The morbidity rates of pancreatic endocrine insufficiency were 46.7%, 28.0%, and 25.3%, respectively, in the groups with different follow-up times. The risk factors for pancreatic endocrine insufficiency after AP were severity (odds ratio [OR] = 3.489; 95% confidence interval [CI]: 1.501-8.111; P = 0.004) and pancreatic necrosis (OR = 4.152; 95%CI: 2.580-6.684; P = 0.001). CONCLUSION: Pancreatic necrosis and severity are independent risk factors for pancreatic endocrine insufficiency after AP. The area of pancreatic necrosis can affect pancreatic endocrine function.

RACK1 Acts as a Potential Tumor Promoter in Colorectal Cancer.

BACKGROUND: The receptor of activated protein kinase C 1 (RACK1) promotes the progression and invasion of several cancers. However, the role of RACK1 in the pathogenesis of colorectal cancer (CRC) has not been clearly defined. Herein, we aimed to investigate the biological role of RACK1 in CRC. MATERIALS AND METHODS: The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) dataset were searched, and the expression of RACK1 in CRC tissues and adjacent normal tissues was evaluated. Immunohistochemical staining was performed to detect the expression of RACK1 in human CRC, adenoma, and normal tissues. Western blotting was used to detect the expression of RACK1 in human CRC cell lines. Functional assays, such as BrdU, colony formation, and wound healing and transwell invasion assays, were used to explore the biological role of RACK1 in CRC. RESULTS: RACK1 was upregulated in CRC tissues compared with its expression in adjacent normal tissues in TCGA and the GEO dataset (P < 0.05). Moreover, RACK1 was significantly overexpressed in CRC and adenoma tissues compared with its expression in normal tissues (P < 0.05). Loss-of-function experiments showed that RACK1 promoted cell proliferation, migration, and invasion in vitro. CONCLUSIONS: Our data indicated that RACK1, as an oncogene, markedly promoted the progression of CRC, which suggested that RACK1 is a potential therapeutic target for CRC management.

Characteristics of Helicobacter pylori antibiotic resistance: data from four different populations.

Aims: To describe the characteristics of Helicobacter pylori (H. pylori) antibiotic resistance in clinical isolates from four populations. Methods: In total, 1463 H. pylori strains were examined for antibiotic resistance. Among these strains, 804 were isolated from treatment-naïve adults, 133 from previously treated adults, 100 from treatment-naïve children and 426 from a population who participated in a health survey (age ≥ 40 years). The minimum inhibitory concentration was determined by the E-test method. Results: In the treatment-naïve adult group, the resistance rates for metronidazole, clarithromycin, levofloxacin, amoxicillin, rifampicin and tetracycline were 78.4, 19.0, 23.3, 1.2, 1.7 and 2.3%, respectively. Compared with this group, the previously treated adult group had significantly higher resistance rates for metronidazole (99.2%), clarithromycin (58.3%) and levofloxacin (52.3%). In addition, the treatment-naïve children had a lower metronidazole resistance rate (46.0%) than the treatment-naïve adults. The resistance rate for clarithromycin was low in treatment-naïve patients with ages ranging from 10 to 24 years. For the strains isolated from the general population group, the resistance rates for metronidazole, clarithromycin, levofloxacin, amoxicillin, rifampicin and tetracycline were 78.6, 10.1, 25.1, 0.5, 2.1 and 0.9%, respectively. Compared with the treatment-naïve adult group, the general population group showed significant differences in clarithromycin resistance. Conclusion: The resistance rates for metronidazole, clarithromycin and levofloxacin were high, especially in previously treated adults. Compared to those in treatment-naïve younger patients, the resistance rates for clarithromycin were significantly lower in treatment-naïve patients with ages ranging from 10 to 24 years and in the general population.

[Novel gene sequence variants of pbp2b in penicillin-nonsusceptible Streptococcus pneumonia isolates].

OBJECTIVE: To investigate the alternations in gene/amino acid sequence of penicillin-binding protein (PBP)2b from clinical isolates of penicillin-nonsusceptible Streptococcus pneumonia (PNSP) in this region. METHODS: 24 strains of Streptococcus pneumonia were collected from January to December 2006. The antibiotics susceptibility of these strains was detected. PCR amplification and direct sequencing of pbp2b genes were performed. The sequence variations of PBP genes of the PNSP in this region were studied with sequence BLAST analysis. RESULTS: Three prominent substitutions were common to 13 PNSP isolates with minimal inhibitory concentration (MIC) at least 0.1 mg/L. These included the replacement of Thr(445)--> Ala following the conservative motif SSN, Glu(475)-->Gly and Thr(488)-->Ala/Ser. The exchange of Glu(332)-->Gly was identified in 12 PNSP isolates of which the MIC was at least 0. 25 mg/L. Seven penicillin resistant Streptococcus pneumonia (PRSP) isolates (MIC > or = 3 mg/L) shared the amino acid substitution Ala(618)-->Gly adjacent to third conserved (KTG) motif and the PBP2b sequences of seven PRSP isolates were classified within Baek's group II and were very similar to those of the Korean J77 isolate. Novel gene and amino acid sequence variants in isolate 14, 15, 8, 11 and 24 was identified in this study and these gene sequences have been deposited in the GenBank database and assigned accession no. EU035970, EU056919, EU056920, EU056921 and EU106886. CONCLUSION: Analysis of pbp2b genes revealed highly similar patterns of nucleotide and amino acid sequence variation among most resistant isolates, while penicillin intermediate Streptococcus pneumonia might be associated with novel gene sequence variants.

[Replacement of third-generation cephalosporins by piperacillin-tazobactam decreases colonization of extended-spectrum beta-lactamases-producing intestinal Escherichia coli].

OBJECTIVE: To investigate the role of replacement of third-generation cephalosporins by piperacillin-tazobactam (pip-tazo) in influencing the colonization of extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli (E. coli) in intestinal tract. METHODS: The study was divided into two phases lasting altogether 9 months, namely the pre-replacement phase (phase I, 3 months) and replacement phase (phase II, 6 months). In the latter phase, third-generation cephalosporins was restricted and replaced by pip-tazo. In phase I and phase IIb (the last 3 months of phase II), clinical data and rectal swab were taken for E. coli isolation as follow: within 24 hrs after admission (baseline screening), every week and 48 hrs before discharge. ESBLs production was detected with double disc test. Acquisition rate of ESBLs-producing E. coli were calculated both in ES1 group (patients' rectal swab collected and tests at least 2 times) and ES2 group (ES1 but with negative ESBLs either at the time of screening on admission or at anytime during the hospital stay). Continuous variable was compared using unpaired t-test and categorical variables was compared using Pearson Chi square test. Fisher's exact test was used in the two phases. RESULTS: In phase IIb, as compared with in phase I, the total consumption of antibiotics other than pip-tazo was reduced by 38.40%, the third-generation cephalosporins consumption was reduced by 70.11%, but pip-tazo consumption was raised by 895.35%. Meanwhile, the acquisition rate of ESBLs-producing E. coli in rectal swab was significantly decreased in phase IIb as compared with phase I (11.4% vs 24.0%) in ES1 group and the same is true in ES2 group (11.8% vs 27.9%). CONCLUSION: Replacement of third-generation cephalosporin with pip-tazo can reduce colonization of ESBLs--producing E. coli in intestinal tract.

[Effects of nucleotides on apoptosis of thymocytes].

OBJECTIVE: To study the effects of nucleotides on apoptosis of thymocytes in mice. METHODS: Apoptosis model in vivo was first established and 25 KM mice, 4 weeks old, were randomly divided into 5 groups. One group was control, and the others were test groups. Mice in test groups were injected with DEX (25 mg/kg) and the controls were treated with normal saline. 4, 8, 16, and 24 hours later the thymus and spleen were weighed and lymphocytes in thymus were separated. The apoptosis of lymphocytes was analyzed by using DNA electrophoresis and flow cytometry. 16 hours later lymphocytes apoptosis reached a peak and lasted 24 hours. Methods used to establish apoptosis model in vivo were: mice (4 weeks old) were injected with DEX (25 mg/kg), and thymus lymphocytes were separated 16 hours later and analyzed. The effects of nucleotides on apoptosis of mice thymocytes were investigated in experiment 2. Sixty KM mice, 20 g +/- 2g, 4 weeks old, were divided into four treatments: negative control group (NC), positive control group (PC), nucleotides-additive group 1 (NTS1) and nucleotides-additive group 2 (NTS2). RESULTS: Body weight gained in NST1 and NST2 were 3.71 g, 4.01 g respectively, significantly higher than NC (2.74 g) (P < 0.01) and in NST2 was significantly higher than in PC (2.96 g) (P < 0.01). Thymus index and spleen index were decreased significantly (P < 0.01), and no difference was found with the supplementation of nucleotides (P > 0.05). [Ca2+]i increased to 167.37 nmol/L, 191.16 nmol/L, 180.78 nmol/L in PC, NST1 and NST2 with DEX, being significantly higher than in NC (103.76 nmol/L) (P < 0.01). The percent of apoptosised thymocytes in groups were 0.31%, 11.93%, 9.82%, 11.15%, respectively. Thymus index and spleen index, cell apoptosis and [Ca2+]i were not differed significantly among PC, NTS1 and NTS2 groups. CONCLUSION: Nucleotides should have no significant effects on apoptosis of thymocytes in mice in vivo.