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Effect of Early Continuous Veno-Venous Haemofiltration in Severe Acute Pancreatitis for the Prevention of Local Pancreatic Complications. Gastroenterol Res Pract 2022; 2022:7575231. [PMID: 35296066 PMCID: PMC8920652 DOI: 10.1155/2022/7575231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 02/12/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To compare the conventional treatment and continuous veno-venous haemofiltration (CVVH) in severe acute pancreatitis (SAP) for the prevention of pseudocyst and walled-off necrosis. Patients and Methods. Forty-two patients were divided into two treatment groups: conventional treatment group contained 24 patients and CVVH had 18. Conventional treatment group patients were treated symptomatically and according to the causes. CVVH group patients were treated symptomatically, and CVVH was done within 2 hours of admission. Results In both groups, there was a decrease in amylase, lipase, CRP, IL-6, IL-10, TNF-alpha, Ranson score, Balthazar score, and APACHE-II score after 72 hours, but the decrease was significantly greater in CVVH patients. There were no any local pancreatic complications in CVVH patients, but 1 patient had an acute peripancreatic fluid collection, 2 patients had pseudocyst, and 2 patients had walled-off necrosis (WON), and a mortality one was seen in the conventional treatment group. Conclusion The present study shows that early CVVH may be able to prevent the formation of pseudocyst and win in SAP patients.
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Yuan X, Luo C, Wu J, Li W, Guo X, Li S, Wang B, Sun H, Tang L. Abdominal paracentesis drainage attenuates intestinal mucosal barrier damage through macrophage polarization in severe acute pancreatitis. Exp Biol Med (Maywood) 2021; 246:2029-2038. [PMID: 34053233 PMCID: PMC8474980 DOI: 10.1177/15353702211015144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/12/2021] [Indexed: 11/15/2022] Open
Abstract
Abdominal paracentesis drainage (APD), as an effective treatment of severe acute pancreatitis (SAP) in clinical settings, can ameliorate intestinal barrier damage and the overall severity of SAP. However, the mechanism underlying therapeutic effects of APD on damaged intestinal mucosal barrier during SAP is still unclear. Here, SAP was induced by injecting 5% Na-taurocholate retrograde into the biliopancreatic duct of rats to confirm the benefits of APD on enteral injury of SAP and further explore the possible mechanism. Abdominal catheter was placed after SAP was induced in APD group. As control group, the sham group received no operation except abdominal opening and closure. By comparing changes among control group, sham group, and APD group, APD treatment obviously lowered the intestinal damage and reduced the permeation of intestinal mucosal barrier, which was evidenced by intestinal H&E staining, enteral expression of tight junction proteins, intestinal apoptosis measurement and detection of serum diamine oxidase, intestinal fatty acid binding protein and D-lactic acid. Furthermore, we found that APD polarized intestinal macrophages toward M2 phenotype by the determination of immunofluorescence and western blotting, and this accounts for the benefits of APD for intestinal injury in SAP. Importantly, the protective effect against intestinal injury by APD treatment was mediated through the inhibited ASK1/JNK pathway. In summary, APD improved the intestinal mucosal barrier damage in rats with SAP through an increasing portion of M2 phenotype macrophages in intestine via inhibiting ASK1/JNK pathway.
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Affiliation(s)
- Xiaohui Yuan
- College of Medicine, Southwest Jiaotong University, Chengdu
610031, China
- Department of General Surgery & Pancreatic Injury and Repair
Key Laboratory of Sichuan Province, The General Hospital of Western Theater
Command, Chengdu 610083, China
| | - Chen Luo
- Department of General Surgery & Pancreatic Injury and Repair
Key Laboratory of Sichuan Province, The General Hospital of Western Theater
Command, Chengdu 610083, China
- Department of Hepatopancreatobiliary Surgery, Panzhihua Central
Hospital, Panzhihua 617000, China
| | - Jun Wu
- College of Medicine, Southwest Jiaotong University, Chengdu
610031, China
- Department of General Surgery & Pancreatic Injury and Repair
Key Laboratory of Sichuan Province, The General Hospital of Western Theater
Command, Chengdu 610083, China
| | - Wei Li
- Laboratory of Basic Medical Sciences, The General Hospital of
Western Theater Command, Chengdu 610083, China
| | - Xin Guo
- Laboratory of Basic Medical Sciences, The General Hospital of
Western Theater Command, Chengdu 610083, China
| | - Shuai Li
- College of Medicine, Southwest Jiaotong University, Chengdu
610031, China
- Department of General Surgery & Pancreatic Injury and Repair
Key Laboratory of Sichuan Province, The General Hospital of Western Theater
Command, Chengdu 610083, China
| | - Bing Wang
- College of Medicine, Southwest Jiaotong University, Chengdu
610031, China
- Department of General Surgery & Pancreatic Injury and Repair
Key Laboratory of Sichuan Province, The General Hospital of Western Theater
Command, Chengdu 610083, China
| | - Hongyu Sun
- College of Medicine, Southwest Jiaotong University, Chengdu
610031, China
- Department of General Surgery & Pancreatic Injury and Repair
Key Laboratory of Sichuan Province, The General Hospital of Western Theater
Command, Chengdu 610083, China
- Laboratory of Basic Medical Sciences, The General Hospital of
Western Theater Command, Chengdu 610083, China
| | - Lijun Tang
- College of Medicine, Southwest Jiaotong University, Chengdu
610031, China
- Department of General Surgery & Pancreatic Injury and Repair
Key Laboratory of Sichuan Province, The General Hospital of Western Theater
Command, Chengdu 610083, China
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Nivy R, Kuzi S, Yochai A, Aroch I, Bruchim Y. Evaluation of serum histone concentrations and their associations with hemostasis, markers of inflammation, and outcome in dogs with naturally occurring acute pancreatitis. Am J Vet Res 2021; 82:701-711. [PMID: 34432516 DOI: 10.2460/ajvr.82.9.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare serum concentrations of histones and inflammatory markers in dogs with acute pancreatitis and healthy control dogs, investigate associations of these variables with coagulation test results and survival (vs nonsurvival) to hospital discharge, and examine the prognostic utility of clinical findings and routine laboratory and coagulation tests in affected dogs. ANIMALS 36 dogs. PROCEDURES Dogs with findings consistent with acute pancreatitis (n = 29) and healthy control dogs (7) were enrolled in a prospective, observational study. Serum concentrations of histones, interleukin (IL)-6, and tumor-necrosis factor-α were assessed for all dogs. Clinical (including ultrasonographic) findings, relevant history, routine laboratory and coagulation test results, and outcomes were recorded for dogs with pancreatitis. Variables were assessed to determine an association with outcome for affected dogs and hospitalization time for survivors; histone concentrations and markers of inflammation were compared among survivors, nonsurvivors, and controls. Correlation between quantitative variables was investigated. RESULTS Serum histone and IL-6 concentrations did not differentiate survivors (n = 23) from nonsurvivors (6); IL-6 concentrations in affected dogs were correlated with 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester lipase activity (rS = 0.436) and hospitalization time (rS = 0.528). Pancreatitis-associated peritoneal fluid, obtundation, and jaundice were more common, and serum bilirubin concentration, serum alanine aminotransferase and aspartate aminotransferase activities, and prothrombin and activated partial thromboplastin times were greater in nonsurvivors than in survivors. Thromboelastometric changes consistent with hypercoagulability were detected in survivors; hypocoagulability was detected in 2 nonsurvivors. CONCLUSIONS AND CLINICAL RELEVANCE Serum histone concentrations were not associated with presence of acute pancreatitis or outcome for affected dogs. Further research is needed to investigate the clinical and therapeutic implications of hypocoagulability, hepatocellular injury, and pancreatitis-associated peritoneal fluid in affected dogs.
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Affiliation(s)
- Ran Nivy
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel.,From the Department of Internal Medicine, Ben-Shemen Specialist Referral Center, Ben-Shemen, Israel
| | - Sharon Kuzi
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel
| | - Avital Yochai
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel
| | - Itamar Aroch
- From the Departments of Internal Medicine, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel
| | - Yaron Bruchim
- From the Emergency and Critical Care, Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, 761001, Israel.,From the Department of Internal Medicine, Ben-Shemen Specialist Referral Center, Ben-Shemen, Israel
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4
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Lu Z, Zhu X, Hua T, Zhang J, Xiao W, Jia D, Yang M. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis. BMJ Open 2021; 11:e045031. [PMID: 34373293 PMCID: PMC8354272 DOI: 10.1136/bmjopen-2020-045031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Zongqing Lu
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingxing Zhu
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jin Zhang
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Di Jia
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Martiny P, Hayes G. Placement of a temporary cholecystostomy tube to relieve pancreatic EHBDO in a dog. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Pia Martiny
- Emergency and Critical CareCornell UniversityIthacaNew YorkUSA
| | - Galina Hayes
- Small Animal Surgery SectionCornell UniversityIthacaNew YorkUSA
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Percutaneous Drainage Versus Peritoneal Lavage for Pancreatic Ascites in Severe Acute Pancreatitis: A Prospective Randomized Trial. Pancreas 2019; 48:343-349. [PMID: 30789387 DOI: 10.1097/mpa.0000000000001251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study aimed to compare the efficacy of percutaneous drainage (PCD) versus peritoneal lavage (PL) for the treatment for severe acute pancreatitis patients with pancreatic ascites (PAs). METHODS Severe acute pancreatitis patients with PAs were randomly assigned within 3 days of onset of symptoms to receive either PL or PCD. The primary end point was a composite of mortality or major complications during hospitalization and within 1 month of discharge. Per-protocol analyses were performed. RESULTS Between September 2011 and June 2014, 86 patients were randomly assigned to intervention with PL or PCD. Ultimately, 41 patients in the PCD group and 39 patients in the PL group completed the study. The primary end point occurred in 15 (36.6%) of 41 patients in the PCD group and in 17 (43.6%) of 39 patients in the PL group (risk ratio, 0.84; 95% confidence interval, 0.49-1.44; P = 0.27). Mortality or major complications did not differ between the groups. Percutaneous drainage reduced intra-abdominal hypertension; however, PL reduced the incidence of deep venous thrombosis and pancreatic encephalopathy and was associated with a reduced need for intervention. CONCLUSIONS In our study, the PCD was not superior to the PL in reducing mortality or major complications in severe acute pancreatitis patients with PAs.
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Liu RH, Wen Y, Sun HY, Liu CY, Zhang YF, Yang Y, Huang QL, Tang JJ, Huang CC, Tang LJ. Abdominal paracentesis drainage ameliorates severe acute pancreatitis in rats by regulating the polarization of peritoneal macrophages. World J Gastroenterol 2018; 24:5131-5143. [PMID: 30568390 PMCID: PMC6288649 DOI: 10.3748/wjg.v24.i45.5131] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/20/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the role of peritoneal macrophage (PM) polarization in the therapeutic effect of abdominal paracentesis drainage (APD) on severe acute pancreatitis (SAP).
METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.
RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin (IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of pro-inflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1 in the pancreas of SAP model rats.
CONCLUSION These findings suggest that APD treatment exerts anti-inflammatory effects by regulating the M2 polarization of PMs, providing novel insights into the mechanism underlying its therapeutic effect.
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Affiliation(s)
- Ruo-Hong Liu
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
- Third Military Medical University (Army Medical University), Chongqing 400037, China
| | - Yi Wen
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
- Third Military Medical University (Army Medical University), Chongqing 400037, China
| | - Hong-Yu Sun
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
| | - Chun-Yu Liu
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
| | - Yu-Fan Zhang
- Jiaotong Hospital Affiliated with the Sichuan Provincial People’s Hospital, Chengdu 611730, Sichuan Province, China
| | - Yi Yang
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
| | - Qi-Lin Huang
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
| | - Jia-Jia Tang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100032, China
| | - Can-Chen Huang
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
| | - Li-Jun Tang
- PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China
- Third Military Medical University (Army Medical University), Chongqing 400037, China
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8
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Peritoneal dialysis beyond kidney failure? J Control Release 2018; 282:3-12. [DOI: 10.1016/j.jconrel.2018.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022]
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Zhou J, Huang Z, Lin N, Liu W, Yang G, Wu D, Xiao H, Sun H, Tang L. Abdominal paracentesis drainage protects rats against severe acute pancreatitis-associated lung injury by reducing the mobilization of intestinal XDH/XOD. Free Radic Biol Med 2016; 99:374-384. [PMID: 27585949 DOI: 10.1016/j.freeradbiomed.2016.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/12/2016] [Accepted: 08/27/2016] [Indexed: 12/20/2022]
Abstract
Our previous study showed that abdominal paracentesis drainage (APD) benefits patients with severe acute pancreatitis (SAP) by delaying or avoiding multiple organ failure. However, the role of APD treatment in SAP-associated lung injury (PALI) remains unclear. Therefore, we investigated the impact of APD on PALI in rats to explore the mechanisms underlying its potential treatment benefits. A drainage tube was inserted into the right lower quadrant of rats immediately after SAP induction via the retrograde infusion of 5% sodium taurocholate into the biliopancreatic duct. Mortality rates, histological scores, wet-to-dry weight (W/D) ratios, inflammatory infiltration and oxidative stress in lung tissues were then examined. Xanthine dehydrogenase (XDH) and xanthine oxidase (XOD) activities in the sera, intestines and lungs were assessed, as was P-selectin expression. APD treatment significantly decreased pathological damage scores, oxidative stress and neutrophil infiltration in lung tissues, indicating that APD has protective effects against PALI in rats. Moreover, APD decreased the levels of serum α-amylase and trypsin and resulted in a significant decrease in XDH mobilization from the intestines, which suppressed P-selectin expression in lung tissues following SAP induction. APD treatment exerts a significant protective effect against lung injury secondary to SAP by reducing the mobilization of intestinal XDH or XOD (XDH/XOD) and the expression of P-selectin in the lungs. These findings provide novel insights into the mechanisms underlying the effectiveness of APD in patients with SAP.
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Affiliation(s)
- Jing Zhou
- The Third Military Medical University, Chongqing 400038, China; General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China
| | - Zhu Huang
- The Third Military Medical University, Chongqing 400038, China; General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China
| | - Ning Lin
- General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China
| | - Weihui Liu
- General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China
| | - Guan Yang
- General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China
| | - Dongye Wu
- General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China
| | - Heda Xiao
- General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China
| | - Hongyu Sun
- General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China.
| | - Lijun Tang
- The Third Military Medical University, Chongqing 400038, China; General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu, Sichuan 610083, China.
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Pancreatic Acinar Cells Employ miRNAs as Mediators of Intercellular Communication to Participate in the Regulation of Pancreatitis-Associated Macrophage Activation. Mediators Inflamm 2016; 2016:6340457. [PMID: 27546996 PMCID: PMC4980583 DOI: 10.1155/2016/6340457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/22/2016] [Indexed: 12/27/2022] Open
Abstract
Macrophage activation plays an important role in the inflammatory response in acute pancreatitis. In the present study, the activation of AR42J pancreatic acinar cells was induced by taurolithocholate treatment. The results showed that the culture medium from the activated AR42J cells significantly enhanced NFκB activation in the macrophages compared to that without taurolithocholate treatment. Additionally, the precipitates obtained from ultracentrifugation of the culture media that were rich in exosomes were markedly more potent in activating macrophages compared with the supernatant fraction lacking exosomes. The results indicated that the mediators carried by the exosomes played important roles in macrophage activation. Exosomal miRNAs were extracted and examined using microarrays. A total of 115 differentially expressed miRNAs were identified, and 30 showed upregulated expression, while 85 displayed downregulated expression. Target genes of the differentially expressed miRNAs were predicted using TargetScan, MiRanda, and PicTar software programs. The putative target genes were subjected to KEGG functional analysis. The functions of the target genes were primarily enriched in MAPK pathways. Specifically, the target genes regulated macrophage activation through the TRAF6-TAB2-TAK1-NIK/IKK-NFκB pathway. As the mediators of signal transduction, miRNAs and their predicted target mRNAs regulate every step in the MAPK pathway.
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Abstract
OBJECTIVE The aim of this study was to assess the efficiency and safety of peritoneal lavage in patients with severe acute pancreatitis. METHODS A comprehensive search was performed to identify randomized controlled trials that compared peritoneal lavage with conservative treatment for severe acute pancreatitis. The primary outcome was all-cause mortality. Secondary outcomes included complications rate, proportion of need for operation, length of hospital stay, and medical costs. RESULTS A total of 899 patients from 15 studies were subjected to this systematic review. Peritoneal lavage did significantly decrease the mortality (relative risk, 0.47; 95% confidence interval, 0.34-0.66; P < 0.01), with low heterogeneity among the studies (I = 7%). Peritoneal lavage also seemed to significantly alter any of the other end points. CONCLUSIONS Peritoneal lavage shows robustly beneficial effect in patients with severe acute pancreatitis in this systematic review. However, the results should be interpreted with caution due to the general high risk of bias in these included studies.
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12
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Percutaneous Catheter Drainage of Pancreatitis-Associated Ascitic Fluid in Early-Stage Severe Acute Pancreatitis. Pancreas 2015; 44:1161-2. [PMID: 26355553 DOI: 10.1097/mpa.0000000000000397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Zhu L, Lu J, Yang J, Sun P. Early-phase peritoneal drainage and lavage in a rat model of severe acute pancreatitis. Surg Today 2015; 46:371-8. [PMID: 25893772 DOI: 10.1007/s00595-015-1172-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/24/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the effects of early-phase drainage on the survival rates and pancreatic pathological changes associated with severe acute pancreatitis (SAP) in a rat model. METHODS Sprague-Dawley rats were divided into the following groups: SAP model (control), early drainage and delayed drainage. The 24-h survival rates were compared among the groups. In addition, the serum and ascites concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α were measured, and pancreatic pathological changes were observed. RESULTS The survival rate significantly improved in the early drainage group. Compared with that observed in the control group, the serum TNF-α and IL-8 concentrations in the early drainage group decreased, while the serum IL-10 levels increased, and the ascites concentrations of IL-1β, IL-6, IL-8 and TNF-α decreased, while that of IL-10 increased significantly. In the delayed drainage group, only the ascites concentrations of TNF-α decreased. Meanwhile, the pancreatic pathological changes at 3, 6 and 24 h worsened in the early drainage group; however, the pancreatic lesions in the early drainage group were less mild than those seen in the control group. CONCLUSIONS Rebalancing the cytokine levels in ascites after early drainage may be a key factor for enhancing the survival rate in rats.
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Affiliation(s)
- Leiming Zhu
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China.
| | - Jilin Lu
- Department of General Surgery, No. 1 Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Shanghai, 200080, China
| | - Jing Yang
- Department of Pathology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China
| | - Peng Sun
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China
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Matsumoto K, Miyake Y, Nakatsu M, Toyokawa T, Ando M, Hirohata M, Kato H, Yamamoto K. Usefulness of early-phase peritoneal lavage for treating severe acute pancreatitis. Intern Med 2014; 53:1-6. [PMID: 24390520 DOI: 10.2169/internalmedicine.53.0745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To improve the prognosis of severe acute pancreatitis, preventing infectious complications, particularly infected pancreatic necrosis, is important. The present study evaluated the efficacy of peritoneal lavage for improving the prognosis of patients with severe acute pancreatitis. PATIENTS We retrospectively reviewed the cases of 23 consecutive patients with severe acute pancreatitis who were treated with peritoneal lavage. RESULTS Peritoneal lavage was started within 72 hours after the initial onset of symptoms in 20 patients (87%). The duration of peritoneal lavage, which was significantly correlated with the number of prognostic factors according to the revised Japanese criteria, Ranson score and serum C-reactive protein level at the start of peritoneal lavage, was a median of seven (3-22) days. There were no adverse events associated with the peritoneal lavage. Eight patients (35%) concurrently underwent continuous regional arterial infusion. Five days after starting peritoneal lavage, the patients' clinical conditions significantly improved. Overall, the survival rate was 96%. One patient (4%) died due to rupture of a pseudoaneurysm of the splenic artery. Complications occurred in seven patients (30%). Infectious complications were observed in three patients (13%) (one patient developed infected pancreatic necrosis and bacteremia, and two patients developed bacteremia). Pseudocysts and pancreatic fistulas developed in five and one patient, respectively. The incidence of complications was lower in the patients receiving peritoneal lavage within 72 hours from the initial onset of symptoms than in the remaining patients (20% vs. 100%; p=0.005). CONCLUSION We speculate that peritoneal lavage reduces the mortality and incidence of complications in patients with severe acute pancreatitis.
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Affiliation(s)
- Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Liu LL, Wang XY. Severe acute pancreatitis complicated with gastrointestinal dysfunction: Pathogenesis, diagnosis and treatment. Shijie Huaren Xiaohua Zazhi 2013; 21:3828-3834. [DOI: 10.11569/wcjd.v21.i34.3828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Severe acute pancreatitis (SAP) is often associated with gastrointestinal dysfunction, leading to gastrointestinal motility disorders and even gastrointestinal failure, which has an important effect on SAP progression and prognosis, directly influences the outcome of treatment, is an important cause of death in patients with SAP, and moreover, has been one of the important prognostic factors for SAP. This review aims to discuss the pathophysiology, pathogenesis, diagnosis and treatment of SAP with gastrointestinal dysfunction.
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Pancreatitis-associated ascitic fluid induces proinflammatory cytokine expression in THP-1 cells by inhibiting anti-inflammatory signaling. Pancreas 2013; 42:855-60. [PMID: 23774701 DOI: 10.1097/mpa.0b013e318279fe5c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We investigated whether pancreatitis-associated ascitic fluid (PAAF) could induce the expression of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in THP-1 cells and the mechanism(s) involved. METHODS THP-1 cells were divided into control and PAAF groups. The PAAF group was incubated with different final concentrations of PAAF, whereas the control group was incubated with culture medium. Effects and mechanisms were determined by measuring the levels of TNF-α and IL-6 mRNA expression; phospho-p38-MAPK, nuclear factor κB, peroxisome proliferator-activated receptor γ activation; and the effect on the inhibitory activity of SB203580 and BAY-117082. RESULTS In response to PAAF, overexpression of TNF-α and IL-6 mRNA was found in THP-1 cells compared with those of the corresponding control (P < 0.05), and in a dose-dependent manner. The levels of phospho-p38 and nuclear factor κB p65 were also increased in different PAAF groups, whereas low expression of peroxisome proliferator-activated receptor γ was found compared with the control group (P < 0.05). Furthermore, we presented that the inflammatory response could be partly alleviated by inhibitors SB203580 or BAY-117082, whereas it was markedly inhibited by the simultaneous treatment of 2 inhibitors. CONCLUSIONS Pancreatitis-associated ascitic fluid up-regulated proinflammatory cytokines by interfering with proinflammatory and anti-inflammatory signaling pathways, thus exacerbating activation in acute pancreatitis.
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Coelho AMM, Kunitake TA, Machado MCC, Martins JO, Patzina RA, D'Albuquerque LAC, Jukemura J. Is there a therapeutic window for pentoxifylline after the onset of acute pancreatitis? Acta Cir Bras 2013; 27:487-93. [PMID: 22760835 DOI: 10.1590/s0102-86502012000700010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 05/21/2012] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To investigate the effects of pentoxifylline (PTX) in experimental acute pancreatitis (AP) starting drug administration after the induction of the disease. METHODS One hundred male Wistar rats were submitted to taurocholate-induced AP and divided into three groups: Group Sham: sham-operated rats, Group Saline: AP plus saline solution, and Group PTX: AP plus PTX. Saline solution and PTX were administered 1 hour after induction of AP. At 3 hours after AP induction, peritoneal levels of tumor necrosis factor (TNF)-α, and serum levels of interleukin (IL)-6 and IL-10 levels were assayed by Enzyme-Linked Immunosorbent Assay (ELISA). Determinations of lung myeloperoxidase activity (MPO), histological analysis of lung and pancreas, and mortality study were performed. RESULTS PTX administration 1 hour after induction of AP caused a significant decrease in peritoneal levels of TNF-α and in serum levels of IL-6 and IL-10 when compared to the saline group. There were no differences in lung MPO activity between the two groups with AP. A decrease in mortality was observed in the PTX treatment compared to the saline group. CONCLUSIONS Administration of PTX after the onset of AP decreased the systemic levels of proinflammatory cytokines, raising the possibility that there is an early therapeutic window for PTX after the initiation of AP.
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Affiliation(s)
- Ana Maria Mendonça Coelho
- Laboratory of Liver Transplantation and Experimental Surgery, Department of Gastroenterology, Medical School, University of São Paulo, Brazil
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Coupled plasma filtration adsorption combined with continuous veno-venous hemofiltration treatment in patients with severe acute pancreatitis. J Clin Gastroenterol 2013; 47:62-8. [PMID: 23090044 DOI: 10.1097/mcg.0b013e318266f455] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe acute pancreatitis (SAP) still has a high mortality rate. Coupled plasma filtration adsorption (CPFA) and continuous veno-venous hemofiltration (CVVH) are 2 extracorporeal blood purification techniques. We hypothesized that CPFA combined with CVVH could preferentially improve prognosis and suppress clinical manifestations of SAP. METHODS In this observational cohort study, 25 patients with SAP were enrolled, in which 12 received CPFA plus CVVH treatment (group 1), and 13 received CVVH therapy (group 2). All the patients underwent a successive 10-day intervention. Clinical indicators were detected before or after the intervention and the results were compared between the 2 groups. The feasibility and the survival rate were evaluated on day 28. RESULTS Compared with group 2, oxygenation index (PaO(2)/FiO(2)), mean arterial pressure, serum amylase, and blood urine nitrogen showed significant differences (all P<0.01) and serum TNF-α, IL-1β, IL-6 were reduced and IL-10 was elevated with time in group 1 (all P<0.01). Liver functions, electrolyte, and acid-base balance did not show significant difference before and after the 10-day treatment with CPFA plus CVVH compared with CVVH (P>0.05). No therapy-related adverse reactions were noted in both groups. Twenty-eight-day survival rate of group 1 was higher than that in group 2 [91.7% (11/12) vs. 53.8% (7/13), P<0.05]. CONCLUSIONS CPFA combined with CVVH was an effective and safe method for treatment of SAP patients, the mechanism being related to its effect on regulating the level of cytokines and serum amylase.
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Huang L, Wang MH, Cheng ZY, Xue P, Jin T, Yang XN, Xia Q. Effects of Chai-Qin-Cheng-Qi decoction () on acute pancreatitis-associated lung injury in mice with acute necrotizing pancreatitis. Chin J Integr Med 2012. [PMID: 23001459 DOI: 10.1007/s11655-012-1207-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVE: To investigate the effects of Chai-Qin-Cheng-Qi Decoction (, CQCQD) on acute pancreatitis-associated lung injury in mice with acute necrotizing pancreatitis (ANP). METHODS: Thirty healthy mice were randomly divided into three groups: an ANP group (ANP+placebo, n=10); a treatment group (ANP+CQCQD, n=10); and a control group (normal mice+placebo, n=10). ANP was induced by intraperitoneal injection with 8% L-arginine (4 μg/kg), and the control group was injected with normal saline. The treatment group received CQCQD (20 mL/kg), and the ANP and control groups received placebo (sucrose and starch) intragastrically at 2 h intervals. After the third intragastric administration, blood, pancreatic tissues and right lung tissues were collected for measurement of serum interleukin-6 (IL-6) and interleukin-10 (IL-10) by enzyme-linked immunosorbent assay, and the expression of heat shock protein 70 (HSP70) in lung tissue was determined by Western blot analysis. Pathological changes of pancreatic tissue and lung tissue were examined. RESULTS: Serum IL-6 was significantly higher in the ANP group compared with the control and the treatment groups (1589.63±377.28 vs. 927.46±210.42 pg/mL, P<0.05, and 1589.63±377.28 vs. 1107.73±351.62 pg/mL, P<0.05, respectively). The IL-10 concentration was significantly lower in the ANP group compared with the treatment group (920.64±101.68 vs. 1177.84±201.72 pg/mL, P<0.05), but no signififi cant difference was found between the ANP and control groups and between the treatment and control groups. The expression level of HSP70 in the ANP and control groups was signififi cantly lower than in the treatment group (0.93±0.03 vs. 1.42±0.21, P<0.01, and 0.81±0.09 vs. 1.42±0.21, P<0.01, respectively). There was no signififi cant difference in HSP70 levels between the ANP and control groups. Histological scores of pancreatic and lung tissue were significantly decreased in the treatment group compared with the ANP groups (4.50±0.54 vs. 6.20±1.65, P<0.05, and 3.00±0.63 vs. 3.87±0.83, P<0.05, respectively). CONCLUSIONS: The incidence of acute pancreatitisassociated lung injury in ANP mice correlates positively with serum IL-6 concentration. CQCQD may inhibit IL-6 induction and increase IL-10 concentration and HSP70 expression, effectively reducing lung injury.
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Affiliation(s)
- Lei Huang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
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Effect of ageing on systemic inflammatory response in acute pancreatitis. Int J Inflam 2012; 2012:270319. [PMID: 22292125 PMCID: PMC3265080 DOI: 10.1155/2012/270319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/04/2011] [Accepted: 11/28/2011] [Indexed: 01/05/2023] Open
Abstract
Elderly patients show increased incidence of multiple organ dysfunction in acute pancreatitis possibly due to bacterial translocation. This is associated with increased susceptibility to infections in older people. Several reports have related this increased susceptibility to a proinflammatory status called inflammaging, which decreases the capacity of the immunological system to respond to antigens. Cellular senescence also contributes to this low-grade chronic inflammation in older subjects. We discuss here the effect of ageing on systemic inflammation, focusing on that induced by acute pancreatitis and some of the mechanisms involved. It is important to understand the immunological changes in the elderly to adjust treatment strategies in order to reduce the morbidity and mortality associated with acute pancreatitis and other conditions that lead to systemic inflammation.
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Erdemoglu E, Seçkin B, Günyeli İ, Güney M, Seçkin M, Mungan T. Reduction of postoperative adhesions by trimetazidine: an experimental study in a rat model. Arch Gynecol Obstet 2011; 285:757-61. [DOI: 10.1007/s00404-011-2072-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
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