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Lackovic MM, Joksimovic BD, Babovic JC, Isenovic ER, Gluvic ZM. Recurrent acute pancreatitis as an initial presentation of primary hyperparathyroidism in juvenile patient. World J Clin Cases 2025; 13:100439. [DOI: 10.12998/wjcc.v13.i17.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 01/13/2025] [Accepted: 01/21/2025] [Indexed: 02/18/2025] Open
Abstract
Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism, especially in younger patients and those with a hereditary condition. When parathyroid abnormalities are adequately recognized and addressed, more recurrent attacks of acute pancreatitis are unlikely to occur.
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Affiliation(s)
- Milena M Lackovic
- Department of Endocrinology, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
| | - Bojan D Joksimovic
- Department of Endocrinology, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
| | - Jelena C Babovic
- Department of Geriatrics, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade 11000, Serbia
| | - Zoran M Gluvic
- Department of Endocrinology, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
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Wu W, Zhang YP, Zhang YL, Qu XG, Zhang ZH, Zhang R, Peng ZY. Nonlinear association between estimated plasma volume status and acute kidney injury in acute pancreatitis patients. World J Gastroenterol 2025; 31:105269. [DOI: 10.3748/wjg.v31.i20.105269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 04/18/2025] [Accepted: 05/12/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND Acute pancreatitis (AP), a severe pancreatic inflammatory condition, with a mortality rate reaching up to 40%. Recently, AP shows a steadily elevating prevalence, which causes the greater number of hospital admissions, imposing the substantial economic burden. Acute kidney injury (AKI) complicates take up approximately 15% of AP cases, with an associated mortality rate of 74.7%-81%.
AIM To evaluate the efficacy of estimated plasma volume status (ePVS) in forecasting AKI in patients with AP.
METHODS In this retrospective cohort study, AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023. Electronic medical records were adopted for data extraction, including demographic data and clinical characteristics. The association between ePVS and AKI was analyzed using multivariate logistic regression models, with potential confounders being adjusted. Nonlinear relationship was examined with smooth curve fitting, and infection points were calculated. Further analyses were performed on stratified subgroups and interaction tests were conducted.
RESULTS Among the 1508 AP patients, 251 (16.6%) developed AKI. ePVS was calculated using Duarte (D-ePVS) and Kaplan-Hakim (KH-ePVS) formulas. After adjusting for covariates, the AKI risk exhibited 46% [odds ratio (OR) = 1.46, 95% confidence interval (CI): 0.96-2.24] and 11% (OR = 1.11, 95%CI: 0.72-1.72) increases in the low tertile (T1) of D-ePVS and KH-ePVS, respectively, and 101% (OR = 2.01, 95%CI: 1.31-3.05) and 51% (OR = 1.51, 95%CI: 1.00-2.29) increases in the high tertile (T3) relative to the reference tertile (T2). Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS, with inflection points at 4.3 dL/g and -2.8%, respectively. Significant interactions were not observed in age, gender, hypertension, diabetes mellitus, sequential organ failure assessment score, or AP severity (all P for interaction > 0.05).
CONCLUSION Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients. A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula, and a J-shaped curve at -2.8% for the Kaplan-Hakim formula.
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Affiliation(s)
- Wen Wu
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei Province, China
| | - Yu-Pei Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Yi-Lan Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Xing-Guang Qu
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Zhao-Hui Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Rong Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Zhi-Yong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei Province, China
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Li B, Chu Y, Wang X, Meng P, Fang L, Tian ZB, Li X. Risk factors associated with pain and pain relief in patients with chronic pancreatitis. Postgrad Med J 2025; 101:545-552. [PMID: 39841129 DOI: 10.1093/postmj/qgae185] [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: 05/25/2024] [Revised: 10/08/2024] [Indexed: 01/23/2025]
Abstract
BACKGROUND Abdominal pain is one of the most prominent symptoms in patients with chronic pancreatitis (CP) and can manifest intermittently or persistently. The mechanism of pain is not yet clear, and no effective treatment is currently available. This study aimed to explore the risk factors for pain in patients with CP, which may provide new insights for developing effective pain control modalities. METHODS This clinical study was based on a single-centre research database that included 570 patients with CP. We compared the differences in baseline data, clinical characteristics, and psychophysiology traits between patients with and without pain. Subsequently, patients will be followed up to assess changes in their risk factors and explore their relationship with pain. RESULTS In the final risk factor model, young age (P = .031; odds ratio [OR] = 0.986 [0.973, 0.999]), prolonged disease duration (P < .001; OR = 1.307 [1.127, 1.516]), heavy smoking (P = .014; OR = 1.331 [1.060, 1.617]), alcohol consumption (P = .003; OR = 1.419 [1.127, 1.788]), low body mass index (P < .001; OR = 0.786 [0.703, 0.879]), pancreatic exocrine insufficiency (P = .040; OR = 1.683 [1.024, 2.767]), acute pancreatitis attacks (P = .027; OR = 1.759 [1.067, 2.902]), anxiety, and depression (P = .016; OR = 1.047 [1.009, 1.088]; P = .014; OR = 1.068 [1.013, 1.126]) were associated with CP pain. Reducing tobacco and alcohol intake (P = .001; OR = 2.367 [1.525, 4.637]; P = .024; OR = 2.011 [1.085, 3.199]), increasing the body mass index (P = .005; OR = 1.968 [1.265, 3.805]), and improving anxiety (P = .001; OR = 1.164 [1.081, 1.340]) were identified to be beneficial for pain relief. Compared to the effects on persistent pain, pancreatic enzyme supplementation (P = .004; OR = 1.794 [1.186, 2.502]) had a clear effect on intermittent pain in patients with CP. CONCLUSION We identified a multifactorial model of pain risk factors for CP and confirmed that modifying these risk factors could influence patient pain symptoms.
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Affiliation(s)
- Bingqing Li
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266075, China
| | - Yuning Chu
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266075, China
| | - Xiaowei Wang
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266075, China
| | - Pin Meng
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266075, China
| | - Liang Fang
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266075, China
| | - Zi-Bin Tian
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266075, China
| | - Xiaoyu Li
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266075, China
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Hawatian K, Sidani M, Hagerman T, Condon S, Chien C, Miller J. Contemporary Approach to Acute Pancreatitis in Emergency Medicine. J Am Coll Emerg Physicians Open 2025; 6:100063. [PMID: 40051813 PMCID: PMC11883301 DOI: 10.1016/j.acepjo.2025.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 12/18/2024] [Accepted: 12/30/2024] [Indexed: 03/09/2025] Open
Abstract
Acute pancreatitis is a commonly encountered pathology in the emergency department. We presented a clinical review summarizing the contemporary emergency medicine approach to managing acute pancreatitis. Although the diagnostic criteria for acute pancreatitis are straightforward, it has many possible causes, several treatment options, and both short- and long-term sequelae. We discussed diagnostic, intervention, and disposition considerations relevant to emergency clinicians and considered risk assessment using available clinical decision tools. We also discussed changes to traditional treatments and ongoing investigational therapies, including steroids, monoclonal antibodies, and calcium release-activated calcium channel inhibitors.
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Affiliation(s)
- Kegham Hawatian
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Munir Sidani
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Thomas Hagerman
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Shaun Condon
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Christine Chien
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Joseph Miller
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
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Liu F, Xiao Z, Zeng H, Li J, Ai F, Qi J. Early enteral nutrition with fructooligosaccharides improves prognosis in severe acute pancreatitis. Sci Rep 2025; 15:5267. [PMID: 39939635 PMCID: PMC11822058 DOI: 10.1038/s41598-025-89739-x] [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: 12/15/2024] [Accepted: 02/07/2025] [Indexed: 02/14/2025] Open
Abstract
Soluble dietary fiber, notably as an adjunct to early enteral nutrition (EEN), is gaining prominence in clinical therapy. This study evaluates the effect of fructooligosaccharides (FOS), a new soluble dietary fiber, on the prognosis of patients with severe acute pancreatitis (SAP). In a retrospective cohort study at the Third Xiangya Hospital of Central South University from July 2017 to July 2023, 110 SAP patients were analyzed. TPF (enteral nutritional suspension of total protein)-normal and TPF-FOS groups both received standard EEN solutions; the latter additionally received FOS. Outcomes were compared between the groups. The study included 37 patients in the TPF-FOS group and 73 patients in the TPF-normal group. Mortality was 13.50% in the TPF-FOS group and 34.20% in the TPF-normal group (P < 0.05). FOS was identified as an independent protective factor (OR: 0.826, P = 0.041). The TPF-FOS group showed lower rates of intra-abdominal infection and decreased the level of inflammation (P < 0.05). FOS potentially acts as an independent protective factor against death in SAP. Additionally, the supplementation of EEN with FOS may contribute to reducing mortality and improving the prognosis of SAP patients.
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Affiliation(s)
- Fangchun Liu
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
- Department of Gastroenterology, The First Hospital of Changsha, Changsha, 410005, Hunan, China
| | - Zhiming Xiao
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Hongyan Zeng
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Jingbo Li
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Feiyan Ai
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Jing Qi
- Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha, 410013, China.
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Shen G, Wen H, Li H, Zhang X, Lan B, Dong X, Ge P, Luo Y, Chen H. Emodin protects against severe acute pancreatitis-associated acute lung injury by activating Nrf2/HO-1/GPX4 signal and inhibiting ferroptosis in vivo and in vitro. BMC Gastroenterol 2025; 25:57. [PMID: 39910464 PMCID: PMC11800461 DOI: 10.1186/s12876-025-03660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 01/30/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND Severe acute pancreatitis (SAP) has high morbidity, a complicated and dangerous course, and many complications, including severe pulmonary complications. SAP-associated acute lung injury (SAP-ALI) is still a significant challenge for surgeons because of its high mortality. Therefore, more effective treatment methods are urgently needed. Emodin (EMO) has shown tremendous potential in treating many refractory diseases. However, its protection mechanism in SAP-ALI needs to be further clarified. This study was undertaken to investigate the protective effects of EMO against lung injury in SAP rats and alveolar epithelial cells, with a particular focus on the classical ferroptosis pathway. METHODS In an in vivo study, forty SD rats were evenly split into five groups: sham operation (SO) group, the biliopancreatic duct was retrogradely injected with 5% sodium taurocholate (STC) to create the SAP group, SAP + EMO group was administered EMO via gavage to the rats following the modeling, SAP + ML385 group (a given inhibitor of nuclear factor erythroid 2-related factor 2 (Nrf2)), SAP + ML385 + EMO group. In an in vitro study, alveolar epithelial A549 cell lines were exposed to lipopolysaccharide (LPS) and treated with EMO. ML385 was also used to inhibit the expression of Nrf2. Pancreatic and lung tissue damage was evaluated using histological examination and molecular experiments. Enzyme-linked immunosorbent assays (ELISA) were used to assess the levels of pro-inflammatory cytokines, Fe2+, and associated oxidative stress indicators in the serum and cell supernatant. Real-time polymerase chain reaction (PCR), Western blot (WB), and immunofluorescence were used to find the expressions of related mRNAs and proteins in the lung tissue or A549 cells. RESULTS The findings demonstrated that suppressing Nrf2 expression exacerbated the inflammatory response brought on by SAP and the pathological alterations of SAP-ALI. Emodin treatment reversed this pathological change by activating the Nrf2/Heme Oxygenase-1 (HO-1)/glutathione peroxidase 4 (GPX4) signal path. Moreover, these results also showed that EMO, contrary to the effects of ML385, suppressed the ferroptosis response, which manifested as up-regulated glutathione (GSH) and GPX4 levels in vivo and in vitro and down-regulated malondialdehyde (MDA), superoxide dismutase (SOD), Fe2+, and reactive oxygen species (ROS) levels. CONCLUSIONS Our results demonstrated that EMO effectively inhibited ferroptosis both in vivo and in vitro, while also modulating the Nrf2/HO-1/GPX4 signaling pathway to provide protection against SAP-ALI.
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Affiliation(s)
- Gang Shen
- Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning Province, 116011, People's Republic of China
- Dalian Women and Children's Medical Center (Group), Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
| | - Haiyun Wen
- Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning Province, 116011, People's Republic of China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
| | - Huijuan Li
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China
| | - Xuetao Zhang
- Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning Province, 116011, People's Republic of China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
| | - Bowen Lan
- Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning Province, 116011, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
| | - Xuanchi Dong
- Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning Province, 116011, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
| | - Peng Ge
- Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning Province, 116011, People's Republic of China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
| | - Yalan Luo
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China
| | - Hailong Chen
- Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian, Liaoning Province, 116011, People's Republic of China.
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China.
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116011, People's Republic of China.
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Fang LH, Zhang JQ, Huang JK, Tang XD. Inflammatory bowel disease increases the risk of pancreatitis: a two-sample bidirectional Mendelian randomization analysis. BMC Gastroenterol 2025; 25:13. [PMID: 39799299 PMCID: PMC11725204 DOI: 10.1186/s12876-024-03571-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 12/17/2024] [Indexed: 01/15/2025] Open
Abstract
BACKGROUND Previous studies have suggested an association between inflammatory bowel disease (IBD), and pancreatitis, including acute pancreatitis (AP) and chronic pancreatitis (CP). We aimed to examine the potential causal relationship between IBD and pancreatitis using the Mendelian randomization (MR) method. METHODS We obtained data from genome-wide association studies (GWASs) in European individuals for IBD and its main subtypes, Crohn's disease (CD) and ulcerative colitis (UC) (31,665 IBD cases, 13,768 UC cases, 17,897 CD cases and 33,977 controls). Four independent summary statistics of pancreatitis from the the European Bioinformatics Institute (EMBL-EBI, 10,630 AP cases and 844,679 controls, 1,424 CP cases and 476,104 controls) and FinnGen Consortium (8,446 AP cases, 4,820 CP cases and 437,418 controls) were used for bidirectional MR analyses and sensitivity analysis. Finally, further meta-analysis was conducted on the MR results. RESULTS Generally, IBD is associated with an increased risk of pancreatitis (IBD-AP, OR = 1.050, 95% CI 1.020-1.080, P = 7.20 × 10-5; IBD-CP, OR = 1.050, 95% CI 1.010-1.090, P = 0.019). In addition, UC increased the risk of pancreatitis (UC-AP, OR = 1.050, 95% CI 1.020-1.070, P = 9.10 × 10-5; UC-CP, OR = 1.090, 95% CI 1.040-1.140, P = 1.44 × 10-4) and CD increased the risk of acute pancreatitis (OR = 1.040, 95% CI 1.020-1.060, P = 9.61 × 10-5). However, no causal association was found between CD and the risk of chronic pancreatitis (P > 0.05). The reverse MR results showed that AP may be associated with a reduced risk of IBD and CD (AP-IBD, OR = 0.880, 95% CI 0.810-0.960, P = 0.003; AP-CD, OR = 0.830, 95% CI 0.730-0.940, P = 0.003). However, there is no causal relationship between AP and the risk of UC, and there is no causal relationship between CP and the risk of IBD and its subtypes(P > 0.05). CONCLUSION In conclusion, based on MR analysis and meta-analysis, our results showed a positive causal effect of IBD on pancreatitis, and subgroup analyses showed that UC and CD may promote the development of acute pancreatitis, whereas UC may promote the development of chronic pancreatitis. Reverse MR analysis suggests that AP may have a potential protective effect on IBD and CD.
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Affiliation(s)
- Li-Hui Fang
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jia-Qi Zhang
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jin-Ke Huang
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xu-Dong Tang
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Schaible J, Grenacher L, Stroszczynski C, Schreyer AG, Huber L, Bäumler W. The chronic pancreatitis (CP) Type Cambridge 2 as a cause of unclear upper abdominal pain: a radiologically underestimated diagnosis. ROFO-FORTSCHR RONTG 2024; 196:1262-1269. [PMID: 38626882 DOI: 10.1055/a-2275-0946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2024]
Abstract
The time interval from symptom onset to the diagnosis of chronic pancreatitis (CP) remains disproportionately long today due to nonspecific symptoms and the absence of a definitive laboratory marker. Nevertheless, mortality is increased by 3.6 times compared to the general population. Additionally, the risk of developing pancreatic carcinoma is 16 times higher in the presence of CP. According to the current S3 guideline, the morphological staging of CP should be based on the Cambridge Classification for CT/MRCP. Most radiologists morphologically associate CP with Cambridge Stage 4, which is characterized by classic calcifications. The subtle morphologies of earlier Cambridge Stages are often unrecognized, leading to delayed diagnosis. The aim of this study was to diagnose CP at Cambridge Stage 2 as the cause of unexplained upper abdominal discomfort.A retrospective analysis was conducted on 266 patients with unexplained upper abdominal pain who underwent outpatient MRI with MRCP between January 1, 2021, and October 1, 2023. The criteria for Cambridge Stage 2 were evaluated: pancreatic duct in the corpus measuring between 2 and 4 mm, pancreatic hypertrophy, cystic changes < 10 mm, irregularities in the duct, or > 3 pathological side branches. Patients with known tumors or other leading diagnoses, which explained the discomfort, were excluded.25 patients (15 female, 10 male) met the criteria for CP Stage 2 (9%). Ductal dilation between 2 and 4 mm was visible in 21 cases. Pancreatic hypertrophy was observed in six cases. Cystic changes < 10 mm were identified in three cases. Irregularities in the duct ("wavy duct") were diagnosed in 19 patients. Dilation of > 3 side branches was recognized in 17 cases. Lipase levels were additionally determined, with 13 patients showing pathologically elevated levels (> 60 U/l).CP at Cambridge Stage 2 is an important and underestimated diagnosis in patients with unexplained upper abdominal pain in the outpatient setting. Radiologists should pay attention not only to common signs like calcifications, large cysts, or duct strictures but also to subtle changes such as duct irregularities ("wavy duct configuration") and pathologically dilated side branches, which could lead to a significantly earlier diagnosis of CP. Lipase determination may be an additional indication of chronic pancreatitis in this context. · Early-stage Cambridge 2 CP is an important and underestimated diagnosis in patients with unexplained upper abdominal pain in the outpatient setting.. · Radiologists should pay attention to subtle signs of early CP.. · Additional information about lipase levels can be helpful in the diagnostic process..
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Affiliation(s)
- Jan Schaible
- Imaging and Prevention Center, Conradia Radiology Munich, Munich, Germany
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lars Grenacher
- Imaging and Prevention Center, Conradia Radiology Munich, Munich, Germany
| | | | - Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
| | - Lorenz Huber
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Zhong L, Yang X, Shang Y, Yang Y, Li J, Liu S, Zhang Y, Liu J, Jiang X. Exploring the pathogenesis, biomarkers, and potential drugs for type 2 diabetes mellitus and acute pancreatitis through a comprehensive bioinformatic analysis. Front Endocrinol (Lausanne) 2024; 15:1405726. [PMID: 39634181 PMCID: PMC11614670 DOI: 10.3389/fendo.2024.1405726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 11/04/2024] [Indexed: 12/07/2024] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease that accounts for > 90% of all diabetes cases. Acute pancreatitis (AP) can be triggered by various factors and is a potentially life-threatening condition. Although T2DM has been shown to have a close relationship with AP, the common mechanisms underlying the two conditions remain unclear. Methods We identified common differentially expressed genes (DEGs) in T2DM and AP and used functional enrichment analysis and Mendelian randomization to understand the underlying mechanisms. Subsequently, we used several machine learning algorithms to identify candidate biomarkers and construct a diagnostic nomogram for T2DM and AP. The diagnostic performance of the model was evaluated using ROC, calibration, and DCA curves. Furthermore, we investigated the potential roles of core genes in T2DM and AP using GSEA, xCell, and single-cell atlas and by constructing a ceRNA network. Finally, we identified potential small-molecule compounds with therapeutic effects on T2DM and AP using the CMap database and molecular docking. Results A total of 26 DEGs, with 14 upregulated and 12 downregulated genes, were common between T2DM and AP. According to functional and DisGeNET enrichment analysis, these DEGs were mainly enriched in immune effector processes, blood vessel development, dyslipidemia, and hyperlipidemia. Mendelian randomization analyses further suggested that lipids may be a potential link between AP and T2DM. Machine learning algorithms revealed ARHGEF9 and SLPI as common genes associated with the two diseases. ROC, calibration, and DCA curves showed that the two-gene model had good diagnostic efficacy. Additionally, the two genes were found to be closely associated with immune cell infiltration. Finally, imatinib was identified as a potential compound for the treatment of T2DM and AP. Conclusion This study suggests that abnormal lipid metabolism is a potential crosstalk mechanism between T2DM and AP. In addition, we established a two-gene model for the clinical diagnosis of T2DM and AP and identified imatinib as a potential therapeutic agent for both diseases.
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Affiliation(s)
- Lei Zhong
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xi Yang
- Department of Plastic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yuxuan Shang
- Department of Plastic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yao Yang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Junchen Li
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuo Liu
- Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunshu Zhang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jifeng Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xingchi Jiang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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10
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Solil D, Dite P, Senkyrik M, Bojkova M, Kianicka B. Acute pancreatitis as a risk factor of chronic pancreatitis and pancreatic cancer. An overview. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:284-287. [PMID: 39254152 DOI: 10.5507/bp.2024.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/28/2024] [Indexed: 09/11/2024] Open
Abstract
This is an overview of relation between acute and chronic pancreatitis and between acute pancreatitis and pancreatic cancer. Acute pancreatitis and recurrent acute pancreatitis are an etiological factor of chronic pancreatitis. Population-based studies have calculated the risk of acute recurrent pancreatitis after the first attack of acute pancreatitis to be 20% and development of chronic pancreatitis after first attack of acute pancreatitis is 10%. An important risk factor is tobacco smoking. Acute and chronic pancreatitis are risk factors for pancreatic cancer. The risk of acute pancreatitis is related to the number of recurrences of acute pancreatitis, but not the etiology of acute pancreatitis. Acute pancreatitis, as well as chronic pancreatitis, are risk factors for pancreatic cancer. After an attack of acute pancreatitis or recurrent acute pancreatitis a patient should be regarded as a high risk.
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Affiliation(s)
- David Solil
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Petr Dite
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
- Department of Clinic Subjects, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Michal Senkyrik
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Martina Bojkova
- Department of Internal Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Bohuslav Kianicka
- 2nd Department of Internal Medicine, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
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11
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Lan Y, Chen L, Yang Q, Zhu B, Lin Z. Association between wait time of central venous pressure and 28-day mortality in critically patients with acute pancreatitis: A restrospective cohort study. Medicine (Baltimore) 2024; 103:e39438. [PMID: 39213238 PMCID: PMC11365617 DOI: 10.1097/md.0000000000039438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/26/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Hemodynamic management is crucial in patients with acute pancreatitis. Central venous pressure (CVP) is widely used to assess volume status. Our aim was to determine the optimal time window for obtaining CVP measurements to prevent adverse outcomes in patients. This study utilized data from the Medical Information Mart for Intensive Care (MIMIC) IV database. The primary outcome under investigation was the 28-day mortality, while secondary outcomes included 90-day mortality and 1-year mortality. To categorize the study population, a CVP waiting time of 12 hours was employed as the grouping criterion, followed by the utilization of Cox regression analysis to compare the outcomes between the 2 groups. Our study included a total of 233 patients, among whom 154 cases (66.1%) underwent CVP measurements within 12 hours after admission to the Intensive Care Unit (ICU). Univariate and multivariate Cox regression analyses revealed a significantly increased risk of 28-day mortality in patients from the delayed CVP monitoring group compared to those who underwent early CVP measurements (HR = 2.87; 95% CI: 1.35-6.13; P = .006). Additionally, consistent results were observed for the risks of 90-day mortality (HR = 1.91; 95% CI: 1.09-3.35; P = .023) and 1-year mortality (HR = 1.84; 95% CI: 1.09-3.10; P = .023). In the ICU, an extended waiting time for CVP measurements in patients with acute pancreatitis was associated with an increased risk of 28-day mortality.
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Affiliation(s)
- Ying Lan
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Qilin Yang
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhu
- Hubei University of Science and Technology, Xianning, China
| | - Zhimei Lin
- Department of Hematology, Affiliated Hospital of Chengdu University, Chengdu, China
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12
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Luo YQ, Xu ZS, Hu JY, Ge QM, Zou J, Wei H, Zhou XM, Liao X, Ling Q, He LQ, Chen C, Wang XY, Zeng YM, Shao Y. Retinal microvascular changes in patients with pancreatitis and their clinical significance. Sci Rep 2024; 14:18935. [PMID: 39147923 PMCID: PMC11327248 DOI: 10.1038/s41598-024-69493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024] Open
Abstract
Acute pancreatitis, a common exocrine inflammatory disease affecting the pancreas, is characterized by intense abdominal pain and multiple organ dysfunction. However, the alterations in retinal blood vessels among individuals with acute pancreatitis remain poorly understood. This study employed optical coherence tomography angiography (OCTA) to examine the superficial and deep retinal blood vessels in patients with pancreatitis. Sixteen patients diagnosed with pancreatitis (32 eyes) and 16 healthy controls (32 eyes) were recruited from the First Affiliated Hospital of Nanchang University for participation in the study. Various ophthalmic parameters, such as visual acuity, intraocular pressure, and OCTA image for retina consisting of the superficial retinal layer (SRL) and the deep retinal layer (DRL), were recorded for each eye. The study observed the superficial and deep retinal microvascular ring (MIR), macrovascular ring (MAR), and total microvessels (TMI) were observed. Changes in retinal vascular density in the macula through annular partitioning (C1-C6), hemispheric quadrant partitioning (SR, SL, IL, and IR), and early diabetic retinopathy treatment studies (ETDRS) partitioning methods (R, S, L, and I). Correlation analysis was employed to investigate the relationship between retinal capillary density and clinical indicators. Our study revealed that in the superficial retinal layer, the vascular density of TMI, MIR, MAR, SR, IR, S, C2, C3 regions were significantly decreased in patients group compared with the normal group. For the deep retinal layer, the vascular density of MIR, SR, S, C1, C2 regions also reduced in patient group. The ROC analysis demonstrated that OCTA possesses significant diagnostic performance for pancreatitis. In conclusion, patients with pancreatitis may have retinal microvascular dysfunction, and OCTA can be a valuable tool for detecting alterations in ocular microcirculation in pancreatitis patients in clinical practice.
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Affiliation(s)
- Yun-Qing Luo
- Department of Ophthalmology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zi-Song Xu
- Huankui Academy, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jin-Yu Hu
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jie Zou
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Hong Wei
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xian-Mei Zhou
- Ophthalmology Department of Affiliated Hospital, Medical School of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Xuan Liao
- Ophthalmology Department of Affiliated Hospital, Medical School of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Qian Ling
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Liang-Qi He
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Cheng Chen
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiao-Yu Wang
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yan-Mei Zeng
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
| | - Yi Shao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
- National Clinical Research Center for Eye Diseases, Shanghai, 200080, China.
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, 200080, China.
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, 200080, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China.
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13
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Xu XY, Gao Y, Yue CS, Tang YJ, Zhang ZJ, Xie FJ, Zhang H, Zhu YC, Zhang Y, Lai QQ, Wang XT, Xu JX, Zhang JN, Liu BW, Zhang JN, Kang K. Predictive and Prognostic Potentials of Lymphocyte-C-Reactive Protein Ratio Upon Hospitalization in Adult Patients with Acute Pancreatitis. J Inflamm Res 2024; 17:1659-1669. [PMID: 38504695 PMCID: PMC10949381 DOI: 10.2147/jir.s450587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose In this study, our objective was to investigate the potential utility of lymphocyte-C-reactive protein ratio (LCR) as a predictor of disease progression and a screening tool for intensive care unit (ICU) admission in adult patients with acute pancreatitis (AP). Methods We included a total of 217 adult patients with AP who were admitted to the First Affiliated Hospital of Harbin Medical University between July 2019 and June 2022. These patients were categorized into three groups: mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), based on the presence and duration of organ dysfunction. Various demographic and clinical data were collected and compared among different disease severity groups. Results Height, diabetes, lymphocyte count (LYMPH), lymphocyte percentage (LYM%), platelet count (PLT), D-Dimer, albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), glucose (GLU), calcium ion (Ca2+), C-reactive protein (CRP), procalcitonin (PCT), hospitalization duration, ICU admission, need for BP, LCR, sequential organ failure assessment (SOFA) score, bedside index for severity in AP (BISAP) score, and modified Marshall score showed significant differences across different disease severity groups upon hospitalization. Notably, there were significant differences in LCR between the MAP group and the MSAP and SAP combined group, and the MAP and MSAP combined group and the SAP group, and adult AP patients with ICU admission and those without ICU admission upon hospitalization. Conclusion In summary, LCR upon hospitalization can be utilized as a simple and reliable predictor of disease progression and a screening tool for ICU admission in adult patients with AP.
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Affiliation(s)
- Xiao-Yu Xu
- Department of Critical Care Medicine, The Second People’s Hospital of Beihai, Beihai, People’s Republic of China
| | - Yang Gao
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Chuang-Shi Yue
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Yu-Jia Tang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Zhao-Jin Zhang
- Department of Critical Care Medicine, The Yichun Central Hospital, Yichun, People’s Republic of China
| | - Feng-Jie Xie
- Department of Critical Care Medicine, The Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, People’s Republic of China
| | - Hong Zhang
- Department of Critical Care Medicine, The Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, People’s Republic of China
| | - Yu-Cheng Zhu
- Department of Critical Care Medicine, The Hongxinglong Hospital of Beidahuang Group, Shuangyashan, People’s Republic of China
| | - Yan Zhang
- Department of Critical Care Medicine, The Hongxinglong Hospital of Beidahuang Group, Shuangyashan, People’s Republic of China
| | - Qi-Qi Lai
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Xin-Tong Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Jia-Xi Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Jia-Ning Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Bo-Wen Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Jian-Nan Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
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Xu MX, Fan Z, Zhao MN. Treatment of pancreaticobiliary maljunction by minimally invasive endoscopic common channel sphinctertomy: Analysis of 35 cases. Shijie Huaren Xiaohua Zazhi 2024; 32:41-49. [DOI: 10.11569/wcjd.v32.i1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/24/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Patients with pancreaticobiliary maljunction (PBM) have a common channel (CC) that is too long, causing the Oddi sphincter not to directly affect the pancreaticobiliary junction. As a result, reflux between pancreatic juice and bile occurs, causing various pathological changes in the bile duct or pancreas. Exploring the application and mechanism of minimally invasive endoscopic shortening of the pancreatic bile duct CC channel in PBM has become particularly important, providing patients with another treatment option.
AIM To investigate the clinical efficacy and safety of minimally invasive endoscopic common channel sphinctertomy (CCEST) in the treatment of patients with PBM.
METHODS The clinical data of 35 PBM patients treated by minimally invasive CCEST were analyzed, and there were BP type (n = 19) and PB type (n = 16) PBM. All 35 patients underwent CCEST with the help of endoscopic retrograde cholangiopancreatography, and the therapeutic effects and complications of minimally invasive CCEST in PBM patients were analyzed.
RESULTS A total of 35 patients were diagnosed with PBM, of whom 12 were male and 23 were female. The patients ranged in age from 3 to 89 years, with a mean age of (46 ± 26.38) years. CCEST was performed in all patients to reduce the length of the CC. Among the 35 patients with PBM, 18 (51.43%) had combined biliary and pancreatic duct stones and underwent intraoperative lithotripsy. First-time ERCP stone extraction was successful in 14 patients, with a success rate of 78% (14/18). One week after minimally invasive intervention therapy, the serum biochemistry and C-reactive protein (CRP) and bile amylase in the 35 patients showed a significant decrease compared to the preoperative levels (P < 0.05). Post-ERCP pancreatitis was observed in five patients, but no serious complications such as postoperative bleeding, gastrointestinal perforation, and severe pancreatitis occurred after symptomatic treatment. After a mean follow-up period of (22.05 ± 10.67) mo in the 35 patients, one patient was diagnosed with carcinoma of the bile duct and treated by surgery, and four were treated by ERCP again because of stone recurrence and achieved satisfactory efficacy. The total effective rate of the treatment was 88.6% (31/35).
CONCLUSION PBM patients often present with an insidious onset. ERCP is a valuable procedure for the diagnosis of PBM. CCEST effectively improves biliopancreatic drainage in early-stage PBM patients by reducing the length of the common biliopancreatic confluence channel. CCEST is a safe and effective minimally invasive intervention for the treatment of PBM patients.
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Affiliation(s)
- Meng-Xiang Xu
- The Forth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zhen Fan
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou 310022, Zhejiang Province, China
| | - Min-Nan Zhao
- The First People's Hospital of Fuyang District, Hangzhou 311400, Zhejiang Province, China
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15
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Chen R, Chen HQ, Li RD, Lu HM. Different timing for abdominal paracentesis catheter placement and drainage in severe acute pancreatitis complicated by intra-abdominal fluid accumulation. World J Gastrointest Surg 2024; 16:134-142. [PMID: 38328315 PMCID: PMC10845288 DOI: 10.4240/wjgs.v16.i1.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis (SAP). However, there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter placement and drainage. AIM To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumulation. METHODS Using a retrospective approach, 184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement: group A (catheter placement within 2 d of symptom onset, n = 89), group B (catheter placement between days 3 and 5 after symptom onset, n = 55), and group C (catheter placement between days 6 and 7 after symptom onset, n = 40). The differences in progression rate, mortality rate, and the number of cases with organ dysfunction were compared among the three groups. RESULTS The progression rate of group A was significantly lower than those in groups B and groups C (2.25% vs 21.82% and 32.50%, P < 0.05). Further, the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C (41.57% vs 70.91% and 75.00%, P < 0.05). The mortality rates in group A, group B, and group C were similar (P > 0.05). At postoperative day 3, the levels of C-reactive protein (55.41 ± 19.32 mg/L vs 82.25 ± 20.41 mg/L and 88.65 ± 19.14 mg/L, P < 0.05), procalcitonin (1.36 ± 0.51 ng/mL vs 3.20 ± 0.97 ng/mL and 3.41 ± 0.98 ng/mL, P < 0.05), tumor necrosis factor-alpha (15.12 ± 6.63 pg/L vs 22.26 ± 9.96 pg/L and 23.39 ± 9.12 pg/L, P < 0.05), interleukin-6 (332.14 ± 90.16 ng/L vs 412.20 ± 88.50 ng/L and 420.08 ± 87.65ng/L, P < 0.05), interleukin-8 (415.54 ± 68.43 ng/L vs 505.80 ± 66.90 ng/L and 510.43 ± 68.23ng/L, P < 0.05) and serum amyloid A (270.06 ± 78.49 mg/L vs 344.41 ± 81.96 mg/L and 350.60 ± 80.42 mg/L, P < 0.05) were significantly lower in group A compared to those in groups B and group C. The length of hospital stay in group A was significantly lower than those in groups B and group C (24.50 ± 4.16 d vs 35.54 ± 6.62 d and 38.89 ± 7.10 d, P < 0.05). The hospitalization expenses in group A were also significantly lower than those in groups B and groups C [2.70 (1.20, 3.55) ten-thousand-yuan vs 5.50 (2.98, 7.12) ten-thousand-yuan and 6.00 (3.10, 8.05) ten-thousand-yuan, P < 0.05). The incidence of complications in group A was markedly lower than that in group C (5.62% vs 25.00%, P < 0.05), and similar to group B (P > 0.05). CONCLUSION Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.
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Affiliation(s)
- Rui Chen
- Department of General Surgery, Chengdu Sixth People’s Hospital, Chengdu 610058, Sichuan Province, China
| | - Hua-Qiang Chen
- Department of General Surgery, Chengdu Sixth People’s Hospital, Chengdu 610058, Sichuan Province, China
| | - Rui-Die Li
- Department of General Surgery, Chengdu Sixth People’s Hospital, Chengdu 610058, Sichuan Province, China
| | - Hui-Min Lu
- West China Center of Exellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University; Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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16
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Akinchits AN, Abramyan EI, Kitaeva AV, Mikhin IV, Vorontsov O. [Interventional radiological and endoscopic technologies in diagnosis and treatment of chronic pancreatitis]. Khirurgiia (Mosk) 2024:84-93. [PMID: 39584519 DOI: 10.17116/hirurgia202411184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024]
Abstract
This review is devoted to internationally accepted diagnostic algorithms for complicated chronic pancreatitis (CP). In addition, the authors discuss interventional radiological and endoscopic diagnostic and therapeutic procedures, as well as their role in surgical approaches for this disease. Chronic pancreatitis is often diagnosed with severe symptoms following severe course of disease and complications. Imaging techniques, such as ultrasound, endoscopic ultrasound, CT, MRI/MR cholangiocreatography (MRCP), secretin-stimulated MRCP, are valuable to assess the pancreas in patients with initial manifestations of CP. Modern treatment of complicated CP includes transpapillary or transmural drainage of false cysts, shock wave lithotripsy and stenting for pancreatic duct strictures and/or stones, stenting for biliary hypertension, endovascular interventions for vascular complications and radical surgical treatment. Endoscopic methods are preferable regarding better short-term quality of life. Early surgical intervention (within 3 years after clinical manifestation) is effective to eliminate or significantly reduce pain and pancreatic insufficiency. Multidisciplinary team including surgeons, endoscopists and interventional radiologists should determine the most optimal diagnostic and treatment approach individually for each patient.
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Affiliation(s)
- A N Akinchits
- Volgograd State Medical University, Volgograd, Russia
| | - E I Abramyan
- Volgograd State Medical University, Volgograd, Russia
| | - A V Kitaeva
- Volgograd State Medical University, Volgograd, Russia
| | - I V Mikhin
- Volgograd State Medical University, Volgograd, Russia
| | - O Vorontsov
- Volgograd State Medical University, Volgograd, Russia
- Sana Klinikum Hof, Hof, Germany
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17
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Hong J, Li Q, Wang Y, Xiang L, Zhou Y, Fan M, Lin R. Comparison of Fluid Resuscitation with Lactate Ringer's Versus Normal Saline in Acute Pancreatitis: An Updated Meta-Analysis. Dig Dis Sci 2024; 69:262-274. [PMID: 38015322 DOI: 10.1007/s10620-023-08187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Fluid resuscitation is one of the main therapies for acute pancreatitis (AP). There is still no consensus on the type of fluid resuscitation. This study investigated the differences between lactate Ringer's (LR) and normal saline (NS) in treating AP. METHODS Two authors systematically searched Web of Science, Embase (via OVID), Cochrane Library, and PubMed to find all published research before July, 2023. The odds of moderately severe/severe AP and intensive care unit (ICU) admission are set as primary endpoints. RESULTS This meta-analysis included 5 RCTs and 4 observational studies with 1424 AP patients in LR (n = 651) and NS (n = 773) groups. The results suggested that the odds of moderately severe/severe AP (OR 0.48; 95%Cl 0.34 to 0.67; P < 0.001) and ICU admission (OR 0.37; 95%Cl 0.16 to 0.87; P = 0.02) were lower in the LR group compared to NS group. In addition, the LR group had lower rates of local complications (OR 0.54; 95%Cl 0.32 to 0.92; P = 0.02), lower level of CRP, as well as a shorter hospital stay (WMD, - 1.09 days; 95%Cl - 1.72 to - 0.47 days; P < 0.001) than the NS group. Other outcomes, such as mortality, the rate of organ failure, SIRS, acute fluid collection, pancreatic necrosis, pseudocysts, and volume overload, did not differ significantly between two groups (P > 0.05). CONCLUSIONS LR is preferred over NS as it decreases the odds of moderately severe/severe AP, the rate of ICU admission, local complication, and length of hospital stay. However, large-scale RCT are lacking to support these evidence.
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Affiliation(s)
- Jiaze Hong
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Qingyuan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yiran Wang
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lizhi Xiang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yifu Zhou
- Department of Neurosurgery, Affiliated Hospital, Shaoxing University, Shaoxing, China
| | - Mengke Fan
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Nickel T. Correspondence. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2023. [DOI: 10.3238/arztebl.m2022.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Beyer G, Mayerle J. Correspondence. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2023; 120:172. [PMID: 37106552 DOI: 10.3238/arztebl.m2022.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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