Etiological diagnosis of recurrent acute pancreatitis

Acute pancreatitis is the leading cause of inpatient care among gastrointestinal conditions. Despite early intervention, one-third of patients experience recurrent acute pancreatitis (RAP). A comprehensive diagnostic approach is warranted to identify and treat underlying factors in order to prevent recurrence. RAP is most frequent among men aged 30-40, smokers, and in those with excessive alcohol consumption. To identify the etiology is paramount to stratify patients according to their individual risk of RAP and for predicting an eventual evolution to chronic pancreatitis. Although the initial management of acute pancreatitis is widely homogeneous according to established guidelines, there are no defined protocols to investigate RAP. In the present editorial article we propose a structured algorithm with precise recommendations to investigate the etiology RAP as part of routine clinical practice. Although there are relevant knowledge gaps in this disease, we believe that our guidance would contribute for a more homogenous diagnostic approach of RAP in clinical practice.

Helicobacter Species and Hepato-Biliary Tract Malignancies: A Systematic Review and Meta-Analysis

Helicobacter species may cause chronic inflammation of the biliary tract, but its relationship with cancer is controversial. We performed a systematic review and meta-analysis to evaluate the association between Helicobacter species and hepatobiliary tract malignancies. Twenty-six studies (4083 patients) were included in qualitative synthesis, and 18 studies (n = 1895 qualified for meta-analysis. All studies were at high-intermediate risk of bias. Most studies combined several direct microbiological methods, mostly PCR (23 studies), culture (8 studies), and/or CLOtest (5 studies). Different specimens alone or in combination were investigated, most frequently bile (16 studies), serum (7 studies), liver/biliary tissue (8 studies), and gastric tissue (3 studies). Patients with Helicobacter species infection had an increased risk of hepatobiliary tract malignancies (OR = 3.61 [95% CI 2.18-6.00]; p < 0.0001), with high heterogeneity in the analysis (I² = 61%; p = 0.0003). This effect was consistent when Helicobacter was assessed in bile (OR = 3.57 [95% CI 1.73-7.39]; p = 0.0006), gastric tissue (OR = 42.63 [95% CI 5.25-346.24]; p = 0.0004), liver/biliary tissue (OR = 4.92 [95% CI 1.90-12.76]; p = 0.001) and serum (OR = 1.38 [95% CI 1.00-1.90]; p = 0.05). Heterogeneity was reduced in these sub-analyses (I² = 0-27%; p = ns), except for liver/biliary tissue (I² = 57%; p = 0.02). In conclusion, based on low-certainty data, Helicobacter species chronic infection is associated with a tripled risk of hepatobiliary tract malignancy. Prospective studies are required to delineate public health interventions.

MO667: Creating a New Cardiorenal Unit: 3-Year Study Results

BACKGROUND AND AIMS

Cardiorenal syndrome is a clinical manifestation of the bidirectional interaction between the heart and kidney diseases, so creating specific units between cardiologists and nephrologists is necessary for better treatment of these patients.

In our hospital we have recently formed a workgroup for better organization of patients who need peritoneal dialysis (PD) and day-hospital assistant.

The aim of this study is to analyse the evolution of the patients in our PD program since the creation of a new cardiorenal unit in our center.

METHOD

This study includes patients beginning PD due to cardiorenal syndrome since the creation of our cardiorenal unit, between 15 June 2018 and 14 June 2021. We have registered the date of PD initiation and also the date of exclusion of the technique. Also we performed a pre–post observational study comparing the number of hospitalizations/emergency visits in the year before PD starts and its evolution for the next year. Statistical study was analysed with SPSS software, for a P-value &lt;0.05.

RESULTS

Twelve patients (9 men and 3 women) have been included in this study. The mean age was 66.50 years (range 50–82). PD survival was 34.43 months (range 7–70). The number of hospitalizations/emergency visits was 8.04 in the year before PD started, and 0.44 the next year (P &lt; 0.05). Nine of 12 patients had zero hospitalizations in the 12 months after initiating PD.

CONCLUSION

PD is an interesting treatment option for patients with cardiorenal diseases, which allows a significant reduction in hospitalization and decompensation rates. Creating new cardiorenal units is a good option for the integral management of these patients.

Malignancy of intraductal papillary neoplasm of the bile duct

The intraductal papillary neoplasm of the bile duct (IPNB) is an uncommon disease which was first included in the World Health Organization classification of neoplasms in 2010. Although some patients may be asymptomatic, symptoms include most frequently abdominal pain, cholangitis and jaundice. Contrary to the pancreatic intraductal papillary mucinous neoplasm, this entity has higher risk of malignancy and progression to invasive carcinoma. However, the postsurgical prognosis for a patient with IPNB is good, with no need of adjuvant therapy. We present the case of a patient with biliary septic shock that prompted urgent surgical intervention. Diagnosis was histopathologically confirmed with the surgical specimen, which showed malignant transformation. During follow up, the patient developed peritoneal carcinomatosis and progression of the disease despite chemotherapy.

Effect of high-oxygen and high-carbon-dioxide atmospheres on strawberry flavor and other quality traits

The effect of high-oxygen atmospheres on strawberry flavor was studied. Strawberry fruits (Fragariax ananassa Duch. cv. Camarosa) were stored at 8 degrees C in four different atmospheres: air, 5% O(2)/20% CO(2), 80% O(2)/20% CO(2), and 90% O(2)/10% CO(2). Changes in several quality parameters were evaluated. Atmospheres combining high O(2) and high CO(2) were the most effective in preventing fungal growth and enhancing strawberry firmness. Other quality parameters such as color, titrable acidity, sugars and organic acids distribution, off-flavor development, and aroma were only mildly affected by superatmospheric O(2) levels. After one week of storage, unexpected high contents of off-flavor related compounds were found in the 80% O(2)/20% CO(2) and 90% O(2)/10% CO(2) atmospheres. Evidence of an altered ester biosynthesis was also found in fruits stored under these high-O(2) atmospheres. Data obtained suggest that stress induced by high CO(2) and stress induced by high O(2) have an additive effect on strawberry flavor alteration.

Cytosolic aldolase is a ripening related enzyme in strawberry fruits (Fragaria x ananassa)

Two aldolase isoenzymes have been isolated from ripe strawberry fruits (Fragaria x ananassa cv. Camarosa and Elsanta) and partially purified by DEAE anion exchange and Sephacryl size exclusion chromatography. The isoenzymes were identified as class I cytosol and plastid aldolase on the basis of their chromatographic behavior on DEAE-cellulose columns, native molecular weight, pH optimum pattern, Km value for D-fructose-1,6-bisphosphate, tendency to be inactivated by lower pH values and SDS-PAGE subunit determination of 40 and 38 kDa, respectively. Total aldolase activity and distribution of both aldolase isoenzymes was also investigated at different stages of strawberry fruit ripening. Strawberries in the green and white ripening stage showed the same ratio of the two isoenzymes as green leaves with 15 and 8% cytosol aldolase activity, respectively. During strawberry fruit development the overall total aldolase activity decreased until the pink ripening stage and then increased due to a rise of cytosol aldolase yielding up to 75% in red strawberries. A cDNA putatively encoding the cytosolic form of aldolase in strawberry was cloned during the course of this study. Both microarray and RNA gel blot analyses showed that the cytosolic aldolase gene expression is induced during ripening as detected for the cytosolic aldolase enzyme. We suggest that induction of the cytosolic aldolase both at the levels of transcription and translation might be part of a ripening related stress response in the receptacle tissue.

Relationship between clinical and biologic variables and chloramphenicol pharmacokinetic parameters in pediatric patients with sepsis

OBJECTIVE

To evaluate the influence of several clinical and biologic factors on the disposition kinetics of oral chloramphenicol in pediatric patients and to determine the usefulness of this information to predict chloramphenicol serum concentrations.

STUDY DESIGN

The clinical, biologic, and pharmacokinetic data of 30 consecutive pediatric patients diagnosed with sepsis and admitted to a tertiary care center were analyzed retrospectively. The patients were randomly assigned to a study group and a validation group. The model was developed by a three-step approach involving Bayesian estimation of pharmacokinetic parameters, selection of covariates by principal component analysis, and final selection by stepwise multiple linear regression. The model was tested in the study group and compared with a general population model using a prediction error analysis.

RESULTS

Regression analysis revealed that weight, albumin, and white blood cell (WBC) count were the most important determinants for chloramphenicol distribution volume, whereas age, WBC count, and serum creatinine were the most important determinants for chloramphenicol clearance. The performance of the constructed population model improved significantly in terms of both bias and precision compared with the general model when tested in the validation group.

CONCLUSIONS

Clinical and biologic factors may significantly influence chloramphenicol's disposition in pediatric patients with sepsis and therefore should be considered in programming dosage regimens.

Effects of ozone treatment on postharvest strawberry quality

The effect of ozone treatment on the postharvest quality of strawberry was evaluated. Strawberry fruits (Fragaria x ananassa Duch. cv. Camarosa) were stored at 2 degrees C in an atmosphere containing ozone (0.35 ppm). After 3 days at 2 degrees C, fruits were moved to 20 degrees C to mimic retail conditions (shelf life). The changes in several quality parameters such as fungal decay, color, sugar and acids distribution, and aroma were evaluated during the strawberries' shelf life. Ozone treatment was ineffective in preventing fungal decay in strawberries after 4 days at 20 degrees C. Significant differences in sugars and ascorbic acid content were found in ozone-treated strawberries. At the end of cold storage, the vitamin C content of ozonated strawberries was 3 times that of control fruits. A detrimental effect of ozone treatment on strawberry aroma was observed, with a 40% reduced emission of volatile esters in ozonated fruits.

Biosynthesis of 4-hydroxy-2,5-dimethyl-3(2H)-furanone and derivatives in in vitro grown strawberries

The biosynthesis of 2,5-dimethyl-4-hydroxy-3(2H)-furanone (Furaneol) and its methyl ether and glucoside derivatives has been studied in strawberries. An in vitro system was used for growing this fruit, showing that the presence in the incubation medium of sucrose or hydroxyquinoline hemisulfate has no effect on the bioformation of these compounds. Strawberries in vitro grown showed an increase in furanone content with time, especially between the second and fourth days, to the same extent as field-grown fruits but at a higher rate. Among the precursors added to the incubation medium, D-fructose gave rise to an increase in furaneol and its glucoside derivative of 42. 6% and 26.3%, respectively. D-fructose 6-phosphate seems to be the precursor of furaneol in strawberries since, when present in the incubation medium, it produced an average increase of 125% in all furanones contents with respect to control fruits.

Lipoxygenase and hydroperoxide lyase activities in ripening strawberry fruits

The enzymes lipoxygenase and hydroperoxide lyase have been identified in strawberry (Fragariax ananassa Duch.) var. Camarosa. Their subcellular localization, substrate preference, and product specificity were determined in mature strawberry fruits. The activity of both enzymes was located mainly in the microsomal fraction. Linolenic acid was the preferred substrate for strawberry lipoxygenase, forming 13- and 9-hydroperoxides of this acid in the proportion 70:30. The strawberry hydroperoxide lyase cleaves 13-hydroperoxide of linoleic (13% relative activity) and linolenic (100% relative activity) acids to form hexanal and (3Z)-hexenal, respectively. Both enzyme activities and endogenous content of volatile aldehydes formed by sequential action of lipoxygenase-hydroperoxide lyase were evaluated during strawberry development and ripening. A sequential enzymatic pathway for the formation of green odor compounds in strawberry is proposed.

Characterization of three potato lipoxygenases with distinct enzymatic activities and different organ-specific and wound-regulated expression patterns

Lipoxygenases are ubiquitous enzymes in eukaryotes. In plants, lipoxygenases are involved in the synthesis of the hormone jasmonic acid that regulates plant responses to wounding and, in addition, is an inducer of tuberization in potato. We have isolated potato lipoxygenase cDNA clones. From their deduced amino acid sequences, three distinct classes are defined (Lox1, Lox2, and Lox3). They are encoded in gene families that display organ-specific expression, lox1 being expressed mostly in tubers and roots, lox2 in leaves, and lox3 in leaves and roots. Consistent with their organ-specific expression pattern, Lox1 expressed in bacteria preferentially uses as substrate linoleic acid, abundant in membrane lipids of tubers, whereas linolenic acid, prevalent in leaves, is the preferred substrate for the other two classes of lipoxygenase. Analyses on reaction products of the enzymes expressed in bacteria reveal that Lox1 primarily produces 9- hydroperoxides. In contrast, the jasmonic acid precursor, 13-hydroperoxylinolenic acid, is the major product of the action of Lox2 and Lox3 on linolenic acid. Upon wounding, the levels of Lox2 and Lox3 transcripts rise markedly in leaves. While Lox3 mRNA accumulation peaks as early as 30 min after wounding, Lox2 shows a steady increase over a 24-h time course, suggesting different roles for these lipoxygenase isoforms in the synthesis of the plant hormone jasmonic acid.

Botryomycosis

A case of botryomycosis was studied in which a coagulase-negative, DNAsenegative Staphylococcus with wide antibiotic sensitivity in vitro was isolated and which could be classified as having a 'low pathogenic capacity'. Nevertheless, there was no improvement with appropriate therapy. IgG and complement (C3) were demonstrated in the grains. Botryomycosis can be considered as a state of 'equilibrium' between the host and the microorganism. It is not clear if this results from low pathogenicity of the organism or from some peculiar characteristic of the host.