Acute Abdominal Disease Research Articles

Characterization of total adenosine deaminase activity (ADA) and its isoenzymes in saliva and serum in health and inflammatory conditions in four different species: an analytical and clinical validation pilot study

BackgroundMeasurement of adenosine deaminase (ADA) can provide information about cell-mediated immunity. This report’s objective was to study the enzymatic activity of total ADA (tADA) and its isoenzymes ADA1 and ADA2 in canine, equine, porcine, and bovine serum and saliva and their changes in different inflammatory situations in each species. Besides, an automated method for ADA2 measurement was developed and validated.ResultstADA was present in serum and saliva of healthy animals of the four species. Erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA) concentration of 0.47 mM was needed for ADA1 inhibition in canine and porcine samples (serum and saliva) and bovine saliva, whereas for equine saliva 0.94 mM was needed. ADA2 activity was not detected in bovine serum and was very low or absent in equine serum and bovine saliva. An automated procedure to measure ADA2 consisting of adding EHNA to a commercial reagent for tADA measurement provided repetitive (coefficients of variation < 8.8% in serum and < 10% in saliva) and accurate (linearity of serial sample dilutions with R2 > 0.90) results, being equivalent to a manual incubation of the sample with EHNA at a similar concentration. Salivary tADA, as well as ADA1 and ADA2, were higher in dogs with leishmaniosis, horses with acute abdominal disease and pigs with lameness than in healthy animals. tADA and isoenzymes in saliva showed a positive significant correlation with serum ferritin in dogs (r = 0.602, P < 0.01; r = 0.555, P < 0.05; and r = 0.632, P < 0.01; respectively for tADA, ADA1 and ADA2) and serum C-reactive protein in pigs (r = 0.700, P < 0.01, for both tADA and ADA1; r = 0.770, P < 0.001, for ADA2), whereas salivary ADA2 significantly correlated with serum amyloid A in horses (r = 0.649, P < 0.01). In cows, salivary tADA and ADA1 significantly increased after calving, correlating with total white blood cell count (r = 0.487, P < 0.05, for both tADA and ADA1).ConclusionsThe activity of total ADA and its different isoenzymes, can be measured in serum and saliva of dogs, horses, pigs and cows by a simple and fast procedure described in this report. When measured in saliva, these analytes correlated with other biomarkers of inflammation and it could potentially be used as a biomarkers of inflammation and immune activation in the species of this study.

Identification of Significant Genes and Pathways in Acute Pancreatitis via Bioinformatical Analysis.

Acute pancreatitis (AP) is one of the common acute abdominal diseases with complicated pathogenesis. The purpose of this study is to identify the differentially expressed genes (DEGs) in the pancreas and underlying mechanisms. Gene expression profiles of GSE109227 and GSE65146 were available from GEO database. Then, an integrated analysis of these genes was performed, including gene ontology (GO) and KEGG pathway enrichment analysis, protein-protein interaction (PPI) network construction, core gene correlation analysis, transcription factors (TFs) prediction, and expression level evaluation in human organs. A total number of 92 differential expressed genes were screened from the datasets, including 81 up-regulated genes and 11 down-regulated genes. The up-regulated genes were mainly enriched in the biological process, such as sarcomere organization, actin cytoskeleton organization, tumor necrosis factor biosynthetic process, response to cytokine, cell-cell adhesion, and the cell migration, and also involved in some signaling pathways, including leukocyte transendothelial migration, proteoglycans in cancer, thyroid cancer, cell adhesion, tight junction, bladder cancer, amoebiasis, glycerolipid metabolism, and VEGF signaling pathway, while down-regulated genes were significantly enriched in the endoplasmic reticulum unfolded protein response, the oxidation-reduction, and no significant signaling pathways. CDH1 and CLDN4 were identified as core genes by PPI network analysis with MCODE plug-in, as well as GO and KEGG re-enrichment. For validation in Gene Expression Profiling Interactive Analysis (GEPIA), CDH1 and CLDN4 were interacting with each other and regulated by the predictive common TFs FOXP3 or USF2. The two core genes and USF2 were expressed in varied human organs including the pancreas, while FOXP3 was not detected in the normal human pancreatic tissues. This study implied that core gene CDH1 and CLDN4, which might be regulated by FOXP3 or USF2, played a significant role in acute pancreatitis. They could be potential diagnostic and therapeutic targets for AP patients.

Multisection spiral CT in the diagnosis of adhesive small bowel obstruction: the value of CT signs in strangulation

Small bowel obstruction (SBO) is usually caused by mechanical obstruction or by irreversible changes in the normal position of the small bowel, with obstruction of bowel contents. According to the blood supply of the intestinal wall, SBO can be divided into simple and strangulated small bowel obstruction. Strangulated small bowel obstruction is one of the most serious acute abdominal diseases in general surgery. The most common aetiology is intraperitoneal adhesions.1,2 Delayed treatment can cause serious complications, such as peritonitis, intestinal perforation, infection, shock, and systemic failure.

Surgery Techniques for Urgent Intestinal Neostomy and Bypass

Introduction. Modern standards for the treatment of acute abdominal surgical diseases suggest a temporary exclusion of the impaired intestinal part from the digestion. This reduces the morbidity of the primary operation, but also results in specific postoperative complications.The aim of the study was to analyze current data on the technique and effectiveness of urgent intestinal neostomy and bypass surgery.Results. The authors analyzed 39 modern literature sources that deal with the problem of urgent intestinal neostomy and bypass surgery. Currently, there is a growing interest in developing techniques for early (before anastomosis) restoration of the chyme passage across the intestine bypassing the impaired intestinal area. It has been reported that a number of unresolved issues do not yet allow full implementation of the concept of intestinal bypass (shunt): a safe mechanism for performing an anastomosis between the small intestine and a synthetic prosthesis has not been developed, the problem of creating unidirectional pathway along a non-peristaltic intestinal prosthesis has not been solved.Conclusion. Solution of these problems can contribute to a significant improvement in the clinical outcomes of patients with acute ischemic or traumatic damage to the intestine.

Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen

Malignant tumor-associated acute abdomen refers to a non-perioperative acute abdominal disease caused by malignant tumors or caused by various anti-tumor treatments with acute abdominal pain as the main clinical manifestation. It is often critical and even life-threatening. For patients with malignant tumor-associated acute abdomen, the occurrence and development of tumors and the evolution of acute complications are often causal to each other. Therefore, diagnosis and treatment of malignant tumor-associated acute abdomen usually require the surgery-based multidisciplinary treatment (MDT). According to imaging features and access to medical resources, oncologists and surgeons, working with other relevant professional teams need to develop the most appropriate treatment strategy through hierarchical management based on different oncology assessments and treatment goals. Yet there is no consensus on diagnosis and treatment of malignant tumor-associated acute abdomen. Therefore, Chinese College of Surgeons, Chinese Society for Clinical Oncologists, Chinese Society of Multidisciplinary Team, and the Chinese Journal of Gastrointestinal Surgery gathered multidisciplinary experts in China to discuss and develop the Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen. This consensus consists of three parts, namely multidisciplinary diagnosis and evaluation, multidisciplinary prevention and treatment, and specific treatment of common malignant tumor-associated acute abdomen. The diagnosis and evaluation section mainly includes oncology, imaging diagnosis and surgical perioperative evaluation. The prevention and treatment section mainly includes the prevention of malignant tumor-associated acute abdomen, the principle of treatment based on surgery, anti-tumor therapy-induced acute abdomen, as well as the prevention and management of special biological types of malignant tumor-associated acute abdomen. The last part discusses specific treatment of malignant tumor-associated acute abdomen such as gastrointestinal obstruction (surgery, palliative care, endoscopic or interventional surgery), gastrointestinal perforation (perioperative and surgical treatment), gastrointestinal bleeding (medical treatment, endoscopic surgery, interventional surgery, and surgical treatment), biliary system-associated acute abdomen (treatment of acute cholangitis, acute cholecystitis, and gallbladder perforation), and rupture of liver cancer (general treatment, transarterial embolization, and surgical treatment). We hope this consensus will help clinicians to understand the multidisciplinary standardized diagnosis and treatment of patients with malignant tumor-associated acute abdomen and to serve as a practical reference.

Application of Six Sigma management in reducing the misdiagnosis rate of acute abdomen pre-examination in emergency department

Objective To explore the effect of the Six Sigma management in reducing the pre-examination and triage error rate of emergency acute abdominal diseases. Methods Data of 367 misdiagnosed patients in Emergency Department of Shanxi Bethune Hospital from January to June 2018 were collected. Six Sigma management method was applied to the management of emergency acute abdomen triage. After analyzing the causes of errors, improvement measures were formulated and implemented.A total of 118 patients who were triaged from September 2018 to February 2019 were taken as the intervention group to evaluate the effect. Results After the implementation of Six Sigma management, the errors of acute abdomen diagnosis were significantly reduced from 9.92%(367/3 698) to 2.80%(118/4 219), and there was a significant difference before and after the implementation (χ2 value was 174.082, P < 0.05). Conclusions The application of Six Sigma management method can effectively reduce the misdiagnosis rate of emergency acute abdomen triage and realize standardized management of acute abdomen triage, which has the value of popularization and application. Key words: Six Sigma theory; Acute abdominal diseases; Emergency pre-examination and triage; Error rate

Edaravone Protects against Pancreatic and Intestinal Injury after Acute Pancreatitis via Nuclear Factor-κB Signaling in Mice.

Acute pancreatitis (AP) is one kind of acute surgical abdominal disease in the world. It causes intestinal damage with subsequent bacterial migration, endotoxemia and secondary pancreatic infections. In this investigation, we determined that edaravone (EDA) reduces pancreatic and intestinal injury after AP in mice. This was demonstrated by a reduction in histological score, apoptosis, interleukin (IL)-6, IL-1β and tumor necrosis factor (TNF)-α, along with obstructing activation of Toll-like receptor 4 (TLR4) and nuclear factor-κB (NFκB). Our study results suggested that EDA exerts its protective effects against pancreatic and intestinal injury after AP via regulation of the TLR4/NFκB pathway. Our findings provide the basis for EDA to treat AP-induced pancreatic and intestinal injury, even might develop as a potential therapy for other inflammatory diseases.

An integrated strategy of TCM and western medicine to prevent and treat acute abdomen during the outbreak of COVID-19

At present, the prevention and control of the COVID-19 is still severe, its pathogen SARS-CoV-2 is highly infectious and pathogenic, and the population is generally susceptible. Thus, it requires a higher standard to diagnose and treat patients with acute abdomen. The first step is to carry out procedures to identify whether the patient is infected or not. Those who are not infected can go through the normal treating procedures. For patients diagnosed with COVID-19 or suspected patients, the second step is to achieve classified diagnoses and treatments, and to adopt a treating plan that integrates TCM and western medicine. In order to protect patients and medical staff, the COVID-19 in hospital transmission must be avoided. For patients with COVID-19 who need emergency surgery, we must strictly comply with the hospital's protection regulations, closely coordinate the relevant departments of surgery, perform the three-level protection, operate in accordance with the principle of damage control in the negative pressure surgery room, and return to the isolation ward according to the prevention and control process after operation. For units without surgical conditions, patients should be transferred to hospital in time on the premise of maximum damage control, and patients must not be delayed for timely diagnosis and treatment due to the epidemic. Key words: Novel coronavirus; Pneumonia, viral; Acute abdominal diseases; Traditional Chinese and Western Medicine

Prevention and treatment strategies of Traditional Chinese and Western Medicine for acute abdomen during the outbreak of COVID-19

At present, the prevention and control of the COVID-19 is still severe, its pathogen SARS-CoV-2 is highly infectious and pathogenic, and the population is generally susceptible. In order to deal with the epidemic, selective operation can be postponed, but most of the patients with acute abdominal diseases are commonly in clinic, with acute onset and severe condition, and most of them are accompanied with fever and gastrointestinal symptoms, so emergency operation is needed.Under the condition of the current epidemic—COVID-19, it requires a higher standard to diagnose and treat patients with acute abdomen. The first step is to carry out procedures to identify whether the patient is infected or not. Those who are not infected can go through the normal treating procedures.For patients diagnosed with COVID-19 or suspected patients, the second step is to achieve classified diagnoses and treatments, and to adopt a treating plan that integrates TCM and western medicine.In order to protect patients and medical staff, the COVID-19 in hospital transmission must be avoided. For patients with COVID-19 who need emergency surgery, we must strictly comply with the hospital's protection regulations, closely coordinate the relevant departments of surgery, perform the three-level protection, operate in accordance with the principle of damage control in the negative pressure surgery room, and return to the isolation ward according to the prevention and control process after operation. For units without surgical conditions, patients should be transferred to hospital in time on the premise of maximum damage control, and patients must not be delayed for timely diagnosis and treatment due to the epidemic. Key words: novel coronavirus; pneumonia; viral; acute abdominal diseases; Traditional Chinese and Western Medicine

The Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis.

Acute appendicitis is one of the most common causes of acute abdominal diseases seen between the ages of 10 and 19, mostly seen in males. The lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females. We aimed to investigate the efficacy of the complete blood count parameters, C-reactive protein, and Lymphocyte-C-reactive Protein Ratio laboratory tests in the diagnosis of acute appendicitis, as well as their relationship with appendix diameter. We retrospectively examined all patients who underwent appendectomy between 1 January 2012 and 30 June 2019 in the General Surgery Clinic of Gaziosmanpasa University Faculty of Medicine. Laboratory tests, imaging findings, age, and gender were recorded. Lymphoid hyperplasia is considered as normal appendix—in other words, as negative appendicitis. The distribution of Lymphoid hyperplasia and appendicitis rates were statistically different in the groups formed according to appendix diameter (≤6 and >6 mm) (p < 0.001). We found a significant correlation between appendix diameter and WBC (White blood count), Lymphocyte, Neutrophil, RDW(Red blood cell distribution width), NLR(Neutrophil to lymphocyte ratio), and PLT/L (Platelet to lymphocyte ratio), MPV (Mean platelet volume) and RDW were significantly different in patients with an appendix diameter of ≤6 mm (p = 0.007, p = 0.006, respectively). WBC, Neutrophil, PDW, and NLR values were significantly different between appendicitis and hyperplasia groups in patients with an appendix diameter of >6 mm. The sensitivity of the NLR score (cutoff = 2.6057) in the diagnosis of appendicitis was 86.1% and selectivity was 50% in these patients. Complete blood count parameters evaluation with the clinical findings revealed that NLR is an important parameter that may help the diagnosis of acute appendicitis with an appendix diameter of >6 mm. In patients whose pathological results indicated acute appendicitis but who had a diameter of ≤6 mm, we found an elevated MPV and low RDW values.

Current trends in emergency abdominal surgery in the Russian Federation

To analyze morbidity and factors affecting mortality in emergency abdominal surgery in the Russian Federation. The study included patients with acute abdominal diseases aged 18 years and older. All patients were hospitalized in emergency surgical care departments of 3.194 state healthcare institutions in 84 regions of the Russian Federation in 2018. Morbidity, surgical activity and mortality were analyzed. There were 680.337 cases of hospitalization in emergency surgical department, morbidity rate was 582 cases per 100 000. The most common emergency surgical diseases were acute appendicitis (142.3 cases per 100 000), acute cholecystitis (139.0 cases per 100 000) and acute pancreatitis (131.2 cases per 100 000). Surgery was performed in 399.051 (58.7%) patients. In-hospital mortality rate was 2.4% (16 051 cases). There are certain factors affecting mortality rate in acute abdominal diseases. The leading problems in organizing emergency surgical care in Russia are insufficient equipment of rural and small municipal surgical hospitals, different staffing with surgeons in rural areas and large cities and late hospitalization of patients.

Biomarkers of system inflammation in local and diffuse peritonitis

In cases of any acute surgical abdominal disease the progression of purulent inflammation can lead to local or diffuse peritonitis. The indicators of the degree and specificity of the inflammatory response in blood such as cytokine concentration, neutrophil activity, plasma antioxidant capacity (thiols concentration) could be considered as potential predictors of complications. The luminol-dependent chemiluminescence (CL) response of blood activated by the phorbol ester (PMA), and the concentration of cytokines IL-6, IL-8, IL-10, myeloperoxidase (MPO) and thiols in plasma were measured in patients with uncomplicated condition (group 1, n=8), local peritonitis (group 2, n=9) or diffuse peritonitis (group 3, n=9) at admission to surgery (before surgical operation, b/o), immediately after surgical operation (a/o) and a day after surgery (1 day) as well as in healthy volunteers (norm, n=12). In all time-points the cytokines and MPO concentrations measured by ELISA, in group 3 were higher than in healthy volunteers and in patients in groups 1 and 2. Blood CL demonstrated a more than 5-fold increase above the normal values in all patients, and was also higher in group 2 as compared to group 1 (b/o and a/o). Patients in group 3 had shown both maximum and minimum of CL values, which could be a consequence of neutrophil priming or exhaustion ("immune paralysis"), respectively. The same patients' plasma exhibited low thiol concentration (≤30% vs normal values). In patients with fatal outcomes (group 3, n=2) within a day after surgery, either a decrease of the CL to zero values concurrently with elevated IL-8 and IL-6 concentrations and low thiol levels was observed, or CL exceeded normal values more than 20 times with concurrent complete exhaustion of the plasma thiol pool. No clear dependency between the plasma parameters and neutrophil activity was found. Hence a parameter set for prognosis and/or early diagnosis of infectious complications in acute abdominal pathology should include different biomarkers of the inflammatory response: cytokine profile (IL-6, IL-8, IL-10), MPO and neutrophil activity, antioxidant plasma capacity (e.g., total thiols concentration).

Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study.

Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which has previously proven reliability for AMI. The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. TDH, IMA, and serum lactate values were measured at h 0, 1, 3, and 6. In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.

Application value of ultrasound interventional technique in the treatment of severe acute pancreatitis

Severe acute pancreatitis (SAP) is an acute abdominal disease characterized by acute onset, serious illness, multiple complications, and high mortality. Surgical interventions have been used throughout the treatment of SAP for a long time, including traditional surgical treatments led by laparotomy and modern surgical treatments led by minimally invasive surgery. Especially in the past 10 years, with the deep understanding of the etiology and pathology of SAP and the increasing complications of traditional surgical treatments, a series of minimally invasive surgical techniques are widely applied in the clinical treatment of SAP, which achieved satisfactory clinical results. Among them, ultrasonic intervention technology plays a key role in the advantages of convenience, minimal invasiveness and strong repeatability. Based on recent literatures at home and abroad, this article reviews the application value of ultrasound interventional techniques in the treatment of SAP. Key words: Minimally invasive surgery; Severe acute pancreatitis; Ultrasonic intervention; Tube drainage; Treatment

Research advance of optimal timing for early enteral nutrition on severe acute pancreatitis

Severe acute pancreatitis is a common clinical acute abdominal disease, characterized by acute onset, rapid progression, high risk, poor prognosis and so on. Due to the high mortality of this disease, it has been the focus and difficulty of clinical research. The traditional treatment of severe acute pancreatitis mainly include fasting and parenteral nutrition. However, recently, international and national consensus suggest that early enteral nutrition is fit for severe acute pancreatitis, although the timing of early enteral nutrition has been controversial. The article summarizes the optimal timing of early enteral nutrition for severe acute pancreatitis. Key words: Pancreatitis; Enteral nutrition; Severe acute pancreatitis; Optimal timing

Pim-3 alleviates lipopolysaccharide-stimulated AR42J pancreatic acinar cell injury via improving the inflammatory microenvironment.

Acute pancreatitis (AP) is a common acute abdominal disease characterized by pancreatic aseptic inflammation, with ~20% of patients progressing to severe AP (SAP) with a high mortality rate. The aim of this study was to explore the protective effects of Pim-3 proto-oncogene, serine/threonine kinase (Pim-3) on rat pancreatic acinar AR4-2J cells damaged by lipopolysaccharide (LPS). The recombinant plasmid p-enhanced green fluorescent protein (pEGFP)-N2/Pim-3 was transiently transfected into AR42J cells and the AR42J cells were then treated with 2 µg/ml LPS. Subsequently, the proliferation of AR42J cells was detected using MTT assay. The cell cycle progression and apoptosis rate of the AR42J cells were examined using flow cytometry. AR42J cell migration was assessed using wound healing assays. Additionally, RT-semi quantitative PCR and western blot analyses were used to detect the mRNA and protein expression levels, respectively, of Pim-3, interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, intercellular adhesion molecule (ICAM)-1 and Occludin in AR42J cells. The results revealed that proliferation of AR42J cells was significantly enhanced and cell apoptosis was markedly reduced in the pEGFP-N2/Pim-3 + LPS group. The proportion of AR42J cells in G1 phase in the pEGFP-N2/Pim-3 + LPS group was decreased, whereas the proportion of cells in the G2 and S phases was increased. The wound healing assays demonstrated that AR42J cell migration was significantly increased in the pEGFP-N2/Pim-3 + LPS group. Finally, the expression levels of IL-6, IL-1β, TNF-α and ICAM-1 were significantly decreased in the pEGFP-N2/Pim-3 + LPS group, whereas the expression of Occludin was significantly increased. The present study demonstrated that raised expression levels of Pim-3 can protect AR42J cells from LPS-induced injury by modifying the inflammatory microenvironment, suggesting that Pim-3 may be a potential target for AP or SAP therapy.

Laparoscopy in acute abdomen between encouragement and inhibition

Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases.Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen.Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of patients but failed to reach the diagnosis in 2 cases and conversion to laparotomy in other 2 cases. Laparoscopic surgery mean was 47.9±12.4 minutes. Hospital stay mean was (1.851) days. Morbidity was 10%. No mortality was found in our study.Conclusions: Laparoscopy can be considered safe for diagnosis and effective in the treatment of patients with acute abdomen. It may be useful to avoid the unnecessary laparotomies in a large number of patients presented with acute abdominal pain.

Iguratimod (T-614) attenuates severe acute pancreatitis by inhibiting the NLRP3 inflammasome and NF-κB pathway

Severe acute pancreatitis (SAP) is an acute abdominal disease that can develop locally to the multiple organs. It is characterized by pancreatic tissue self-digestion, and the rapid release of inflammatory cytokines, which play a dominant role in local or even systemic inflammation. In this study, we investigate the protective effect of T-614 against SAP induced by cerulein plus LPS in mice. Biochemical markers associated with pancreatitis in serum such as inflammatory cytokines, amylase and lipase activities were measured. Related proteins of NLRP3 inflammasome and NF-κB signaling pathway were evaluated by western blotting. Hematoxylin-eosin staining (HE) and immunohistochemistry (IHC) were used to evaluate changes of inflammation in pancreatic tissue. T-614 significantly alleviated the elevation markers of pancreatitis and suppresses the pancreatic tissue damage, including histopathological and molecular manifestations. In conclusion, T-614 plays a protective role in experimental SAP mice model via anti-inflammatory effects.

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

BACKGROUNDAcute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients.AIMTo investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications.METHODSThe clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed.RESULTSIn this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin.CONCLUSIONIn this study, we identified the timing, the common species, and site of infection in patients with NP.

Changes in saliva analytes in equine acute abdominal disease: a sialochemistry approach

BackgroundThe biochemical components of saliva can change in certain pathologies in horses, for example in acute abdominal disease. The aim of this study was (1) to evaluate if a panel of biochemical analytes usually used in serum can be measured in saliva of horses and (2) to study the possible changes of these biochemical analytes in saliva of horses affected by acute abdominal disease. A panel of 23 analytes was analytically validated in saliva of horses and possible changes in these analytes in a pilot study with six healthy horses and six horses with acute abdominal disease were evaluated. The analytes with significant changes were then evaluated in a larger population of 20 healthy and 37 diseased horses.ResultsSeven analytes showed significant increases in the pilot study which were confirmed in the larger population. The analytes which showed significant changes, and their median fold increase and significance shown in the larger population were salivary γ-glutamyl transferase (gGT, 2.3 fold, P = 0.001), creatine kinase (CK, 6.2 fold, P < 0.001), urea (2.3 fold, P = 0.001), total bilirubin (2.6 fold, P < 0.001), total proteins (3.2 fold, P < 0.001), phosphorus (P, 4.5 fold, P < 0.001) and alpha-amylase (sAA, 8.5 fold, P < 0.001). Total proteins, P and sAA showed sensitivities higher than 70% at their optimal cut-off points and a specificity of 100% in differentiating between healthy horses and those with acute abdominal disease.ConclusionsA panel of 23 biochemical analytes can be measured in saliva of horses, where gGT, CK, urea, total bilirubin, total protein, P and sAA levels are raised in horses with acute abdominal disease.