Acute Panereatitis Research Articles

Protective mechanism of omega-3 fish oil on mucosal barrier with severe acute panereatitis

Objective To evaluate the protective effect of omega-3 fish oil on the intestinal mucosal barrier with severe acute pancreatitis (SAP).Methods Forty Six SAP patients were enrolled (23 patients in each group) and received total parenteral nutrition (TPN) for 6 days,providing 0.8 g/(kg· d)soybean oil +0.2 g/(kg·d) ω-3 FAs based fat (FO group) or 1.0 g/(kg·d) standard soybean-oil based fat (SO group).The levels of plasma endotoxin,D-lactate and serum I-FABP expression were measured before and 7 days day after TPN.Results Forty-six patients included had significantly higher plasma level of endotoxin and D-lactate,and higher serum I-FABP concentration in the first 72 h (P ＞ 0.05).At 7th day aforementionged indexes were significantly decreased in all SAP patients.Gastrointestinal function score,plasma endotoxin and D-lactate,and serum I-FABP concentrations in FO group were significantly lower than in SO group (P ＜ 0.05,1.61 ± 0.79 vs.2.02 ± 0.68 ; 0.24 ± 0.15 vs.0.42 ± 0.11 ; 2.89 ±1.23 vs.3.95 ± 1.17 ; 77.5 ± 38.4 vs.100.5 ± 42.8).Conclusion Omega-3 fish oil supplementation reduces plasma endotoxin and D-lactate,and serum I-FABP concentrations,protects the intestinal mucosal barrier,and thereby decreases intestinal mucosal permeability in SAP. Key words: Acute pancreatitis; Omega-3 fish oil; Intestinal mucosal barrier

Effects of Shenmai injection on the expression of intercellular adhesion molecule-1 in rats with severe acute panereatitis

Objective To explore the impact of Shenmai injection on the levels of plasma soluble intercellular adhesion molecule-1 ( sICAM-1 ) and ICAM-1 mRNA in the pancreas tissue of rats with severe acute pancreatitis (SAP).Methods One hundred and eight SD male rats were randomly divided into three groups:sham operation group (group A),SAP model group (group B),Shenmai injection group ( group C).The rats in groups B and C were further divided into four subgroups based on the time points of constructing model:4,8,16 and 24 h subgroups (n =12 each).The levels of plasma sICAM-1 and the ICAM-1 mRNA in the pancreas tissue of rats were compared among the three groups.Results The levels of plasma sICAM-1 were significantly higher in group B than in 4,8,16 and 24 h subgroups of group A (128.07±15.86 vs 87.31 ±13.16,142.33±22.61 vs 98.82 ±11.39,187.45±17.39 vs 129.51 ±15.61,and 176.18 ± 19.36 vs 123.57 ± 17.03) ( all P ＜0.05).The levels of plasma sICAM-1 were significantly lower in group C than those in 4,8,16 and 24 h subgroups of group B (92.55 ± 8.09 vs 128.07 ± 15.86,105.28 ± 14.29 vs 142.33 ± 22.61,142.36 ± 18.25 vs 187.45 ± 17.39,131.32 ± 21.83 vs 176.18 ±19.36) ( all P ＜ 0.05 ).The expression of 1CAM-1 mRNA in the pancreatic tissue was significantly higher in group B than that in4,8,16 and 24 h subgroups of group A (0.97 ±0.12 vs 0.52 ±0.11,1.08 ±0.18 vs 0.61±0.13,1.32±0.18 vs0.82±0.14,1.23 ±0.09vs0.74±0.13) (allP＜0.05).The expression of ICAM-1 mRNA in the pancreatic tissue was significantly lower in group C than that in 4,8,16 and 24 h subgroups of group B ( 0.59 ± 0.13 vs 0.97 ± 0.12,0.68 ± 0.09 vs 1.08 ± 0.18,0.96 ±0.20vs1.32±0.18,0.88±0.09vs1.23±0.09) (allP＜0.05).Conclusion Shenmai injection could improve microcirculation and protect rats with SAP through decreasing the levels of plasma sICAM-1and the ICAM-1 mRNA of the pancreas tissue. Key words: Severe acute pancreatitis ; Intercellular adhesion molecule-1 ; Shenmai injection

Comparative evaluation of blood markers and extrapancreatic inflammatim on CT score in the early prediction of the severity of acute panereatitis

Comparative evaluation of blood markers and extrapancreatic inflammatim on CT score in the early prediction of the severity of acute panereatitis

The protective effect of rosiglitazone on renal injury of severe acute pancreatitis

Objective To investigate the effects of rosiglitazone, the agent of highly selective peroxisome proliferator-activated receptor-γ agonist, on the renal injury of rats with severe acute pancreatitis. Methods Fifty-four male Wistar rats were randomly (random number) divided into three groups : sham operation group ( SO group), severe acute pancreatitis group ( SAP group ) and rosiglitazone pretreatment group (ROSI group) . Severe acute pancreatitis model was induced by retrograde infusion of 5％ sodium taurocholate into the biliopancreatic duct. Rosiglitazone (6 mg/kg) dissolved in 10％ DMSO were injected into the femoral vein 30 minutes prior to the modeling. The solution of 10％ DMSO was given to rats of SO group and SAP group. Rats were sacrificed 3, 12 and 24 h after modeling. The levels of serum amylase, serum creatinine, urea nitrogen, urinary albumin, urinary lgG and αl-microglobulin were measured and analyzed statistically. Kidney tissue samples were stained respectively with hematoxylin and eosin for histopathological evaluation. Results The levels of serum amylase, serum creatinine, urea nitrogen, urinary albumin, urinary IgG and αl-microglobulin were significantly increased (P ＜ 0. 05 )after modeling, while lesser increases were found in ROSI group 12 h and 24 h after modeling (P ＜0. 05)compared with those in SAP group. Conclusions Renal injury can be induced by severe acute pancreatitis,while Rosiglitazone protects rats from renal injury in the setting of severe acute panereatitis. Key words: Rosiglitazone; Pancreatitis; Acute necrotizing; Renal injury; Animal experimentation; Peroxisome proliferators-activated receptor; Inflamation ; Protection

The effects of hyperbaric oxygen therapy on T cell subpopulation and structure changes of electron microscopy in rats with acute pancreatitis

Objective To investigate the effect of hyperbaric oxygen therapy on T-lymphocyte subpopulations in rats with acute pancreatitis. Methods 56 rats were randomly divided into three groups the sham group ( n = 8 ),control group( n = 24) and hyperbaric oxygen therapy group( treatment group, n = 24), then the control group and treatment groups were divided into three subgroups of 8 rats each undergoing euthanasia on days 1,3,7 after the acute pancreatitis induction. The CD4+ ,CD8+ subpopulations of T-lymphocytes in peripheral blood were detected respectively at the fist day and each day of the euthanasia. The sham group was used to make sure that the model was successfully induced. After euthanasia the pancrea was examined using electron microscopy. Results In the control group, the CD4+ cells in AP rats was significantly decreased and the ratio of CD4+/CD8+ also decreased. After 7days of HBO therapy,compared with the control group, the CD4+ lymphocytes of peripheral blood in the treatment group markedly increased( P ＜0.01 ). The CD8+ lymphocytes also increased to a certain extent. And the CD4+/CD8+ ratio of peripheral blood was obviously increased(P ＜0. 01 ). Also more severe pathological changes appeared in the untreated group than in the treatment group. Conclusion Hyperbaric oxygen therapy could improve the oxygen supply in acute panereatitis, regulate T cell immune function. Key words: Pancreatitis; Hyperbaric Oxygen ; T-lymphocyte subpopulations; Electronmicroseopy; Rats

Diagnostic value of double balloon enteroscopy for intestinal diseases

Objective To assess the diagnostic value of double balloon enteroscopy （DBE） for sus- pected intestinal diseases. Methods The data of 141 patients with suspected intestinal diseases, who un- derwent DBE with intravenous sedation from July 2007 to November 2009, were retrospectively analyzed. Oral and anal routes DBE were performed in 59 and 46 patients, respectively, while 36 patients underwent a com- bination of both approaches. Results The overall diagnostic yield of DBE was 74. 5% （ 105/141 ）, with benign and malignant tumors in 32, Crohn＇s disease in 14, non-specific enteric inflammation in 17, polyp in 15, divertieulosis in 16, vascular lesions in 9, intestinal tuberculosis in 3 and intestinal aneylostomiasis in 1. Acute panereatitis was complicated in 1 patient. Conclusion DBE is a safe and effective method in diagnosis of suspected intestinal diseases. Key words: Diagnosis; Double Balloon enteroscopy; Small intestinal disease

Effect of continuous veno-venous hemofiltration in treatment of severe acute pancreatitis

Objective To explore the effect of continuous veno-venous hemofiltration(CVVH) on patients with severe acute panereatitis(SAP). Methods Twenty patients with severe acute pancreatitis were treated with CVVH. Their clinical data including cell gene mensuration、part of biochemistry index、APACHEⅡscore etc were analysed. Results All patients'temperature and abdominal distention、bellyache were evidently easely after the CVVH treat ment,TNF-α、IL-8 in blood were declined, K+ 、 Cr were also improved to some extent. Exactly after treated 24 hours. The steadiness of haemodynamics was maintainable. Conclusion The early CVVH treatment in patients with SAP could alleviate clinical sign obviously in acute reactive period. Key words: Continuous veno-venous hemofileration; Ssevere acute pancreatitis

Tat-NBD peptide inhibits inflammation effects related to NF-kB on AR42J cell

Objective To investigate the effects of Tat-NBD（NEMO-binding domain, NBD） peptide on LPS-stimulated AR42J acinus cells inflammatory response. Method Lipopolysaecharide （LPS） was added to culture media at doses of 10 mg/kg for 24 hours to stimulate the AR42J cells. For pretreatment, cells were incubated with different peptides for 2 hours before LPS stimulation. The expression of TNF-α mRNA was conducted using a semi-quantitative RT-PCR method. TNF-α protein in culture medium were detected by enzyme linked immunoserbent assay（ELISA）. The expression and transloeation of the NF-κB-p65 protein of AR42J was determined by Strept Actividin-Biotin Complex （SABC） method. Results LPS （ 10 mg/L） resulted in an increase of TNF-α mRNA and TNF-α protein, whereas significant inhibitory effects were observed when cells were incubated with Tat-NBD（WT） just on dose of 0.1 mg/L （P 〈 0.05）. The Tat-NBD（WT） peptide decreased inflammatory cytokine expression by a dose-dependent mariner and its peak role was on dose of 100 mg/L. Consisting with TNF-α expression decrease, NF-κB-p65 expression significantly decreased in Tat-NBD（WT） pretreatment group, especially on the largest dose. NO significant changes in the control peptide group. Conclusions Tat-NBD（WT） peptide can inhibit the inflammation of acinus simulated by LPS. Key words: Acute panereatitis; Lipopolysaccharide; Nuclear factor-kappa B; Tumor necrosis factor; Peptide; Pancreatic acinus AR42J cell

Nursing of patients with intra-abdominal haemorrhage after surgery of severe acute pancreatitis

Objective To investigate the reason of intra-abdominal haemorrhage caused by severe a-cute pancreatitis (SAP) and its nursing experience. Methods A retrospective study was carried out in 19 patients with intra-abdominal haemorrhage after SAP surgery in the Second Affiliated Hospital of Harbin Medical University from March 1998 to March 2007. Results All other patients received good hemosta-sis effect except one case,who showed no effect with hemostatic drug and local compression,but at last showed effect by transfixion under direct vision. Conclusions Intra-abdominal haemorrhage after SAP surgery has high mortality rate. It should be dealt with in a timely manner with a view to improve the prog-nosis of patients. Key words: Acute panereatitis; Haemorrhage; Nursing care

The effect of rosiglitazone on the activity of STAT1 in rats with severe acute pancreatitis

To explore the effect of rosiglitazone on the activity of signal transducer and activator of transcription 1 in rats with severe acute pancreatitis. Fifty-four male Wistar rats were randomly allocated into three groups (n = 18). SO group: sham-operated animals served as control, operation was executed and sodium chloride but not sodium taurocholate was injected. SAP group: SAP was induced by the retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. ROSI group: same as SAP group, but rosiglitazone (6 mg/kg) was administered intravenously 30 min before operation. Rats in each group were sacrificed at 3,6 and 12 h after operation. The levels of serum amylase and histologic scores of pancreatic tissue were measured. The expression of TNF-alpha mRNA in pancreatic tissue were determined by reverse transcription-polymerase chain reaction (RT-PCR). The expression of phosphorylated STAT1 in pancreatic tissue was assayed by immunohistochemistry. Compared to SO group, the levels of serum amylase and phosphorylated STAT1, TNF-alpha mRNA and histologic scores of pancreatic tissue were significantly elevated at the same time points after SAP (P < 0.01). The levels of these detection in ROSI group were lower than those of the SAP group at the same time points (P < 0.05), but higher than SO group (P < 0.05). STAT1 was activated in severe acute pancreatitis. Rosiglitazone has a protective effects in rats with severe acute pancreatitis. The mechanism of its protective effects maybe that it inhibits the activation of JAK/STAT pathway, which can down-regulate the expression of TNF-alpha mRNA and block the the inflammatory cascade partially.

Role of microfold cell in intestinal barrier after acute pancreatitis in rats

Objective To investigate TNF-α and IL-18 expression levels in mierofold cells in rat's intestine after acute panereatitis to evaluate the role of mierofold cells (M cells) in intestinal barrier.Methods Fifty SD rats were randomized into the acute panereatitis 6 h group,12 h group,24 h group,48 h group and control group.The model of acute pancreatitis was established.Serum,peyer,s patch,ileum,and mesenteric lymph nodes (MLN) were harvested.Serum amylase,glutamate pyrurate transaminse,total bilirubin,endotoxin,TNF-α,and IL-18 were detected.Pathologic changes of the ileal mucous were observed.M cells were obtained with laser capture microdisseetion and the expression of TNF-α mRNA and IL-18 mRNA in M cells were observed with RT-PCR.The expression of TNF-a and IL-18 was determined with immunofluoreseence dual staining.Result 1)The level of serum amylase in pancreatitis increased obviously in 6,12,24 h group,but decreased in 48 h group.2) Endotoxin in blood serum obviously increased in 12,24,48 hours after acute pancreatitis.The number of colony of bacterium aversion in MLN increased in acute pancreatitis.3)TNF-a in blood serum obviously increased in 6,12,24 h groups in acute pancreatitis,and then decreased to normal level in 48 h.IL-18 in blood serum increased in acute pancreatitis.4)Edema was observed in ileal mucus in acute pancreatitis.5)The immunofluoreseence double staining showed that TNF-α and IL-18protein expressed in M cell of all groups of acute pancreatitis but not in control group.6)The level of TNF-αmRNA and IL-18 mRNA expression was significantly higher in acute panereatitis groups than in the control group.Conclusion Intestinal barrier is damaged in acute pancreatitis. M cells can excrete TNF-α and IL 18 in acute pancreatitis and may play important roles in intestinal mucosal immune. Key words: Pancreatitis; Intestinal barrier; M cell; TNF-α; IL-18

Nursing of patients with early severe acute pancreatitis undergoing laparoscopic treatment

Objective To discuss nursing of patients with early severe acute pancreatitis undergoing laparoscopic treatment and in comparison with open surgery. Methods Totally 56 patients with early se-vere acute pancreatitis were admitted from October 2002 to October 2007,among which 30 cases (group A) received laparoscopic.treatment and the other 26 cases (group B) was given open surgery.The average time of hospital stay,incidence of complication and re-operation were compared between the two groups. Re-sults The average time of hospital stay,incidence of complication and re-operation of group A were lower than those of group B (P<0.05). Conclusions Treatment of severe acute pancreatitis with laparoscopy proved to be a desirable method in that it performs good effect with little trauma and low fatality.Other basic treatment,regulation of water and electrolyte balance and acid-base balance,enforcement of nutritional sup-port,fasting and gastrointestinal decompression should not be ignored. Key words: Laparoscopic treatment; Severe acute panereatitis; Nursing

Pancreatic stent therapy for pancreatic fistulae

PANCREATIC STENT THERAPY FOR PANCREATIC FISTULAE DR Lichtenstein A Roston, A Slivka, S Tanner, DC Brooks, PA Banks, DL Carr-Locke. Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Background: Fistulous tracts from the pancreatic duct (PD) may communicate externally with the skin (pancreatico-cutaneousPC)or internally with the peritoneal (pancreatico-peritoneal PP) or pleural (pancreatico-pleural PL) cavities. Traditional approaches to the management of these fistulae have included conservative medical therapy and surgery, although the former fails in up to 50% of cases and the latter is associated with significant morbidity. Patients: In a period of 17 months (May 1993-Sept 1994), we attempted endoscopic insertion of pancreatic stents or drains in seven patients with pancreatic fistulae. There were five males and two females, mean age 53 (range 28-72). The nature of the fistulae were PC in two, PL in two, and PP in three. Five of the patients (2PC, 1PP, and 2PL) had been unsuccessfully treated with octreotide prior to stenting. The etiology of the fistulae included ethanol-induced chronic pancreatitis (2 PL), idiopathic acute pancreatitis (PC), acute panereatitis secondary to pancreas divisum (PP), operative injury during splenectomy (PP) and nephrectomy (PC), and Vou HippeI-Lindau disease (PP) Results: ERP demonstrated the fistulae in all patients. The mean duration between clinical presentation and pancreatic stenting was 3.5 weeks Transpapillary PD stents of 5,7, &l 0 French diameter were inserted in five patients, with the intention of the leak by placing them beyond the site of PD disruption. A short stent was placed in the patient with operative injury to the tail of the pancreas following a splenectomy. There were two endoscopic failures due to an obstructing intraductal PD stone (PP) and a PD stricture (PC), both preventing stent placement and thus necessitating surgical management. All other patients had complete resolution of symptoms as well as fistula closure documented clinically and by ERP at the time of stent removal. The mean duration of stent therapy was 55 weeks. There were no procedure-related complications and none have developed recurrent fistulae. Conclusions: 1) ERCP is a safe and accurate method for demonslrating the site and context of pancreatic fistulae. 2) Endoscopic drainage is an appropriate non-surgical therapy for pancreatic fistulae irrespective ofefiology. 3) Possible mechanisms for fistula closure incIude equilibration of elevated intraductal pressure and/or stent bridging of the disruption acting as a mechanical seal. 4) The stent must cross the site of obstruction in the presence of a coexistent distal pancreatic duct stricture.