Blood Amylase Levels Research Articles

Selected Blood Biochemical Parameters after Right and Left Nephrectomy in Clinical Practice

Introduction. Radical nephrectomy is considered as a common operation associated with significant changes in the topography of the upper abdominal cavity which appear in the postoperative period. Analysis of the literature fails to provide sufficient information about functional changes in the parenchymatous abdominal organs that occur after nephrectomy. Aim. To investigate a number of liver and pancreatic enzymes in the blood of patients at the pre­ and post­ operative stages of the radical nephrectomy. Materials and methods. The study involved a retrospective analysis of medical records of 111 patients after radical nephrectomy. The patients underwent biochemical examination at the pre­operative stage, on day 1, and day 7 after the operation: ALT, AST, amylase, diastase. The examination was performed by means of biochemistry analyzers Bio Systems BA 400 and Beckman Coulter AU 480. Statistical data processing was carried out using Statistica 10.0. Results. The analysis of the obtained materials shows that the level of liver and pancreatic enzymes increases after radical nephrectomy. A side of the operation was revealed significant: left­sided nephrectomy leads to an increase in the level of blood amylase and diastase, right­sided nephrectomy results in an increase in the level of ALT and AST. No dependence on the sex of patients was determined. No increase in the level of the studied enzymes was found in a number of patients in the postoperative period; however, almost half of patients were detected with a significant, 1.5–2 times and higher, increase in the level of enzymes, thus requiring special control and correction. The maximum level of ALT reached 245 U/L (norm 0–35 U/L), the maximum level of AST comprised 184 IU/L (norm 0–35 IU/L). Discussion. The obtained results indicate the interrelation of functional disorders of the liver and pancreas and changes in their topography after radical nephrectomy. Conclusion. Radical nephrectomy is associated with significant functional disorders of the liver and pancreas depending on the side of the operation: the level of blood amylase and diastase increases after left nephrectomy, the level of ALT and AST grows after right nephrectomy. The level of enzymes exceeds the norm by 1.5–2 times in almost half of patients.

The Value of Bedside Ultrasound Evaluation of Intravenous Ultrasound Grading System Combined with TyG Index in Predicting Acute Renal Injury in Patients with Acute Hyperlipidemic Pancreatitis.

Aims/Background Bedside ultrasound evaluation of venous excess ultrasound (VExUS) combined with the triglyceride-glucose (TyG) index plays an important role in predicting acute kidney injury (AKI) in patients with acute hyperlipidemic pancreatitis. VExUS can effectively evaluate the degree of venous congestion, while the TyG index is valuable in predicting severe pancreatitis. The combination of these two methods is expected to provide a more accurate AKI risk assessment tool for clinical practice. This study explores the value of combining bedside ultrasound evaluation using the VExUS grading system with the TyG index in predicting acute renal damage in patients with acute hyperlipidemic pancreatitis. Methods From January 2021 to December 2023, 110 patients with acute hyperlipidemic pancreatitis were selected. The patients were divided into two groups based on whether they were complicated with acute kidney injury (AKI): the AKI group (n = 23) and the non-AKI group (n = 87). The general data of the two groups were compared, and the risk factors for AKI in patients with acute hyperlipidemic pancreatitis were analyzed using multivariate logistic regression. The predictive value was assessed using receiver operating characteristic curve (ROC) analysis. Results There were no statistically significant differences in age, gender, outcome, triglyceride (TG), total cholesterol, low-density lipoprotein (LDL) levels at admission, blood nutrition at discharge, creatinine (CREA) at discharge, underlying diseases, start time of enteral nutrition, complications, length of stay, Intensive Care Unit (ICU) days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood glucose level, blood amylase level, CREA, blood urine nitrogen (BUN), blood purification treatment (p > 0.05). However, there were significant differences (p < 0.05) between the TyG index and the VExUS score, with variables including the TyG index and the VExUS score (included in the logistic regression analysis as variables), and AKI (AKI = 1, non-AKI = 0) as dependent variables. Multiple logistic regression results showed that the TyG index and VExUS score were independent predictors of AKI in patients with acute hyperlipidemia pancreatitis (p < 0.05). The standard error, sensitivity and specificity of the TyG index, VExUS score and combined model for predicting AKI in these patients were 0.064, 73.91 and 87.45; 0.036, 78.16 and 95.65; 0.010, 100.00 and 95.65, respectively (p < 0.05). Conclusion The VExUS score combined with the TyG index is highly valuable in predicting AKI in patients with acute hyperlipidemic pancreatitis.

Improvement of laparoscopic interventions on the bile ducts in choledocholithiasis

Objective. To improve the technique of laparoscopic choledocholithotomy to improve the results of choledocholithiasis treatment. Materials and methods. The study covers the period from 2012 to 2022, during which 144 patients with choledocholithiasis were treated. In 120 patients, the surgical intervention was successfully performed using a fully laparoscopic approach: in 48 patients (group 1), the common bile duct was drained with a T-shaped drainage; in 34 patients (group 2), the intervention on the common bile duct was completed with a primary suture of the duct; in 38 patients (group 3), a biliary stent was inserted integrally with subsequent suturing of the choledochotomy opening. Results. In group 1, 5 (10.4%) patients had serious complications that required repeated surgical interventions: dislocation of the T-shaped drainage in 1 (2.1%) patient, development of biliary peritonitis in 4 (8.3%) patients. In the treatment of patients in group 2, a number of advantages were noted compared to the treatment of patients with T-shaped drains. The majority of patients with primary common bile duct suture were discharged on the 3rd day after surgery, and they returned to active work in 2 to 3 weeks. At the same time, 3 (8.8%) patients in this group had complications that required repeated surgical interventions: in 1 patient with multiple choledocholithiasis, bile leakage into the abdominal cavity was caused by a residual stone, in 2 patients - by papillitis and partial inflammatory stenosis of the large duodenal papilla. They underwent endoscopic papillotomy. Of the 38 patients in group 3, 32 had biliary stents that migrated to the intestine on their own. These patients had no complaints in the long term. In 6 patients, the stents remained in the ducts for 30 days after surgery. In 5 of them, endoscopic dosed papillotomy with a needle papillotome was performed, after which the stents were easily removed from the ducts. In 1 patient, a stone up to 6 mm in diameter fell out of the common bile duct along with the stent. None of the patients had signs of pancreatitis or elevated blood amylase levels. Conclusions. Laparoscopic interventions on the common bile duct allow successful removal of large and numerous calculi in one stage. Primary suturing of the common bile duct has significant advantages over the installation of T-shaped drains and allows to reduce the treatment time. In case of multiple choledocholithiasis and suspected stenosis of the duodenal papilla, it is advisable to combine primary common bile duct suture with antegrade stenting of the bile ducts.

Gene Regulation of Neutrophils Mediated Liver and Lung Injury through NETosis in Acute Pancreatitis.

Acute pancreatitis (AP) is one of the most common gastrointestinal emergencies, often resulting in self-digestion, edema, hemorrhage, and even necrosis of pancreatic tissue. When AP progresses to severe acute pancreatitis (SAP), it often causes multi-organ damage, leading to a high mortality rate. However, the molecular mechanisms underlying SAP-mediated organ damage remain unclear. This study aims to systematically mine SAP data from public databases and combine experimental validation to identify key molecules involved in multi-organ damage caused by SAP. Retrieve transcriptomic data of mice pancreatic tissue for AP, lung and liver tissue for SAP, and corresponding normal tissue from the Gene Expression Omnibus (GEO) database. Conduct gene differential analysis using Limma and DEseq2 methods. Perform enrichment analysis using the clusterProfiler package in R software. Score immune cells and immune status in various organs using single-sample gene set enrichment analysis (ssGSEA). Evaluate mRNA expression levels of core genes using reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Validate serum amylase, TNF-α, IL-1β, and IL-6 levels in peripheral blood using enzyme-linked immunosorbent assay (ELISA), and detect the formation of neutrophil extracellular traps (NETs) in mice pancreatic, liver, and lung tissues using immunofluorescence. Differential analysis reveals that 46 genes exhibit expression dysregulation in mice pancreatic tissue for AP, liver and lung tissue for SAP, as well as peripheral blood in humans. Functional enrichment analysis indicates that these genes are primarily associated with neutrophil-related biological processes. ROC curve analysis indicates that 12 neutrophil-related genes have diagnostic potential for SAP. Immune infiltration analysis reveals high neutrophil infiltration in various organs affected by SAP. Single-cell sequencing analysis shows that these genes are predominantly expressed in neutrophils and macrophages. FPR1, ITGAM, and C5AR1 are identified as key genes involved in the formation of NETs and activation of neutrophils. qPCR and IHC results demonstrate upregulation of FPR1, ITGAM, and C5AR1 expression in pancreatic, liver, and lung tissues of mice with SAP. Immunofluorescence staining shows increased levels of neutrophils and NETs in SAP mice. Inhibition of NETs formation can alleviate the severity of SAP as well as the levels of inflammation in the liver and lung tissues. This study identified key genes involved in the formation of NETs, namely FPR1, ITGAM, and C5AR1, which are upregulated during multi-organ damage in SAP. Inhibition of NETs release effectively reduces the systemic inflammatory response and liver-lung damage in SAP. This research provides new therapeutic targets for the multi-organ damage associated with SAP.

Pancreatitis-induced prediabetes and hepatic lipidosis in a mixed breed cat

Pancreatitis can lead to decreased insulin production and elevated blood glucose levels. Reduced insulin levels can cause excessive lipolysis, leading to hepatic lipidosis. This report aimed to illustrate how pancreatitis can result in prediabetes and hepatic lipidosis, providing insight into selecting appropriate and causal therapies. This case report discusses a 5-year-old male mixed-breed cat weighing 3.9 kg presented with anorexia and hypersalivation. Despite a routine physical examination, blood tests revealed decreased creatinine and Ca2+ levels and elevated blood glucose, SGPT, cholesterol, and amylase levels. These findings suggested a diagnosis of pancreatitis accompanied by prediabetes and hepatic lipidosis. The treatment administered included intravenous Ringer’s Lactate, subcutaneous Ornipural® injection, oral cephalexin (Rilexine®) and Samylin®, and dietary management with specialized renal wet food.

- Effects of Individualized Comprehensive Nutritional Support on Inflammatory Markers, serum amylase (AMS), prealbumin (PA), albumin (ALB), calcium ion (Ca2+) in Patients with Severe Pancreatitis

Objective: To study the effectiveness of individualized comprehensive nutritional support on inflammatory markers, serum amylase (AMS), prealbumin (PA), albumin (ALB), calcium ion (Ca2+) in patients with severe acute pancreatitis (SAP). Methods: 102 participants with SAP treated in our hospital were chosen as the study objects. The participants were randomly split into control group and observation group, and both groups were given routine treatment. Observation group received individualized comprehensive nutrition support additionally. The inflammatory indexes, biochemical indexes and symptom improvement time were observed and analyzed on the day of admission, intervention 1d, intervention 3d, intervention 7d and intervention 14d. Results: Among the 102 patients included in this study, 3 cases had sudden exacerbation during the intervention, 1 case had clinical data missing &gt;10%, and 1 case voluntarily withdrew due to personal factors, all of which were eliminated. Finally, the effective data of 97 patients were recovered. There were significant differences in the hypersensitive C-reactive protein (hs-CRP), white blood cell count (WBC), procalcitonin (PCT) and interleukin1β (IL-1β) between the two groups. The inter-group, time and interaction differences of AMS, PA, ALB and Ca2+ levels were significant different. The recovery time of abdominal pain, bowel sound, blood amylase level and urine amylase level in observation group was inferior to control group, and the differences were statistically significant (P&lt;0.05). Conclusion: Individualized comprehensive nutritional support is more conducive to the improvement of inflammatory indexes in SAP patients, and can accelerate the symptom relief and promote the recovery of nutritional status.

Software engineering implementation and e-commerce model design based on neural digestive system monitoring and rapid prediction of amylase

Convolutional neural networks can be used to predict amylase levels in patients with acute abdomen. Based on this algorithm, we can reduce the error rate in hospital emergency work. As a biomedical engineering study, this study processed a series of continuous data such as patient age, symptoms, pain index, and life risk exposure factors. This software project has the ability to perform regression analysis based on the above characteristics, it can be used to determine whether the blood amylase level is normal, which provides assistance in the clinical diagnosis of pancreatitis, a disease that directly affects the 24-hour survival of patients. We believe that this software engineering can serve as a purchasing option for e-commerce systems and propose a solution for this situation.

Interleukin-22 Alleviates Caerulein-Induced Acute Pancreatitis by Activating AKT/mTOR Pathway

BackgroundAcute pancreatitis (AP) is one of the most common acute abdominal disorders; due to the lack of specific treatment, the treatment of acute pancreatitis, especially serious acute pancreatitis (SAP), is difficult and challenging. We will observe the changes of Interleukin -22 levels in acute pancreatitis animal models, and explore the mechanism of Interleukin -22 in acute pancreatitis.ObjectiveThis study aims to assess the potential protective effect of Interleukin -22 on caerulein-induced acute pancreatitis and to explore its mechanism.MethodsBlood levels of amylase and lipase and Interleukin -22 were assessed in mice with acute pancreatitis. In animal model and cell model of caerulein-induced acute pancreatitis, the mRNA levels of P62 and Beclin-1 were determined using PCR, and the protein expression of P62, LC3-II, mTOR, AKT, p-mTOR, and p-AKT were evaluated through Western blot analysis.ResultsInterleukin -22 administration reduced blood amylase and lipase levels and mitigated tissue damage in acute pancreatitis mice model. Interleukin -22 inhibited the relative mRNA levels of P62 and Beclin-1, and the Interleukin -22 group showed a decreased protein expression of LC3-II and P62 and the phosphorylation of the AKT/mTOR pathway. Furthermore, we obtained similar results in the cell model of acute pancreatitis.ConclusionThis study suggests that Interleukin -22 administration could alleviate pancreatic damage in caerulein-induced acute pancreatitis. This effect may result from the activation of the AKT/mTOR pathway, leading to the inhibition of autophagy. Consequently, Interleukin -22 shows potential as a treatment.

Obesity Model in White Male Wistar Rats: The Impact of Moringa (Moringa Oleifera) Flower Extract on Pancreatic Function as Deduced from Serum Amylase and Lipase Levels and the Histopathological Image of the Pancreas

Diabetes and obesity go hand in hand. Antidiabetic drugs are effective in treating diabetes. However, currently available antidiabetic drugs are too expensive, do not work, and cause major side effects. A significant therapeutic option for Diabetes Mellitus and obesity is using bioactive chemicals produced by plants. This compound is efficacious, easily accessible, safe, and affordable. The main aim of this study was to determine whether pancreatic extract from Moringa oleifera flowers affected blood amylase and lipase levels, as well as the histological appearance, of obese male Wistar white rats (Rattus norvegicus). This is a True experimental study, with the research design used as a test control Group Design. The research data was then analyzed with the help of SPSS using ANOVA and Post Hoc Test with LSD technique. This researcher used 24 male rats. Treatment with Moringa oleifera flower extract improves pancreatic function in obese Wistar white rats by reducing serum lipase and amylase levels. The results of research on serum lipase and amylase levels showed that a dose of 600mg/Kg BW improved pancreatic function in white rats of the Wistar strain that were obese.

A Case Report of Abdominal Pain with Acute Kidney Injury and Elevated Pancreatic Enzymes

Objectives: The aim of this study is to report the effectiveness and safety of herbal medicine treatment for abdominal pain with acute kidney injury.Methods: A 80-year-old female patient presented with abdominal pain. Blood test results showed increased blood urea nitrogen, serum creatinine, amylase, and lipase. The patient was treated with acupuncture and herbal medicine, specifically &lt;i&gt;Hyangsayukgunja-tang-gahwangryeon&lt;/i&gt; for 4 days and &lt;i&gt;Gagam-gunbi-tang&lt;/i&gt; for 11 days. Gastrointestinal symptoms were assessed using the Numerical Rating Scale, Gastrointestinal Symptom Rating Scale, and abdominal examination.Results: Gastrointestinal symptoms improved after taking Korean herbal medicine. Additionally, blood urea nitrogen, serum creatinine, amylase, and lipase levels showed improvement compared to values before treatment.Conclusions: Korean medicine treatment can improve clinical symptoms without damaging the kidneys of patients with acute kidney injuries.

Experience of transmural endoscopic drainage in treatment of pancreatic pseudocysts

Objective. To evaluate the possibilities of transmural endoscopic drainage in the treatment of postnecrotic pancreatic pseudocysts in the immediate and long-term periods. Materials and methods. From 2018 to 2022, a transmural endoscopic drainage method was used in the treatment of 36 patients with pancreatic pseudocysts at Perm Regional Clinical Hospital. The results were evaluated in the immediate postoperative period, 47 months before the removal of the stent and 14 years by the complaints of patients, blood amylase content, the results of ultrasound and CT examination of the abdominal cavity. Results. Two-three days after the endoscopic intervention, the cyst completely disappeared in 30.56 % of patients, decreased by half or more of the diameter in 63.89 % and only in 5.56 % decreased slightly. After 14 years, the absence of cysts was registered in 80 %, small diameter (from 15 to 24 mm) in 10 %. Pancreatic cysts persisted in three patients (10 %). Statistical analysis showed that the wider was the main pancreatic duct and the higher the blood amylase level before transmural endoscopic drainage, the poorer was the treatment result. Conclusions. Transmural endoscopic drainage of pancreatic pseudocysts makes it possible to achieve complete disappearance or significant reduction in the size of pancreatic cysts a year or more after the intervention in 90 % of cases. The clinical result of transmural endoscopic drainage in the treatment of pancreatic pseudocysts depended on the initial width of the main pancreatic duct and the level of blood amylase.

Hematology profile, digestive enzymes, thyroid hormones, productivity, and nitrogen balance of growing male rabbits supplemented with exogenous dietary lysozyme

In a simple randomized design trial, 420 growing male V-Line rabbits were randomly distributed into four groups to investigate the impact of exogenous dietary lysozyme on some physiological and nutritional parameters of male growing rabbits supplemented with exogenous dietary lysozyme. The witness group received a basal diet without exogenous dietary lysozyme (LYZ0), while the exogenous dietary lysozyme groups received 50, 100 and 150 mg/kg of basal diet (Groups; LYZ50, LYZ100 and LYZ150), respectively. The results showed significantly increased in blood cell count, hemoglobin concentration, total white blood cell, lipase, protease, amylase, total protein, triiodothyronine and thyroxine levels, while thyroid stimulating hormone levels significantly lessened in rabbits received LYZ. The LYZ- rabbit diets improved total digestible nutrient, digestible crude protein, and digestible energy values, with the LYZ100 group outperforming the others. LYZ-treated rabbits had significantly higher nitrogen intake, digestible nitrogen, and nitrogen balance than the witness group. The lysozyme in a rabbit’s diet is taking on a new role as a digestive enzyme, enhancement thyroid hormones, as well as improvement hematology, daily protein efficiency ratio, daily performance index, hot carcass, total edible parts, nutritional value, and nitrogen balance, with decreasing the daily caloric conversion ratio and total non-edible parts.

Management of postoperative pancreatic fistula after pancreaticoduodenectomy.

A postoperative pancreatic fistula (POPF) is the main complication after cephalic pancreaticoduodenectomy (CPD). Unlike its prevention, the curative management of POPFs has long been poorly codified. This review seeks best practices for managing POPFs after CPD. The diagnosis of a POPF is based on two signs: (i) an amylase level in drained fluid more than 3 times the upper limit of the blood amylase level; and (ii) an abnormal clinical course. In the standardised definition of the International Study Group of Pancreatic Surgery, a purely biochemical fistula is no longer counted as a POPF and is treated by gradual withdrawal of the drain over at most 3 weeks. POPF risk can be scored using pre- and intraoperative clinical criteria, many of which are related to the quality of the pancreatic parenchyma and are common to several scoring systems. The prognostic value of these scores can be improved as early as Day 1 by amylase assays in blood and drained fluid. Recent literature, including in particular the Dutch randomised trial PORSCH, argues for early systematic detection of a POPF (periodic assays, CT-scan with injection indicated on standardised clinical and biological criteria plus an opinion from a pancreatic surgeon), for rapid minimally invasive treatment of collections (percutaneous drainage, antibiotic therapy indicated on standardised criteria) to forestall severe septic and/or haemorrhagic forms, and for the swift withdrawal of abdominal drains when the risk of a POPF is theoretically low and evolution is favourable. A haemorrhage occurring after Day 1 always requires CT angiography with arterial time and monitoring in intensive care. Minimally invasive treatment of a POPF (radiologically-guided percutaneous drainage or, more rarely, endoscopic drainage, arterial embolisation) should be preferred as first-line treatment. The addition of artificial nutrition (enteral via a nasogastric or nasojejunal tube, or parenteral) is most often useful. If minimally invasive treatment fails, then reintervention is indicated, preserving the remaining pancreas if possible, but the expected mortality is higher.

Analysis of the risk factors and prognosis for severe fever with thrombocytopenia syndrome associated encephalopathy

ObjectiveSevere fever with thrombocytopenia syndrome (SFTS) is frequently associated with neurological injury, but there are currently few relevant studies. The goal of this study was to look at the risk factors for SFTA-associated encephalopathy (SFTSAE) and the short- and long-term prognosis of such patients. MethodsWe retrospectively studied 145 patients with SFTS who were treated at our hospital between May 2019 and November 2021. Clinical characteristics were collected, and patients were divided into two groups based on whether there was neurological injury during the disease: SFTSAE group and non-SFTSAE group. Univariate analysis was used to compare the differences in clinical data and outcomes between two groups, and multivariate Logistic regression analysis was used to reveal the independent risk factors for SFTSAE, and the predictive efficacy was assessed using the receiver operating characteristic (ROC) curve. Furthermore, survivors of SFTSAE were contacted by phone 6 months after discharge to assess the case fatality rate and quality of life. ResultsThe prevalence of SFTSAE was 22.7% (33/145). Bleeding symptoms, D-dimer level and blood amylase level were all independent risk factors for SFTSAE (P < 0.05). The combined AUC of these three factors was 0.969. Patients with SFTSAE had a 45.4% in-hospital mortality rate, and survivors had a largely normal quality of life after discharge. ConclusionPatients with SFTSAE frequently have multiple organ dysfunction, a high mortality rate, and a favorable long-term prognosis for survivors. Clinical manifestations of bleeding symptoms, elevated serum amylase, and elevated D-dimer were all independent risk factors for SFTSAE.

Preoperative predictor laboratory markers for complicated appendicitis: A retrospective analysis of single center experience

In this study, we aimed to investigate the pre-operative predictive role of the serum white blood cell and platelet counts, C-reactive protein (CRP), bilirubin, amylase, lipase, and sodium levels for complicated appendicitis in patients aged≥18 years. We retrospectively evaluated 574 patients (aged≥18 years) who underwent appendectomy due to acute appendicitis (AA) between March 2018 and March 2022 at our clinic. The patient population was divided into two groups as perioperative complicated and uncomplicated appendicitis and the preoperative predictor role of serum white blood cell counts, platelet counts, CRP, bilirubin, amylase, lipase, and sodium levels were compared for complicated versus uncomplicated appendicitis. In multivariate analyses, age&gt;38 years, the timing of Emergency Department (ED) arrival to admission ≥2 days, CRP ≥3.36 mg/dL, and total bilirubin ≥0.76 mg/dL are independent risk factors for detecting complicated AA. Moreover, in the designed scoring system, the AUC: 0.877 (CI: 0.847-0.907) for perforated AA at scores below or above. Estimation of the complications of AA can help clinicians practically with the scoring system designed because of the determined predictive factors.

Efficacy and safety of endoscopic retrograde cholangiopancreatography in children

Objective: To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of biliary and pancreatic diseases in children. Methods: The clinical data of 127 children who were treated with ERCP in the First Affiliated Hospital of Nanchang University from January 2007 to July 2021 were analyzed. According to the diseases they suffered from, the children were divided into biliary group and pancreatic group. The operation times, technical success rate, diagnosis, interventions and post-ERCP complications between the groups were compared by t-test or χ2 test. The risk factors of post-ERCP pancreatitis (PEP) were analyzed by multivariate Logistic regression. Results: A total of 127 children, including 54 males and 73 females, with a median age of 14 years at first ERCP, were included in this study. ERCP was performed in 181 cases, with a success rate of 98.3% (178/181). In pre-ERCP imaging examination, the positive diagnostic rates of ultrasound, CT and magnetic resonance cholangiopancreatography (MRCP) for biliary and pancreatic diseases were 54.1% (53/98), 56.1% (37/66) and 79.3% (88/111), respectively. MRCP had the highest positive diagnostic rate, and the difference among the three measures was statistically significant (χ2=17.33, P<0.001). The most common indications for ERCP in biliary and pancreatic diseases were choledocholithiasis (77.0%, 107/139) and congenital structural abnormalities of the pancreas (31.0%, 13/42), respectively. After ERCP, the abdominal pain was dramatically relieved and the liver function was significantly improved (all P<0.001). The blood amylase level of the children with pancreatic diseases was significantly lower than that before ERCP (t=7.73, P<0.001). The overall incidence of post-ERCP complications was 12.2% (22/181), of which post-ERCP pancreatitis (PEP) was the most common (7.2%, 13/181). The incidence of PEP was significantly higher in the pancreatic group than in the biliary group (16.7% (7/42) vs. 4.3% (6/139),χ2=7.38, P=0.007). Multivariate Logistic regression analysis showed that young age was the independent risk factor of PEP (OR=0.80, 95%CI 0.67-0.96). Conclusions: MRCP is the first choice for pre-ERCP imaging examination of biliary and pancreatic diseases in children. ERCP can be safely and effectively used in the diagnosis and treatment of biliary and pancreatic diseases in children, with a high success rate and obvious alleviation of symptoms.

Association, Clinical and Biochemical Profile of Pediatric Acute Pancreatitis in a Tertiary care hospital of Bangladesh

Background: Acute pancreatitis in children typically presents differently and has a different course than in adults. Objective: To evaluate the association, clinical profile &amp; biochemical evidence of childhood acute pancreatitis. Method: This cross-sectional study was done in the Department of Pediatrics Dhaka Medical College Hospital, Dhaka, Bangladesh during January 2019 to July 2022. Total 65 children below 12 year of age having diagnostic criteria of acute pancreatitis made by INSPPIRE group were included in this study. Results: Children examined had a mean age of 8.1 3.2 years, with 35 (53.8%) being boys. The majority of patients presented with abdominal discomfort. The epigastric area was the most prevalent site of discomfort (82%), affecting 55 people (84.6%). Before being admitted, the average patient had been in agony for 3.4 2.2 days. Fifty (76.0%) patients presented with vomiting, 22 (33.8%) cases presented with fever, 5.7 (7.7%) cases presented with shock, and 3.4 (4.6%) cases presented with melena. Leukocytosis was detected in 32% of patients, whereas elevated blood lipase and amylase levels were found in 89% and 72% of patients, respectively, according to laboratory testing. We detected biochemical abnormalities including hypokalemia (8, or 12.3%), elevated ALT (6, 9.2%), hypocalcemia (5, or 7.7%), and elevated triglycerides (3, 4.6%). In 40 (61.5%) individuals, positive ultrasonographic results were seen. Four patients (6.2%) had pancreatic pseudocysts, while three patients (4.6%) had pancreatic necrosis. Acute pancreatitis occurred for no apparent reason in 36 people (55.4%). Five patients (7.7%) had biliary sludge, four (6.2%) had biliary ascariasis, four (6.2%) had a choledochal cyst, three (4.6%) had Henoch-Schönlein purpura, and three (4.6%) had hepatitis caused by drugs (valproic acid/L-asparginase). Conclusion: Epigastric pain was shown to be the most prevalent symptom of acute pancreatitis in youngsters. This was usually due to an unknown ....

Evaluation of the influence of methods of sanitation of the common bile duct on the course of the postoperative period of endoscopic papillosphincterotomy

Gallstone disease continues to occupy a leading position in terms of the number of surgical interventions in modern emergency surgery. The purpose of our study is to determine the risks of developing post-manipulation pancreatitis depending on the method of sanitation of the choledochus, to determine the dynamics of regression of hyperamylasemia and hyperbilirubinemia in patients after endoscopic papillosphincterotomy (EPST), to assess long-term results—the frequency of repeated hospitalizations and the need to perform surgical interventions for restenosis of the papilla. Materials and methods : a prospective analysis of 60 clinical cases of patients after EPST was performed. Patients were divided into 2 groups depending on the method of sanation of the common choledochus. The frequency of development of an increase in the level of blood amylase and bilirubin and the timing of regression of these indicators were assessed. An analysis was also made of repeated cases of hospitalizations and the need for interventions on the papilla. Results : the development of hyperamylasemia in the group of revision of the choledochus occurred in 23% of cases, in the group without mechanical sanitation — in 13%. Hyperbilirubinemia in the immediate postoperative period developed in 27 and 23% of cases, respectively. The terms of regression of elevated biochemical parameters were higher in the group of patients with a mechanical method of sanation of the common choledochus. Conclusion : mechanical methods of sanation of the common choledochus can increase the incidence of post-manipulation complications after EPST and increase the recovery time for normal values of biochemical parameters. To assess the longterm results of the development of papillary restonosis after EPST, it is necessary to form larger groups of patients with the possibility of conducting a multicenter study.

OA18 A rare presentation of Polyarteritis Nodosa

OA18 A rare presentation of Polyarteritis Nodosa

Baseline Health and Nutritional Parameters of Wild Sand Tigers Sampled in Delaware Bay.

Species-specific hematological reference values are essential for diagnosis and treatment of disease and maintaining overall health of animals. This information is lacking for many species of elasmobranchs maintained in zoos and aquaria, thus reducing the effectiveness of care for these animals. Descriptive statistics and reference intervals were calculated for hematocrit and complete blood cell counts, biochemistry and protein electrophoresis parameters, trace minerals, vitamins, heavy metals, reproductive hormones, and fatty acids in the blood of 153 wild Sand Tigers Carcharias taurus of both sexes and a range of sizes caught in Delaware Bay (Delaware, USA). Mean hematocrit, total white blood cell counts, lymphocyte differentials, glucose, phosphorus, amylase, and aspartate aminotransferase levels were significantly higher in juveniles than in adults. Levels of estradiol, progesterone, testosterone, and differences in selenium and eicosapentaenoic acid (a polyunsaturated fatty acid) between males and females suggest that they are important parameters for improving Sand Tiger breeding success in managed care. Finally, blood metal levels for arsenic, cadmium, lead, and mercury suggest low levels of contaminant exposure for Sand Tigers during their summer residence in Delaware Bay. The results of this study provide baseline health parameters for wild Sand Tigers that will aid in effective maintenance of aquarium animals and contribute to a greater understanding of the biology of these sharks and efforts to accomplish sustainable management of their populations.