Blood Amylase Research Articles

COMPLICATIONS OF NEOADYAVANT THERAPY FOR CANCER OF THE HEAD OF THE PANCREAS

Aim: to study complications of preoperative chemoembolization of the gastroduodenal artery and external beam radiation therapy in patients with pancreatic head cancer.Material and Methods. Sixty patients underwent chemoembolization of the gastroduodenal artery and external beam radiation therapy. Femoral artery angiography was performed using the Seldinger’s technique. Lipiodol 5–7 ml and gemcitabine 400 mg/m2 were used for transarterial chemoembolization. Radiation therapy was given at a total dose of 50 Gy (2 Gy/fraction, 5 times a week, over 5 weeks) using AGAT -R apparatus.Results. Complications after chemoembolization of the gastroduodenal artery were observed in 18.3 % of patients: abdominal pain in 3.3 % of patients; pain and nausea in 3.3 %; pain, nausea and fever in 6.7 %; pain, nausea and increased blood amylase in 1.7 %; pain, nausea and fever, blood amylase in 1.7 %; nausea, fever and blood amylase in 1.7 %. Radiation-induced injuries were observed in 23.3 % of patients: erythema in 18.3 %, grade 1 leukopenia in 1.7% and grade 2 leukopenia in 3.3 %.Conclusion. Complications of neoadjuvant therapy in terms of frequency and severity were consistent with literature data, were manageable with conservative treatment, and did not increase the duration of the preoperative period.

Role of Tumor Necrosis Factor alpha promoter polymorphisms in interferon related side effects in chronic hepatitis B patients under interferon alpha 2b treatment

Objective(s). Interferon alpha therapy is associated with series of adverse effects leading premature discontinuation of treatment. Here we aimed to determine the effects of Tumor necrosis alpha promoter polymorphisms on interferon related side effects during interferon alpha 2b treatment in chronic hepatitis B patients
 Material and Method(s). This observational study enrolled 50 chronic hepatitis B patients, who were treated with interferon alpha 2b 10 tiw plus lamivudine 100mg/day at Selçuk University Meram Medical Faculty Department of Infectious Diseases and Clinical Bacteriology between 2006-2007. Patients were followed-up with complete blood count, transaminases and amylase monthly at out patient clinics of our department. All patients were asked to fill a questionnaire to evaluate the interferon related side effects at every visit. Tumor necrosis factor alpha -238 and -308 polymorphisms were investigated with PCR-Restriction fragment length polymorphisms.
 Result(s) and Conclusion Arthralgia was present in 93.8% of patients. Exhaustion, loss of appetite, mount dryness and fever are the leading complaints of the patients. Median complaint scores were 9, 9.5, 11 and 5 at 4th, 12th, 24th and 48th week visits, respectively. Thrombocytopenia and leucopenia were detected in 8 (16%) and 5 (10%) patients, respectively. One-third of the patients reported depressive mood however, depression was diagnosed in 5 (10%) patients. TNF alpha promoter 238GG and 308GG allele was present in 42/50 and 43/50 patients, respectively. No association was found between TNF promoter allele and certain patient-reported side effect, complaint score, hematological and psychological adverse effects. TNF alpha promoter polymorphisms do not contribute to occurrence of IFN alpha treatment related side effects.

Cholelithiasis: Presentation and Management.

Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and nonmodifiable. Women are more likely to experience cholelithiasis than are men. Pregnancy, increasing parity, and obesity during pregnancy further increase the risk that a woman will develop cholelithiasis. The classic presentation of persons experiencing cholelithiasis, specifically when gallstones obstruct the common bile duct, is right upper quadrant pain of the abdomen that is often elicited upon palpation during physical examination and documented as a positive Murphy's sign. Referred pain to the right supraclavicular region and/or shoulder, nausea, and vomiting are also frequently reported by persons with cholelithiasis. Cholelithiasis can result in complications, including cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). Lack of physical examination findings does not rule out a diagnosis of cholelithiasis. Laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may assist the clinician in diagnosing cholelithiasis; however, ultrasonography is the gold standard for diagnosis. Management is dependent on severity and frequency of symptoms. Lifestyle and dietary modifications combined with medication management, such as use of gallstone dissolution agents, may be recommended for persons who have a single symptomatic episode. If symptoms become severe and/or are recurrent, laparoscopic cholecystectomy is recommended. It is recommended that individuals with an established diagnosis of cholelithiasis be referred to a surgeon and/or gastroenterologist within 2 weeks of initial presentation regardless of severity or frequency of symptoms.

Endoscopic dissection of refractory pancreatic duct stricture via accessory pancreatic duct approach for concurrent treatment of anomalous pancreaticobiliary junction in aging patients.

BackgroundAlthough endoscopic management of pancreatic strictures by dilation and stenting is well established, some high-grade strictures are refractory to conventional methods. Here, we report a novel technique via accessory pancreatic duct (APD) approach to simultaneously release chronic pancreatitis-associated pancreatic stricture and correct anomalous pancreaticobiliary junction (APBJ). Due to APBJ and stricture of proximal main pancreatic duct, the APD turned out to be compensatory expansion. The stiff stenosis was dissected along the axial of APD using needle-knife electrocautery or holmium laser ablation, and then the supporting stent was placed into the pancreatic body duct. By doing so, the outflow channels of pancreatic and biliary ducts were exquisitely separated.Patients and methodsTwo patients aged 69 and 71 years underwent stricture dissection and stent insertion for fluent drainage of pancreatic juice. The postoperative course was marked by complete abdominal pain relief and normal blood amylase recovery. In the first patient, wire-guided needle-knife electrocautery under fluoroscopic control was applied to release refractory stricture. The second patient was treated by SpyGlass pancreatoscopy-guided holmium laser ablation to lift pancreatic stricture.ResultsPlastic stents in APD were removed at 3 months after surgery, and magnetic resonance imaging at 6 months showed strictly normal aspect of the pancreatic duct.ConclusionAlthough both cases were successful without severe complications, we recommend this approach only for selected patients with short refractory pancreatic strictures due to chronic pancreatitis. In order to prevent severe complications (bleeding, perforation or pancreatitis), direct-view endoscopy-guided electrotomy needs to be developed.

An experimental study on endoscopic ultrasound-guided microwave ablation for porcine liver and pancreas

Objective To evaluate the feasibility and safety of endoscopic ultrasound-guided microwave ablation (EUS-MWA) for porcine liver and pancreas by assessing physiological state and pathological changes. Methods EUS-MWA was performed on liver and pancreas of 8 healthy pigs after general anesthesia. The needle size was 1.9 mm in diameter, and the power of ablation was 65 W, 10 min on liver and 60 W, 5 min on pancreas. The levels of blood amylase and hepatic transaminase were examined before and after the operation. All pigs underwent CT scan on the right postoperative day to assess the extent of ablation and complications. Two pigs were killed 6 hours after operation and 2 others were killed 24 hours after operation to assess structural damage around the puncture path. The remaining 4 pigs were raised to 2 weeks after operation to observe diet, activities and mental state. The ablated areas of liver and pancreas underwent pathological analysis after dissection, and non-ablation regions were treated as the control. Results All 8 pigs underwent EUS-MWA and their vital signs were stable during the operation. Except for the difficulty in locating the pancreas in one case, other surgical procedures were smooth and 18 ablations were performed totally (10 in liver and 8 in pancreas). CT scans showed quasi-circular low density lesions in the liver and pancreas, and the maximum diameter of the ablation area in liver and pancreas was 2.8±0.3 cm, 1.8±0.2 cm respectively. There was no free intraperitoneal gas, ascites or pleural effusion. The level of blood amylase increased at 6 hours after operation and the peak value occurred within 12-24 hours. The level of hepatic transaminase had a mild elevation. The rearing group showed transient food refusal and activity reduction after the operation, but all returned to normal within 1-2 days. No fever, vomiting or other abnormalities occurred. Puncture path burn, adjacent organ damage and bleeding was not observed except for one case of gastric wall burns during pancreas ablation. Pathology showed massive coagulative necrosis and peripheral bleeding area in the liver ablation center, and diffuse focal necrosis in the tissue of the pancreatic ablation area. Conclusion EUS-MWA is safe and feasible for porcine liver and pancreas, which can be used for the treatment of human liver and pancreatic diseases in the future. Key words: Ultrasonography; Microwaves; Endoscopes; Animal experimentation

α-Amylase and α-glucosidase inhibitor effects and pancreatic response to diabetes mellitus on Wistar rats of Ephedra alata areal part decoction with immunohistochemical analyses.

Ephedra alata, known as a medicinal plant in China, was used in this study as aqueous extract from aerial parts, for diabetes mellitus treatment. This study was carried out on two parts, in vitro, we tested the effect of the studied extract on the inhibition of α-glucosidase and α-amylase activities, and in vivo on Wistar male rats receiving alloxan intraperitoneally at a rate of 125mg/kg. Extract (100, 200, and 300mg/kg of body weight) was administrated for 28days by oral gavage. Blood glucose, amylase, lipase, and lipid profile level were determined. Oxidative stress was evaluated by enzymatic activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), and by estimation of lipid peroxidation and protein carbonyl (PC) level. Histopathological changes in pancreas were investigated under photonic microscopy using immunohistochemical procedure. Our findings showed that aqueous extract inhibited in vitro both α-glucosidase and α-amylase activities and its use in vivo at 300mg/kg of body weight restored pancreas weight and weight gain, ameliorated significantly (p˂0.05) biochemical parameters; it prevented the increase in lipid and protein oxidation and the decrease in enzymatic and non-enzymatic defense system. Histological study of treated animals showed a comparable healed regeneration of beta cells.

Diagnosis and treatment of pregnancy complicated with hyperlipidemic pancreatitis: a report of 12 cases

Objective To investigate the clinical characteristics, diagnosis and treatment of pregnancy complicated with hyperlipidemic pancreatitis (HLAP). Methods The clinical data of 12 patients with hyperlipidemic pancreatitis in our hospital from 2010 to 2017 were analyzed retrospectively, including general data, clinical manifestations, laboratory examinations, imaging examinations, treatment methods and prognosis. Results 12 cases of HLAP were mainly occurred in the middle and late pregnancy and often recurs. The main cause of the disease was the high fat diet. The main manifestations of the disease are abdominal pain and vomiting. It may be accompanied by gestational diabetes or hypothyroidism. Blood amylase and lipase are often not significantly elevated, with pseudohyponatremia and abnormal coagulation function. Ultrasonography and computed tomography (CT) are important methods for the diagnosis of HLAP. In 12 cases of HLAP, except for one abortion, all the other 11 cases were successfully treated. Conclusions For pregnancy complicated with hyperlipidemic pancreatitis, prevention is the first, and the key is the correct diagnosis. After combined treatment, the patients usually have a good prognosis. Key words: Pregnancy complications; Hyperlipidemias; Pancreatitis

A study of Acute Liver Failure in adults in a tertiary care hospital

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis.

Acute necrotizing pancreatitis (ANP) is the most severe form of acute pancreatitis (AP), and it has high mortality rates. Therefore, early diagnosis and treatment are of critical importance for the prognosis. The aim of this study was to investigate the effectiveness of immature granulocyte percentage (IG%) in the early prediction of ANP. This retrospective study included 96 adult patients hospitalized with a diagnosis of AP. Demographic data of the patients were recorded. The white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), IG%, C-reactive protein (CRP), and amylase levels were determined. Furthermore, computed abdominal tomography was applied to the patients, and the length of hospital stay was recorded. Patients were divided into two groups as those with acute edematous pancreatitis and ANP, according to the tomography results. The differences between the groups were analyzed statistically. The WBC count, NLR, CRP, and IG% were significant markers in the prediction of ANP. However, IG% had higher values with regard to the sensitivity, specificity, AUROC, and negative and positive predictive values (100%, 95%, 0.982, 78.9%, and 100%, respectively). An increased IG% is a simple, fast, and effective marker in the early prediction of ANP. This retrospective study was carried out on 96 adult patients who were hospitalized with a diagnosis of acute pancreatitis. Demographic data of the patients were recorded. White blood cell count, neutrophil/lymphocyte ratio, IG%, C-reactive protein and amylase levels were determined. Furthermore computed abdominal tomography was applied to the patients and the length of hospital stay was recorded. The patients were divided into two groups as acute edematous pancreatitis and acute necrotizing pancreatitis according to the tomography results. The differences between the groups were analyzed statistically. White blood cell count, neutrophil/lymphocyte ratio, C-reactive protein and IG% were significant markers in the prediction of acute necrotizing pancreatitis. However, IG% had higher values of sensitivity, specificity, AUROC, negative and positive predictive values ( 100%, 95%, 0.982, 78.9%, 100%,respectively). Increased IG% is a simple, fast, and effective marker in the early prediction of acute necrotizing pancreatitis.

Protection of acute renal injury in severe experimental acute pancreatitis

Background: Acute renal failure is a serious early complication in patients with acute pancreatitis (AP) significantly increases mortality rates. Thus, it is essential to protect renal function in patients with severe AP. Methods: Acute necrotizing pancreatitis was induced by L-ornithine in 26 Wistar rats. 16 rats served as control. We administered enoxaparin in 10 rats after induction of acute pancreatitis during 5 days. The effect of enoxaparin was evaluated by determining the levels of serum amylase, creatinine, hydrogen sulfide, and fibrinogen, time of recalcification, activity of NO-synthase and myeloperoxidase (MPO) in pancreas. Results: The concentration of creatinine in serum is increase at 86.86%. It was noticed that the level of creatinine significantly directly correlated with the concentration of MPO and activity of iNOS in the pancreas, amylase in serum blood, and reverse with the concentration of H2S in serum. Renal failure in rats was accompanied by a hypercoagulation, determined by probable direct correlation between the levels of creatinine and fibrinogen, inverse relationship between creatinine concentrations and plasma recalcification time. Enoxaparin ameliorates morphology of the pancreas and kidney. The enoxaparin normalized serum creatinine, fibrinogen, amylase, MPO, H2S, decreased activity of iNOS. Conclusion: Enoxaparin in experimental AP reduces morphological signs of damage in the pancreas and kidneys, the intensity nitrosative stress and inflammation, normalizes hemostasis.

Protection of acute renal injury in severe experimental acute pancreatitis

Background: Acute renal failure is a serious early complication in patients with acute pancreatitis (AP) significantly increases mortality rates. Thus, it is essential to protect renal function in patients with severe AP. Methods: Acute necrotizing pancreatitis was induced by L-ornithine in 26 Wistar rats. 16 rats served as control. We administered enoxaparin in 10 rats after induction of acute pancreatitis during 5 days. The effect of enoxaparin was evaluated by determining the levels of serum amylase, creatinine, hydrogen sulfide, and fibrinogen, time of recalcification, activity of NO-synthase and myeloperoxidase (MPO) in pancreas. Results: The concentration of creatinine in serum is increase at 86.86%. It was noticed that the level of creatinine significantly directly correlated with the concentration of MPO and activity of iNOS in the pancreas, amylase in serum blood, and reverse with the concentration of H2S in serum. Renal failure in rats was accompanied by a hypercoagulation, determined by probable direct correlation between the levels of creatinine and fibrinogen, inverse relationship between creatinine concentrations and plasma recalcification time. Enoxaparin ameliorates morphology of the pancreas and kidney. The enoxaparin normalized serum creatinine, fibrinogen, amylase, MPO, H2S, decreased activity of iNOS. Conclusion: Enoxaparin in experimental AP reduces morphological signs of damage in the pancreas and kidneys, the intensity nitrosative stress and inflammation, normalizes hemostasis.

Examination of protective and therapeutic effects of ruscogenin on cerulein-induced experimental acute pancreatitis in rats.

PurposeTo determine the potential protective and therapeutic effects and action mechanism of ruscogenin on cerulein-induced acute pancreatitis (AP) model in rats.MethodsOverall, 32 rats were attenuated to the sham (2-mL/kg/day isotonic solution for 4 weeks), control (20-µg/kg cerulein-induced AP for 12 hours), prophylaxis groups (cerulein-induced AP following 3-mL/kg/day ruscogenin for 4 weeks) and treatment (3-mL/kg/day ruscogenin following cerulein-induced AP for 12 hours). Blood samples were collected for biochemical analysis of nitric oxide synthase 1 (NOS1/neuronal NOS), malondialdehyde (MDA) and intercellular adhesion molecule 1 (ICAM-1). After sacrification, pancreas tissues were collected and prepared for light microscopic (hematoxylin and eosin), immunohistochemical (nuclear factor kappa B) and biochemical analysis (tumor necrosis factor-alpha [TNF-α], interleukin-6 and 1β [IL-6 and IL-1β], CRP, high-sensitivity CRP [hs-CRP] amylase, lipase, and ICAM-1). Ultrastructural analysis was performed by transmission electron microscopy.ResultsThe protective and therapeutic actions of ruscogenin were accomplished by improvements in histopathology, by decreasing blood cytokine levels of CRP, hs-CRP levels, TNF-α, IL-6, IL-1β, ICAM-1, by reducing the pancreatic enzymes amylase and lipase in blood, and by suppressing the expression of nuclear factor kappa B, ICAM-1, and NOS-1, but not MDA in pancreatic tissues. Ruscogenin also improved cerulein-induced ultrastructural degenerations in endocrine and exocrine cells, especially in treatment group.ConclusionThe present findings have demonstrated the beneficial protective and therapeutical effects of ruscogenin, nominating it as a highly promising supplementary agent to be considered in the treatment of AP, and even as a protective agent against the damages induced by disease.

Experimental study in vivo ablation of swine pancreas using high-intensity focused ultrasound.

The objective of this study is to evaluate the feasibility and safety of high-intensity focused ultrasound (HIFU) for ablation of swine pancreas and to detect the pathological variations in pancreas damage. (a) Eight swine were involved and randomly divided into two groups (Group A and B). HIFU was applied on swine in both groups for in vivo ablation of pancreas. The animals were anesthetized, and the artificial acoustic window was built. Then, the irradiation of FEP-BY02 type HIFU on pancreas was applied. (b) Swine in Group A were euthanized immediately after treating with HIFU to examine variations in pancreas. The biochemical evidence of pancreatitis was evaluated by blood samples collected from swine in Group B before and after HIFU. Then, the pancreas of swine in Group B was euthanized on day 5 after treatment to examine the pancreas. All specimens were visually inspected for both ultrasonic focal damage region (UFDR) and pathological routine by a skilled pathologist. (a) The vital signs of all animals were stable during HIFU treatment and recovered well after treatment. (b) UFDR were observed in all HIFU irradiation region of the specimens, without significant size difference between the two groups. The coagulation nucleus pyknosis, cytochylema vacuolation, and nucleus membrane disruption were observed after HIFU in both groups. Membranous structure dissolution and inflammatory cell infiltration were also found after HIFU in swine of Group B. (c) There was no significant difference in the levels of blood amylase in swine of Group B before and after HIFU treatment. It was feasible and safe to use HIFU for ablation of the pancreas in swine.

Mediastinal pancreatic cysts: review and own clinical observations

To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC). There were 5 patients with MPC. Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide. MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.

Biochemical Findings and outcomes of the treatment of the Patients with pancreatitis admitted in Nobel Medical College Teaching Hospital, Biratnagar, Nepal

Background: Pancreatitis is well known for its painful state of illness causing a severe impact on the quality of life which can be followed by life-threatening long-term sequelae of diabetes mellitus and pancreatic cancer as its complications.The present study was conducted to evaluate biochemical findings and outcomes following treatment of ICU admitted patients suffering from pancreatitis in Nobel Medical College Teaching Hospital (NMCTH).
 Materials and Methods: All the patients admitted in the ICU of NMCTH from 15th January 2017 to 14th January 2018 having been diagnosed as suffering from pancreatitis were enrolled in this study. Age, sex, differential diagnosis, blood amylase and lipase level and outcomes of the treatment of the patients were measured as major variables. Blood amylase and lipase level of these patients were estimated in the department of Biochemistry, NMCTH by the standard protocols using Randoxkits, provided by the manufacturer. The study was carried out after getting the approval from Institutional review committee (IRC). Statistical significance was compared using Student's two-tailed t-test. Results were considered significant if p ≤ 0.05.
 Results: The number of patients admitted in ICU and suffering from pancreatitis was 136 out of 2204 total admission in ICU within a period of 1 year. Out of 136 pancreatitis patients, 44 were of biliary pancreatitis, 40 of alcoholic and 52 were patients of pancreatitis suffered from some other unknown factors. The mean age of the patients was 41.5±14.2 year. While analyzing the pancreatitis cases gender wise, it was found that male (N=80) were more sufferers than females (N=56). The mean ±SD value of blood amylase and lipase of these patients with pancreatitis were 1040±1062 IU/L & 442±425 IU/L respectively, which was significantly higher than the normal range. The maximum numbers of pancreatitis cases were seen in age group (30-39), (44 patients). It was found in our study that male patients were more sufferers of alcoholic pancreatitis than females; where as female patients were more in number among patients with biliary pancreatitis than males. The patients after getting the proper line of treatment, 88 of them recovered completely without any complication, 38 patients developed some complication, in which 26got recovered fully and 12 were referred. Mortality was seen in 10 patients.
 Conclusion: The results shows a very high prevalence rate of pancreatitis, the highest number being shared by those suffering from unknown factors followed by biliary pancreatitis and alcoholic pancreatitis in the descending order. In biliary pancreatitis, female patients are more whereas, the males are taking the major share among alcoholic pancreatitis. The level of the marker enzymes (amylase & lipase) are significantly higher than the normal confirming the cases to be of pancreatitis. Out of 136 patients, except for 12 cases referred and 10 patients died, all are fully recovered and discharged.

Targeting peptidylarginine deiminase reduces neutrophil extracellular trap formation and tissue injury in severe acute pancreatitis.

Recent evidence suggests that neutrophil extracellular traps (NETs) play an important role in the development of acute pancreatitis (AP). Herein, we examined the role of peptidylarginine deiminase (PAD), which has been shown to regulate NET formation, in severe AP. AP was induced by retrograde of taurocholate infusion into pancreatic duct in C57BL/6 mice. PAD was pharmacologically inhibited using Cl-amidine, a pan-PAD inhibitor. Pancreata were collected, and histones, citrullinated histone 3, chemokines, myeloperoxidase, and NETs were quantified. Chemokines, matrix metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), and DNA-histone complexes were determined in plasma samples. Infusion of taurocholate induced formation of NETs in pancreatic tissues of mice. Pretreatment with Cl-amidine markedly reduced the NET formation in the inflamed pancreas. Moreover, inhibition of PAD decreased the levels of blood amylase as well as edema, acinar cell necrosis, hemorrhage, and neutrophil infiltration in the pancreas of animals with AP. Administration of Cl-amidine attenuated the myeloperoxidase levels in the pancreas and lung of mice exposed to taurocholate. In addition, Cl-amidine decreased pancreatic levels of CXC chemokines, plasma levels of IL-6, and MMP-9 in mice with severe AP. This study shows that Cl-amidine is a potent inhibitor of NET formation in severe AP. Also, our results suggest that PAD regulates pathological inflammation and tissue damage in the inflamed pancreas. Thus, targeting PAD might be a useful strategy to treat patients with severe AP.

Clinical study of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis

Objective To investigate the effects of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis (SAP). Methods A total of 62 patients with SAP meeting the inclusion criteria were randomly divided into 2 groups, with 31 cases in each group. The control group was treated with western medicine routine treatment. The study group was given the combination of raw and rhubarb water infusion and mirabilite external application on the basis of the control group. After treated with 28 d, the duration of blood purification, abdominal pain disappeared time, blood amylase recovery time, bowel peristalsis recovery time, hospitalization time and 28 d mortality were observed in the 2 groups. Results The duration of blood purification time, abdominal pain disappeared time, blood amylase recovery time, bowel peristalsis recovery time, hospitalization time of the study group were significantly lower than those of the control group (t=2.434, 2.507, 2.804, 2.318, 2.614, P<0.05). After treatment 1, 3, 7 d, the level of D-lactic acid in the study group was respectively which were significantly lower than those of the control group (t=38.752, 36.975, 36.018, P<0.05). The level of DAO in the study group was respectively which were significantly lower than those of the control group (t=4.119, 4.632, 3.907, P<0.05). The level of ET in the study group was respectively which were significantly lower than those of the control group (t=25.699, 23.805, 24.472, P<0.05). The level of hs-CRP in the study group was respectively which were significantly lower than those of the control group (t=4.791, 5.025, 5.288, P<0.05). The level of PCT in the study group was respectively which were significantly lower than those of the control group (t=4.350, 4.742, 6.012, P<0.05). The APACHE II scores in the study group were respectively which were significantly lower than those of the control group (t=3.988, 4.350, 5.722, P<0.01). Conclusions The application of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis can protect the intestinal mucosal barrier of SAP patients, reduce the level of inflammatory reaction, shorten the time of symptom relief and improve the curative effect. Key words: Severe acute pancreatitis; Rheum officinale; Natrii sulfas; Hypersensitive C reactive protein; procalcitonin

Fetal microchimerism in mouse caerulein-induced pancreatitis model.

Objective(s):Fetal microchimerism is the persistence of allogeneic cell population that transfer from the fetus to the mother. The aim of this study was to evaluate the presence of fetal microchimerism in the pancreas of the mouse with acute pancreatitis (AP).Materials and Methods:In this experimental study, female wild-type mice were mated with male EGFP+. AP model was obtained by injection of caerulein two days after delivery. Sixty mice were divided into 3 groups: the virgin pancreatitis-induced animals, pregnant pancreatitis-induced animals mated with transgenic EGFP mice, and pregnant sham animals. To prove pancreatitis induction, the blood amylase and lipase were assessed; and pancreas was removed from a subpopulation of each group for histopathological examinations after 6 hr. The remaining mice were kept for 3 weeks and histopathological exanimation, immunohistochemistry, and PCR were performed.Results:EGFP+ cells were found in acini and around the blood vessels in the pancreas of pregnant pancreatitis-induced animals. They differentiated to acinar, adipocyte-like, and mesenchymal-like cells. PCR showed that 20% of the pregnant pancreatitis-induced animals were EGFP+. The histopathological study showed improvement in pancreatitis scores in the mice with history of pregnancy. Conclusion:It seems that pregnancy has a beneficial impact on caerulein-induced pancreatitis and improves the pancreatitis score in mouse.

One-Year Blood Glucose Level is the Best Metabolic Marker for the Prediction of Late Pancreas Graft Failure

Aim The goal of this study was to explore whether donor and recipient’s characteristics, and one-year biological parameters could have a predictive value for the diagnosis of late pancreas graft failure. Methods 354 type 1 diabetic patients underwent pancreas transplantation between 2000 and 2015. Pancreas graft failure was defined as return to oral antidiabetics, permanent insulin-dependence. Recipient and donor characteristics were analyzed at the time of transplantation to determine potential risk factors for late graft dysfunction (after one year). Biological parameters such as HbA1c, fasting blood glucose, C-peptide, insulin, amylase, lipase, OGTT, Matsuda index, Beta score, HOMA IR and HOMA B, were analyzed one year after transplantation. Results 280 SPK, 38 PTA and 36 PAK were performed in 139 men and 215 women, with a mean age of 40 years. Median follow-up was 6 years. Patient survival was 96% at 1 year, 93% at 3 years and 87.5% at 5 years, whithout any significant difference between the three pancreas categories. Cardio-vascular diseases were the first cause of late recipient death. 111 patients experienced graft failure, 50 of them after the first year of transplantation. Pancreas survival was 80.5%, 70.7% and 67.5%, respectively at 1, 3 and 5 years, without any difference between the three categories. After the first year post-transplantation, death with a functioning graft occurred in 35.5% of patients with graft dysfunction. Donor death from cardiovascular cause was the only risk factor for late graft failure (OR 1,82 [1.05; 3.75], p=0,0345). One-year fasting blood glucose was the best predictive marker for a future graft dysfunction, especially when this value was over 5,4 mmol/l (OR 3.44 [1.80; 6.58] p=0.0002). 2-hour OGTT glucose level was also a risk factor for graft failure (OR 1.19 [1.04; 1.37] p=0,0109) while high Beta score (OR 0.62 [0.41; 0.94] p=0.0231) and high values of HOMA-B (OR 0.996 [0.992; 0.999] p=0,0483) were protective factors. Multivariate analysis identified a value of fasting blood glucose over 5.4 mmol/l (OR 4.24 [1.28; 14.04] p=0.0180) as the only significant risk factor. Graft survival was significantly different between patients with one-year blood glucose over or below 5.5 mmol/l: 85.2 vs 94.5% at 3 years and 72.3% vs 91.5% at 5 years (p<0,05), respectively. Conclusion Donor death from cardiovascular cause was the single risk factor for late graft failure among all donor and recipient’s base-line data. One-year fasting blood glucose level was the most significant biochemical parameter among patients at risk for graft failure, especially when the value was over 5,4 mmol/l. Two-hour OGTT glucose level, Beta score and HOMA B performed one year after transplantation are additional useful tools for identification of patients at risk. Whether medical intervention (i.e. GLP-1 analogue) among patients with still “normal glucose metabolism” could improve long-term graft survival requires prospective evaluation.

The inverse relationship between blood amylase and insulin levels in pigs during development, bariatric surgery, and intravenous infusion of amylase.

The purpose of this research is to explore the link between plasma amylase and insulin levels in growing pigs. Blood was obtained from piglets ranging in age from preterm (8 days to full gestation period), up to postnatal day 90 (2 months post-weaning) that underwent either duodenal-jejunal bariatric interposition surgery or a sham-operation. Plasma amylase activities in preterm and full-term neonates ranged between 500–600 U/L and were decreased by 50% two months post-weaning. Preprandial insulin and C-peptide levels in neonate piglets were not detectable, however they rose gradually after weaning. An increase in plasma amylase activity was observed in the young pigs that underwent duodenal-jejunum bypass (metabolic) surgery. The increase in blood pancreatic amylase activity after an intravenous amylase infusion lowered the subsequent glucose-stimulated insulin/C-peptide release. We suggest a role for blood amylase in the regulation of glucose homeostasis after observing high blood amylase levels in neonate pigs, in pigs that underwent metabolic surgery, and as a result of the reduced glucose-stimulated insulin response following intravenous amylase administration. Blood amylase level is a dynamic physiological parameter, which is not merely a consequence of exocrine pancreatic digestive enzyme production, but rather a regulated factor involved in glucose assimilation and prandial insulin regulation.