Serum Amylase Levels Research Articles

Isorhamnetin Alleviates Mitochondrial Injury in Severe Acute Pancreatitis via Modulation of KDM5B/HtrA2 Signaling Pathway.

Severe acute pancreatitis (SAP), a widespread inflammatory condition impacting the abdomen with a high mortality rate, poses challenges due to its unclear pathogenesis and the absence of effective treatment options. Isorhamnetin (ISO), a naturally occurring flavonoid, demonstrates robust antioxidant and anti-inflammatory properties intricately linked to the modulation of mitochondrial function. However, the specific protective impact of ISO on SAP remains to be fully elucidated. In this study, we demonstrated that ISO treatment significantly alleviated pancreatic damage and reduced serum lipase and amylase levels in the mouse model of SAP induced by sodium taurocholate (STC) or L-arginine. Utilizing an in vitro SAP cell model, we found that ISO co-administration markedly prevented STC-induced pancreatic acinar cell necrosis, primarily by inhibiting mitochondrial ROS generation, preserving ATP production, maintaining mitochondrial membrane potential, and preventing the oxidative damage and release of mitochondrial DNA. Mechanistically, our investigation identified that high-temperature requirement A2 (HtrA2) may play a central regulatory role in mediating the protective effect of ISO on mitochondrial dysfunction in STC-injured acinar cells. Furthermore, through an integrated approach involving bioinformatics analysis, molecular docking analysis, and experimental validation, we uncovered that ISO may directly impede the histone demethylation activity of KDM5B, leading to the restoration of pancreatic HtrA2 expression and thereby preserving mitochondrial function in pancreatic acinar cells following STC treatment. In conclusion, this study not only sheds new light on the intricate molecular complexities associated with mitochondrial dysfunction during the progression of SAP but also underscores the promising value of ISO as a natural therapeutic option for SAP.

Abstract 5096: Clinical feature of immune checkpoint inhibitor-induced pancreatic injury

Abstract Immune checkpoint inhibitors(ICIs) cause multiple adverse inflammatory reactions known as immune-related adverse events(irAEs), but ICI-related pancreatic injury(ICI-PI) is rare. ICI-PI ranges from asymptomatic hyperamylasemia to acute pancreatitis(ICI-AP), and its clinical features are not fully understood. We investigated the frequency and clinical features of ICI-PI and ICI-AP as well as their possible risk factors. Of the 186 consecutive cases who received ICI for GI cancers in our hospital from January 2020 to May 2022, 185 could be evaluated for serum amylase(AMY) levels pre- and post- ICI treatment. We retrospectively examined the clinical features and predictors of ICI-PI. Hyperamylasemia of grade 2 or higher according to CTCAE(v.5.0) was considered ICI-PI, and cases with other obvious factors were excluded. In the case of ICI-AP, we analyzed the pathological features of the tissues collected by EUS-FNA as well as the clinical features. The median of ICI doses was 6.0(range, 1-64), and the median duration of observation was 236 days(range, 17-1162). There were 25 cases of hyperamylasemia (higher than ULN) before starting ICI treatment. After starting ICI treatment, 14 patients(7.6%) developed ICI-PI, in all cases grade 2. The median time to onset of ICI-PI was 37.5 days(7-715). No cases discontinued ICI dosing due to ICI-PI, and no cases developed obvious pancreatic endocrine or exocrine insufficiency during the observation period. Overall survival was significantly longer in cases with ICI-PI than in those without ICI-PI(MST; 855 vs. 347days, p=0.029) and there was a trend toward longer PFS(MST; 160 vs. 96 days, p=0.057). Multivariate analysis revealed that only pretreatment serum AMY level(≥80 U/L) was a significant independent predictor of developing ICI-PI(HR: 5.00, 95% CI: 1.057-23.668, p=0.04). ICI-AP occurred in 2 cases(1.1%), both of them discontinued ICI treatment. Both cases showed enlarged pancreas on CT scan, negative serum IgG4 level, and responded well to steroid therapy. Pathological findings showed lymphoplasma cell infiltration, flower-like fibrosis, and obstructive phlebitis, which were similar to type 1 autoimmune pancreatitis(AIP) in one case. In the other case, neutrophil infiltration was observed in the stroma and epithelium, similar to type 2 AIP. The best overall response was PR in both cases with ICI-AP. The findings of this study indicate that higher pretreatment serum AMY levels may increase the probability of ICI-PI. ICI-PI cases without pancreatitis did not show any pancreatic endocrine or exocrine insufficiency during the observation period without interruption of ICI treatment and had favorable prognosis, but a more long-term evaluation of the impact on pancreatic function is needed. The clinical implications of ICI-related hyperamylasemia and its differences from ICI-AP remain uncertain and need to be explored in the future. Citation Format: Junichiro Itani, Takeshi Ishikawa, Toshifumi Doi, Daiki Sone, Ryuichi Morita, Naoto Iwai, Ryohei Hirose, Ken Inoue, Osamu Dohi, Naohisa Yoshida, Kazuhiko Uchiyama, Tomohisa Takagi, Hideyuki Konishi, Yoshito Itoh. Clinical feature of immune checkpoint inhibitor-induced pancreatic injury [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5096.

Differences in glucose homeostasis and islet injury among diverse mice strains post acute pancreatitis

Diverse animal models have been used to study postpancreatitis diabetes mellitus (PPDM) development; however, no study has yet conducted a comparative analysis of the specific differences in glucose homeostasis and islet injury between these models. Therefore, we investigated the differences in pancreatic islet injury and glucose homeostasis among diverse strains in a cerulein-induced acute pancreatitis (AP) model to determine the appropriate animal model for PPDM. BALB/cJ, C57BL/6J, C57BL/6 N, and FVB/NJ mice were administered cerulein to induce AP. Serum amylase levels, pancreatic acinar injury, blood glucose homeostasis, islet function, and islet injury were measured and analyzed. All strains exhibited elevated amylase secretion post pancreatitis, and BALB/cJ, C57BL/6J, and C57BL/6 N mice exhibited sex-related differences. All strains exhibited pancreatic acinar injury post pancreatitis but mostly recovered within 15 days. Overall, glucose homeostasis remained balanced post pancreatitis in all strains compared to that in the control groups, except in FVB/NJ male and female mice, which exhibited an imbalance in glucose homeostasis on day 7 post pancreatitis. All the strains, except BALB/cJ mice, exhibited a decline in Homeostasis model assessment-β(HOMA-β) values post pancreatitis, with significant decrease in C57BL/6J females and FVB/NJ males. Islet size decreased post pancreatitis in all strains, except BALB/cJ mice. Pancreatic islet insulin secretion levels significantly decreased in male FVB/NJ mice post pancreatitis onset and did not recover within 15 days. Therefore, FVB/NJ male mice are a useful model for studying PPDM.

Clinical and Biochemical Characteristics of Acute Pancreatitis Patients Attended in a Tertiary Hospital of Bangladesh

Introduction: Acute pancreatitis is a complex, life- threatening disease resulting from acute inflammation of the pancreas which causes considerable morbidity and mortality among the patients. Objectives: To find out the clinical and biochemical characteristics of acute pancreatitis patient attended at the Combined Military Hospital (CMH) Dhaka. Methods: This observational study was conducted at CMH Dhaka among 40 patients of acute pancreatitis admitted from 1st January 2013 to 30th June 2013. Data were collected through face-to-face interview using a pre-tested semi- structured questionnaire and review of the hospital records. Results: Highest number of the respondents (42.5%) belongs to the age group of 20-39 years. The mean age was 44.90 years (±13.46) years and 60.0% of them were male. More than half (57.5%) of the respondents had monthly income in the 20001 to 50000 Taka with average of 31,650(±15,255.60) Taka. All the patients presented with pain in the abdomen which was followed by nausea/ vomiting (82.5%), abdominal distention (72.5%). On examination, it was revealed that all the respondents had abdominal tenderness which was followed by muscle guard (10.0%), ascites (7.5%) and jaundice (5.0%). Almost half (47.50%) of the respondents developed acute pancreatitis due to stone in the gall bladder which was followed by idiopathic origin (30.0%). Eighty five percent of the patients had severe symptoms and rest (15%) had mild symptoms. All the respondents had elevated serum amylase level and 82.5% had elevated serum lipase level. Conclusion: Acute pancreatitis mostly affect young adult male. Most common clinical presentations are upper abdominal pain, nausea/vomiting and abdominal tenderness. Gallstone is the commonest cause of the condition. Serum amylase is the most important biochemical abnormality found in acute pancreatitis. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 38-41

Aetiology and Clinical Profile of Acute Pancreatitis in a Tertiary Care Hospital

Background: Acute Pancreatitis is a potentially serious condition with an overall mortality of 10%. Early diagnosis is important for its management. So clinician must carefully evaluate the patient with history, physical examination, laboratory tests and imaging studies before arriving a correct diagnosis. Death is more likely in certain subgroups of patients including elderly, co-morbidity, severe coexisting hospital acquired infection and organ dysfunction. Objectives: To assess aetiology and clinical profile of acute pancreatitis in a tertiary care hospital. Methods: A six-month Cross sectional study carried out at the department of Medicine, Comilla Medical College. Ethical approval from the institutional review board was obtained to ensure patient privacy and confidentiality. Results: The majority of patients are within the age group of 21-60 years (88.4%), with a higher proportion of males (71.2%) than females (28.8%). The most common clinical presentations were abdominal pain (95.6%) and nausea/vomiting (89.6%). Idiopathic (38%) and gallstone-related (38.4%) causes were the most common etiologies, while necrotizing pancreatitis (9.6%) and pancreatic pseudocysts (4.8%) were the most frequent complications. Regarding outcomes, a majority of patients experienced a favorable prognosis, with 64.4% recovering and being discharged. However, the complexity and severity of some cases were evident, as 17.6% of patients required referral to higher levels of care for further management. Additionally, a small percentage of patients left against medical advice (14.8%), and mortality was observed in 3.2% of cases. Laboratory investigations played a crucial role in diagnosing acute pancreatitis, and elevated levels of serum amylase (64.4%) and lipase (95.2%) were prominent diagnostic markers. Other abnormal laboratory parameters, such as elevated transaminase (90.8%) and C-reactive protein (86.4%), provided valuable insights for diagnosis and management. Conclusion: The study found acute pancreatitis with a wide range of clinical presentations and aetiologies. Abdominal pain is the most common symptom and gallstones are the most common causes. The study has evaluated the outcomes and complications of acute pancreatitis indicating that a significant proportion of cases had a favorable prognosis. A notable proportion required referral to higher levels of care, suggesting the complexity and severity of some instances of acute pancreatitis. A smaller percentage left against medical advice, and a few cases resulted in mortality. J Com Med Col Teachers’ Asso July 2023; 27(2): 67-74

Noninvasive rapid urinary trypsinogen-2 dipstick test for early exclusion of post-endoscopic retrograde cholangiopancreatography pancreatitis within hours after endoscopic retrograde cholangiopancreatography: Clinical diagnosis and considerations.

Few reports have explored the application of urinary trypsinogen-2 measurement in the early diagnosis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and none have demonstrated the benefits of noninvasive testing. This study aimed to evaluate the clinical application of the rapid urinary trypsinogen-2 dipstick test (Nipro, Japan) compared with serum amylase and lipase levels for the early diagnosis of post-ERCP pancreatitis (PEP). A total of 100 consecutive patients (54 men and 46 women) who were admitted and underwent ERCP at Tokyo Medical University Hospital from August 2021 to December 2021 were recruited. All patients underwent rapid urinary trypsinogen-2 measurement using the dipstick test before and after ERCP. Measurements were taken 24 h before ERCP for pre-ERCP and 1-4 h after ERCP for post-ERCP. Additionally, serum amylase and lipase levels were measured at 8:00 a.m. of the day after ERCP (at least 8 h after ERCP), and their diagnostic abilities for PEP were compared and evaluated. PEP occurred in 5/100 patients (5%). The sensitivity, specificity, positive predictive value, and negative predictive value of the dipstick test for diagnosing PEP were 100%, 83.2%, 23.8%, and 100%, respectively. These results were comparable to the diagnostic performance of serum amylase and lipase levels at 8:00 a.m. on the day after ERCP (at least 8 h after ERCP). However, false positives must be considered. The dipstick test may be useful in clinical practice as a noninvasive screening test for the early prediction of PEP.

Soat2 inhibitor avasimibe alleviates acute pancreatitis by suppressing acinar cell ferroptosis.

Ferroptosis, characterized by lipid peroxidation, plays a significant role in the pathogenesis of acute pancreatitis (AP). While sterol O-acyltransferase 2 (Soat2) is known for its crucial regulatory role in cholesterol homeostasis, its involvement in the development of AP remains unreported. We conducted this study to identify the pivotal role of Soat2 in AP using transcriptomic databases. Subsequently, we confirmed its alterations through both in vitro and in vivo experimental models. Furthermore, we performed intervention with the Soat2 inhibitor avasimibe to evaluate pancreatic tissue pathology and serum enzymatic levels and observe inflammatory cell infiltration through immunohistochemistry. Additionally, changes in indicators related to ferroptosis were also observed. The results showed that in the AP mouse model, the protein and mRNA levels of Soat2 were significantly increased. Following avasimibe administration, there was a decrease in serum amylase levels, reduction in pancreatic tissue pathological damage, and attenuation of inflammatory cell infiltration. Furthermore, avasimibe administration resulted in downregulation of ferroptosis-related indicators. In conclusion, our findings suggest that the Soat2 inhibitor avasimibe protects against AP in mice through inhibition of the ferroptosis.

The primary prevention of pancreatic fistula using a vascularised rectus abdominis muscle flap – A porcine model

A pancreatic fistula is one of the most devastating complications following a Whipple's procedure. Fistula rates remain high despite various modifications to surgical techniques. We propose the use of a vascularised muscle flap in the primary prevention of pancreatic fistulas. A distal pancreatectomy was performed on 5 pigs in our porcine model. A pancreaticojejunal (PJ) anastomotic leak was simulated. The pigs were divided into treatment (4 pigs) and control groups (1 pig). A left pedicled rectus abdominis flap was wrapped around the PJ anastomosis for the treatment group and omitted for the control group. Serum and drain amylase levels were recorded. The PJ-rectus abdominis flap complex was evaluated histologically. There was no biochemical evidence of anastomotic leak in the treatment group. The drain-serum amylase ratio was less than 1.5 in the treatment group (p=0.006). Microscopically, the muscle adjacent to the anastomotic leak showed mild necrotic changes with an affected muscle depth of less than 10%. The vascularised rectus abdominis muscle is a durable flap to withstand proteolytic pancreatic enzymes. It is able to provide a water-tight seal around the PJ anastomosis and mitigate intraperitoneal haemorrhage and infection caused by erosion from the pancreatic fistula.

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.

Ayurvedic Management of Pancreatitis

Pancreatitis is the life threatening metabolic pathology of the gastrointestinal system. It progressively damages the pancreas and result in the loss of its functions. The prevalence rate of pancreatitis in India is 7.9 per 10, 0000. For male and female respectively 8.6 and 8 in India. With overall 10 year and 20 year survival rates are estimated to be about 70% to 45% respectively. In the contemporary science the treatment protocol is limited to painkillers, intravenous fluids and pancreatic enzymes. Despite of advance techniques in the allopathic science the prognosis of the disease is unclear. Ayurvedic formulations of mineral complex including a diet and moderate rest have shown excellent result. In this case report a 40 year old male patient a known case of chronic pancreatitis with recurrent abdominal pain which radiates to back, nausea, vomiting, tenderness, anorexia, along with elevated serum amylase level was managed effectively with Ayurvedic medications by the Department of PG Study in Shalyatantra OPD Dr. BRKR Government Ayurvedic Medical College and Hospital, Hyderabad. In Ayurveda this condition can be correlated Agnashayashoth which comes under Pittodara. And it was successfully treated with the medications like Shankha vati, Kravyadi ras, Arogyavardgani vati. Within 4 months of treatment patient become normal. There was no pain abdomen, nausea, vomiting, bloating of abdomen. And serum amylase came to its normal level. This shows that Ayurvedic herbo mineral formulations showing promising result in the management of pancreatitis.

Gastrodin ameliorates acute pancreatitis by modulating macrophage inflammation cascade via inhibition the p38/NF-κB pathway

Acute pancreatitis (AP) is a prevalent, destructive, non-infectious pancreatic inflammatory disease, which is usually accompanied with systemic manifestations and poor prognosis. Gastrodin (4-hydroxybenzyl alcohol 4-O-β-d-glucopyranoside) has ideal anti-inflammatory effects in various inflammatory diseases. However, its potential effects on AP had not been studied. In this study, serum biochemistry, H&E staining, immunohistochemistry, immunofluorescence, western blot, real-time quantitative PCR (RT-qPCR) were performed to investigate the effects of Gastrodin on caerulein-induced AP pancreatic acinar injury model in vivo and lipopolysaccharide (LPS) induced M1 phenotype macrophage model in vitro. Our results showed that Gastrodin treatment could significantly reduce the levels of serum amylase and serum lipase while improving pancreatic pathological morphology. Additionally, it decreased secretion of inflammatory cytokines and chemokines, and inhibited the levels of p-p38/p38, p-IκB/IκB as well as p-NF-κB p-p65/NF-κB p65. Overall our findings suggested that Gastrodin might be a promising therapeutic option for patients with AP by attenuating inflammation through inhibition of the p38/NF-κB pathway mediated macrophage cascade.

Qing Xia Jie Yi Formula granules alleviated acute pancreatitis through inhibition of M1 macrophage polarization by suppressing glycolysis

Ethnopharmacological relevanceHerbal formulas from Traditional Chinese Medicine are common and well-established practice for treating acute pancreatitis (AP) patients. However, little is known about their bioactive ingredients and mechanisms, such as their targets and pathways to inhibit inflammation. Aim of the studyThis study aimed to evaluate the effect of Qing Xia Jie Yi Formula (QXJYF) granules on AP and discuss the molecular mechanisms involved. Materials and methodsMajor compounds in QXJYF granules were identified using UPLC-quadrupole-Orbitrap mass spectrometry (UPLC-Q-Orbitrap MS). The effect of QXJYF granules on experimental AP models both in vitro and in vivo, and detailed mechanisms were clarified. Two AP models were induced in mice by intraperitoneally injections of caerulein or L-arginine, and QXJYF granules were used to treat AP mice in vivo. Histological evaluation of pancreas and lung, serum amylase and lipase levels, serum inflammatory cytokines, inflammatory cell infiltration and macrophage phenotype were assessed. Bone marrow derived macrophages (BMDMs) were cultured and treated with QXJYF granules in vitro. BMDM phenotype and glycolysis levels were measured. Lastly, clinical effect of QXJYF granules on AP patients was verified. Predicted severe AP (pSAP) patients eligible for inclusion were assessed for enrollment. ResultsNine major compounds were identified in QXJYF granules. Data showed that QXJYF granules significantly alleviated AP severity both in caerulein and L-arginine-induced AP models in vivo, pancreatic injury and inflammatory cell infiltration, systematic inflammation, lung injury and inflammatory cell infiltration were all improved after QXJYF treatment. QXJYF granules significantly reduced M1 macrophages during AP both in vivo and in vitro; besides, the mRNA expression levels of M1 genes such as inos, Tnfα, Il1β and Il6 were significantly lower after QXJYF treatment in M1 macrophages. Mechanistically, we found that HK2, PFKFB3, PKM, LDHα levels were increased in M1 macrophages, but significantly decreased after QXJYF treatment. Clinical data indicated that QXJYF granules could significantly reduce CRP levels and shorten the duration of organ failure, thereby reducing the incidence of SAP and preventing pSAP patients from progressing to SAP. ConclusionQXJYF granules alleviated AP through the inhibition of M1 macrophage polarization by suppressing glycolysis.

Role of Madhutailik basti and Shaman Section chikitsa in the Management of Acute on Chronic Pancreatitis: A Case Report

Chronic pancreatitis is a condition characterised by persistent inflammation of the pancreas, leading to permanent damage and loss of its exocrine and endocrine functions. Clinical symptoms of the disease include abdominal pain, nausea, vomiting, steatorrhoea, indigestion, and weight loss. In Ayurveda, it can be correlated with Grahani dosha, a disorder of the duodenum and gut. Mandagni, which is the hypo-functioning of Agni, is considered the root cause of Grahani dosha and is addressed through various treatment modalities in Ayurveda. Hereby, the authors present a case report of 40-year-old male diagnosed with chronic pancreatitis presented with severe pain in the epigastric and left hypochondriac region of the abdomen, decreased appetite, nausea, and constipation for five years. After three years of conservative treatment and unsuccessful advice to undergo Endoscopic Retrograde Cholangiopancreatography (ERCP), the patient sought Ayurvedic treatment. The treatment involved Shodhan (purificatory) and Shamana (palliative) approaches, including Vata pitta shamaka kriya, Mridu virechana (mild purgation), and the use of Yakrutottejaka (hepato stimulant), Pramehaghna (pancreas protecting), and Rasayana (rejuvenating) formulations. Within four months, the patient experienced a significant improvement, with total remission of symptoms and a notable reduction in objective criteria such as serum lipase and serum amylase levels. The present case report suggests that Ayurvedic modalities can be effective in treating chronic pancreatitis. However, to draw definitive conclusions, further research with extensive follow-up and a larger sample size is necessary.

Functional role of IL-19 in a mouse model of L-arginine-induced pancreatitis and related lung injury.

IL-19 is a member of IL-10 family and is mainly produced by macrophages. Acute pancreatitis (AP) is an inflammatory disease characterized by acinar cell injury and necrosis. In the present study, the role of IL-19 in AP and AP-associated lung injury in mice was explored using L-arginine-induced pancreatitis. Experimental pancreatitis was induced by intraperitoneal injection of L-arginine in wild-type (WT) and IL-19 gene-deficient (IL-19 KO) mice. Among the mice treated with L-arginine, the serum amylase level was significantly increased in the IL-19 KO mice, and interstitial edema, analyzed using hematoxylin and eosin-stained sections, was aggravated mildly in IL-19 KO mice compared with WT mice. Furthermore, the mRNA expression of tumor necrosis factor-α was significantly upregulated in IL-19 KO mice treated with L-arginine compared with WT mice treated with L-arginine. IL-19 mRNA was equally expressed in the pancreases of both control and L-arginine-treated WT mice. The conditions of lung alveoli were then evaluated in WT and IL-19 KO mice treated with L-arginine. In mice with L-arginine-induced pancreatitis, the alveolar area was remarkedly decreased, and expression of lung myeloperoxidase was significantly increased in IL-19 KO mice compared with WT mice. In the lungs, the mRNA expression of IL-6 and inducible nitric oxide synthase was significantly increased in IL-19 KO mice compared with WT mice. In summary, IL-19 was proposed to alleviate L-arginine-induced pancreatitis by regulating TNF-α production and to protect against AP-related lung injury by inhibiting neutrophil migration.

Infection - The Comrade of Acute Pancreatitis in Systemic Lupus Erythematosus: A Case Series from Single Tertiary Centre in India

Introduction: Acute Pancreatitis in systemic lupus Erythematous is rare but has high mortality. Incidence varies from 1-5% and reported mortality is 3-37.04% with mortality being higher in juvenile SLE. Objective: Study of Clinical and serological profile of SLE patients presenting with acute pancreatitis. Method: Retrospective data of SLE patients visiting our institution was collected. Diagnosis was considered if patients had clinical + biochemical and radiological evidence of pancreatitis. Patients with diagnosis of gallstone, history of alcohol intake, serum Triglycerides>500 mg/dl, serum calcium>10.5 mg/dl and taking Azathioprine at the time of diagnosis were excluded. Results: 9 patients fulfilled inclusion and exclusion criteria. 7 had severe and 2 had moderately severe acute pancreatitis. Female: Male ratio was 8:1, Median age was 25(15-50) years, Median disease duration 12 months (3-48), 4(44.45%) presented within 1 year of disease onset. Mean SELENA-SLEDAI at the time of presentation was 26(19-41). 4(44.45%) were on corticosteroids at the time of presentation. Other active domains at the time of diagnosis were Nephritis in 7(77.78%), NPLE in 3(33.34%), Myositis in 4(44.45%), Autoimmune haemolytic anaemia in 2 (22.22%), Macrophage activation syndrome in 4 (44.45%) enteritis in 1 (11.11%) Myocarditis in 2 (22.22%) and Mucocutaneous in 9 (100%) patients. All patients had elevated Serum Amylase and Lipase level with Median serum Amylase being 545 Units/Litre (normal[Formula: see text]176) and median serum Lipase being 511 ([Formula: see text]160) Units/litre. 6(66.67%) had hypocalcemia and 5 (55.56%) had hypertriglyceridemia. Raised dsDNA was seen in 9(100%, median 277 IU/ml) and hypocomplementemia was seen in 7(77.78%, Median C3 value 49 mg/dL)). None of the patients had associated antiphospholipid syndrome but persistent antiphospholipid antibodies were present in 5(55.56%)-4 had lupus anticoagulant and 1 had Anticardiolipin antibody. 6(66.67%) patients had microbiologically confirmed infection the time of diagnosis of acute pancreatitis (4 bacterial and 1 fungal) among which 3 had lower respiratory tract infection, 1 had urinary tract infection, 1 had pseudomembranous colitis and 1 had peri-pancreatic abscess. 7 patients received only corticosteroids, and 2 patients received IVIG with corticosteroids. 3 out of 9 patients (33.34%) expired due to multi-organ failure. Out of 6 surviving patients all received IV cyclophosphamide (NIH protocol) and are doing fine. Conclusion: Acute pancreatitis in SLE has high mortality probably due to associated high clinical and serological disease activity and high incidence of concomitant infection. Extensive investigation for underlying infection (bacterial, viral and fungal) should be done in SLE patients presenting with acute pancreatitis for comprehensive management.

Computed Tomography Assessment of Severity of Acute Pancreatitis in Bangladeshi Children.

Acute pancreatitis (AP) is common among children in Bangladesh. Its management depends mainly on risk stratification. This study aimed to assess the severity of pediatric AP using computed tomography (CT). This cross-sectional, descriptive study was conducted in pediatric patients with AP at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh. Altogether, 25 patients with AP were included, of whom 18 (mean age, 10.27±4.0 years) were diagnosed with mild AP, and 7 (mean age, 10.54±4.0 years) with severe AP. Abdominal pain was present in all the patients, and vomiting was present in 88% of the patients. Etiology was not determined. No significant differences in serum lipase, serum amylase, BUN, and CRP levels were observed between the mild and severe AP groups. Total and platelet counts as well as hemoglobin, hematocrit, serum creatinine, random blood sugar, and serum alanine aminotransferase levels (p>0.05) were significantly higher in the mild AP group than in the severe AP group (p=0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of CT severity index (CTSI) were 71.4%, 72.2%, 50%, and 86.7%, respectively. In addition, significant differences in pancreatic appearance and necrosis were observed between the two groups on CT. CT can be used to assess the severity of AP. In the present study, the CTSI effectively assessed the severity of AP in pediatric patients.

Investigating the regulatory effect of Shen Qi Bu Qi powder on the gastrointestinal flora and serum metabolites in calves.

To investigate the effects of Shen Qi Bu Qi Powder (SQBQP) on the average daily gain, blood indexes, gastrointestinal microflora, and serum metabolites of calves. A total of 105 calves were randomly assigned to three groups (n = 35 per group): the control group (C, fed with a basal diet for 21 days) and two treatment groups (SQBQP-L and SQBQP-H, fed with the basal diet supplemented with 15 and 30 g/kg of SQBQP), respectively for 21 days. The active components of SQBQP were identified using LC-MS/MS. Serum digestive enzymes and antioxidant indices were determined by ELISA kits and biochemical kits, respectively. Serum differential metabolites were analyzed by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS), while flora in rumen fluid and fecal were analyzed by 16S rDNA sequencing. Further correlation analysis of gastrointestinal flora and serum metabolites of SQBQP-H and C groups were performed with Spearman's correlation. The principal active components of SQBQP mainly includes polysaccharides, flavonoids, and organic acids. Compared to the control group (C), calves in the SQBQP-H (high dose) and SQBQP-L (low dose) groups showed a significant increase in serum amylase (AMS) levels (P<0.001), while lipase content significantly decreased (P<0.05). Additionally, the average daily gain, T-AOC, and cellulase content of calves in the SQBQP-H group significantly increased (P<0.05). Proteobacteria and Succinivibrio in the rumen flora of the SQBQP-H group was significantly lower than that of the C group (P<0.05). The relative abundance of Proteobacteria, Actinobacteria, Candidatus_Saccharibacteria, Deinococcus_Thermus, Cyanobacteria, and Succinivibrio in the SQBQP-H group was significantly increased (P<0.05), while the relative abundance of Tenericutes and Oscillibacter was significantly decreased (P<0.05). Serum metabolomics analysis revealed 20 differential metabolites, mainly enriched in amino acid biosynthesis, β-alanine metabolism, tyrosine, and tryptophan biosynthesis metabolic pathways (P<0.05). Correlation analysis results showed that Butyrivibrio in rumen flora and Oscillibacter_valericigenes in intestinal flora were significantly positively correlated with average daily gain, serum biochemical indexes, and differential metabolite (-)-Epigallocatechin (R>0.58, P<0.05). SQBQP can promote calves weight gain and enhance health by modulating gastrointestinal flora and metabolic processes in the body.

Interleukin-6 Concentration in Early Assessment of Severity and Prediction of Outcome among Patients with Acute Pancreatitis: A Prospective Cohort Study

Introduction: Various inflammatory markers, such as C-reactive Protein (CRP), Interleukin (IL), and Tumour Necrosis Factor (TNF), are used as indicators of illness severity in acute pancreatitis. Concentrations of inflammatory mediators are correlated to the severity of the disease. If detected before the occurrence of multiple organ dysfunction, early initiation of aggressive therapy might prevent its development. IL-6, released by macrophages in response to tissue injury, peaks 24 hours after the onset of inflammation and can be used to predict early disease severity. The Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring system was used to assess the severity of acute pancreatitis. Aim: To study the association of IL-6 levels with the BISAP in predicting the outcome. Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery at Government Medical College, Kottayam, Kerala, India. The duration of the study was 12 months, from January 1, 2019 to December 31, 2019. The study was done on patients of either gender, aged between 18 and 60 years, with clinical features suggestive of acute pancreatitis. After obtaining informed consent, a 4 mL venous blood sample was taken, and serum amylase and serum lipase levels were estimated. If serum amylase/lipase levels were three times above the normal range, a diagnosis of acute pancreatitis was made according to revised Atlanta criteria. Meanwhile, the BISAP score was calculated. After reaching a sample size of 77 for the present study, IL-6 estimation was performed using an Enzyme-linked Immunoassay (ELISA) kit. At the end of the study, IL-6 concentration was compared with the BISAP score to assess severe acute pancreatitis. The data entered in Microsoft Excel were analysed using the Chi-square test and Fisher’s-exact test. Results: The mean age of the study participants was 30 years, with 37 patients (48%) between the ages of 20-40 years and 40 patients (52%) between the ages of 40-60 years. Out of the 77 study subjects, 71 were males and six were females. There was a significant association between Intensive Care Unit (ICU) admission with persistent organ failure, which indicates severe acute pancreatitis. Conclusion: In the present study, no significant association was found between IL-6 and the BISAP score in the early assessment and prediction of the severity of acute pancreatitis.

Tectoridin alleviates caerulein-induced severe acute pancreatitis by targeting ERK2 to promote macrophage M2 polarization

Severe acute pancreatitis (SAP) is an inflammatory disease of the pancreas with a high mortality rate. Macrophages play a crucial role in the pathogenesis of pancreatitis. Tectoridin (Tec) is a highly active isoflavone with anti-inflammatory pharmacological activity. However, the role of Tec in the SAP process is not known. The purpose of this study was to investigate the therapeutic effect and potential mechanism of Tec on SAP. To establish SAP mice by intraperitoneal injection of caerulein and Lipopolysaccharide (LPS), the role of Tec in the course of SAP was investigated based on histopathology, biochemical indicators of amylase and lipase and inflammatory factors. The relationship between Tec and macrophage polarization was verified by immunofluorescence, real-time quantitative PCR and Western blot analysis. We then further predicted the possible targets and signal pathways of action of Tec by network pharmacology and molecular docking, and validated them by in vivo and in vitro. In this study, we demonstrated that Tec significantly reduced pancreatic injury in SAP mice, and decreased serum levels of amylase and lipase. The immunofluorescence and Western blot analysis showed that Tec promoted macrophage M2 polarization. Network pharmacology and molecular docking predicted that Tec may target ERK2 for the treatment of SAP, and in vivo and in vitro experiments proved that Tec inhibited the ERK MAPK signal pathway. In summary, Tec can target ERK2, promote macrophage M2 polarization and attenuate pancreatic injury, Tec may be a potential drug for the treatment of SAP.

Effects of cold stress on physiologic metabolism in the initial phase and performance of broiler rearing

This study aimed to investigate the effects of 8 h of cold stress (18 °C) every day in broiler chicks during the first 7 days of rearing on crop filling analysis, yolk sac consumption, digestive and immune organs weights, and physiological metabolism at seven days and performance between 1 and 35 days. Cobb500 male broiler chickens (n = 274) were randomly assigned to two treatments. The treatments consisted of varying environmental temperatures during the first week post-housing. Chicks were reared at a thermoneutral temperature (32 °C) or under cold stress (18 °C) for 8 h/day during the first week, and both groups were subsequently reared at a thermoneutral temperature for 8–35 days. The thermoneutral group reached 90% full crop after 48 h of housing (P < 0.05), while the cold-stressed group had more empty crops at 2 h and 48 h after housing (P < 0.05). The chick cloacal temperature was not affected by the treatments (P > 0.05). Additionally, the treatment did not affect serum amylase and corticosterone levels, feed intake, body weight gain, or feed conversion ratio (P > 0.05, while the cold-stressed group had elevated heterophil/lymphocyte count at day 7 (P < 0.05). The thermoneutral group showed higher viability (%) at 7 and 35 days and a higher production factor at 35 days (P < 0.05). Broiler chickens under cyclic cold stress experienced decreased yolk sac absorption during the first week and increased feed intake and feed conversion ratio after 35 days of rearing. Viability was also lower in the cold-stressed group. An appropriate strategy to minimize these adverse effects is to rear the chicks in a thermoneutral environment during the first week.