Treatment Of Acute Pancreatitis Research Articles

A double blinded comparative study between omega 3 fatty acid infusion versus octreotide infusion in acute pancreatitis

Background: Over decades the treatment of acute pancreatitis remains debatable with no common consensus on treatment guidelines, with some workers using octreotide infusion and some workers only relying on fluid therapy and symptomatic management. This double blinded comparative trial between omega 3 fatty acid infusion versus octreotide infusion and its response in cases of acute pancreatitis. Methods: This is a study where a double blinded randomised control trial was undertaken in proven cases of acute pancreatitis and patients were given omega 3 fatty acid infusion and octreotide infusion and the observations were documented and followed upon. 50 cases were given omega 3 fatty acid infusion and other 50 were given octreotide infusion and the clinical response, symptomatic improvement was assessed and compared using BISAP and Marshal scoring systems and lipase levels.Results: Omega 3 fatty acid infusion was found to be highly significant as compared to octreotide in cases of acute pancreatitis in terms of clinical improvement, reduced hospital stay, and SIRS.Conclusions: Omega 3 fatty acid infusion is the future in cases of acute pancreatitis which is cheap and easily available with no side effects and reduces the morbidity and mortality in acute pancreatitis with reduced hospital stay in turn resulting in overall reduced medical expenditure.

Acute pancreatitis: 31-Year trends in incidence and mortality – A Danish population-based cohort study

BackgroundObjectives: Increasing incidence rates and declining mortality rates have made acute pancreatitis a common cause of hospitalization. We aimed to examine 31-year trends in first-time hospitalization for acute pancreatitis, the subsequent short-term and long-term mortality, and the prognostic impacts of age, sex, and comorbidity. MethodsIn this nationwide Danish population-based cohort study of 47,711 incident cases, we computed the annual sex-specific age-standardized incidence rates of acute pancreatitis for 1988–2018. Among patients with incident hospitalization for acute pancreatitis, we computed sex-specific 30-day and 31–365-day mortality rates, stratified them, and performed proportional-hazards regression to estimate mortality rate ratios adjusted for sex, age, and comorbidity, measured by Charlson Comorbidity Index categories. ResultsFrom 1988 to 2018, the standardized incidence rate of acute pancreatitis per 100,000 person-years increased by 29% for men (28.8–37.0%) and by 148% for women (15.7–38.9%). Among patients with pancreatitis, the 30-day mortality declined from 10.0% in those diagnosed in 1988–1992 to 6.3% for those diagnosed in 2013–2017. The corresponding 31–365 day mortality increased from 5.5% to 6.0%. In comparing periods 1988–1992 and 2013–17, the adjusted 30-day mortality rate ratio was 0.36 (95% confidence interval: 0.32–0.41) and the adjusted 31–365 day mortality rate ratio was 0.64 (95% confidence interval: 0.56–0.74). Comorbidity was a strong predictor of mortality among patients with pancreatitis. ConclusionsOver the 31 years of observations, annual rates of acute pancreatitis more than doubled among women, converging with those among men. The comorbidity burden was a strong prognostic factor for short and long-term mortality. Treatments for acute pancreatitis should focus on existing comorbidities.

A comparative study on clinical features and outcomes of acute pancreatitis between diabetic and non-diabetic hospitalized patients

Background: Pancreatitis is a serious disorder of pancreas. This study was designed to investigate the clinical features and outcomes of the hospitalized patients with acute pancreatitis (AP) with or without diabetic mellitus (DM).
 Methods: A total of 90 adult hospitalized patients with AP diagnosed in three different tertiary hospitals were evaluated for inclusion in prospective study on clinical, laboratory and outcome parameters. After exclusion according to exclusion criteria, 68 patients were enrolled finally, and out of 68 patients 34 were diabetic with AP from BIRDEM and 34 AP patients were non-diabetic from Dhaka Medical College and BSMMU.
 Results: The major clinical features, laboratory markers were significantly (p<0.05) higher whereas serum albumin levels was significantly (p<0.05) lower in diabetic AP group as compared to the non-diabetic AP group. DM was associated with severe form of AP compared to the non-diabetic group (p<0.05).
 Conclusions: The results of the present study suggest that DM increases the disease severity of AP. Therefore, clinicians should pay more attention in the treatment and management of acute pancreatitis if the patients have DM.
 Birdem Med J 2020; 10(3): 172-181

MiR-92b-3p ameliorates inflammation and autophagy by targeting TRAF3 and suppressing MKK3-p38 pathway in caerulein-induced AR42J cells

Acute pancreatitis (AP) is an inflammatory disease with high morbidity and mortality. Dysregulation of microRNAs (miRNAs) was involved in human diseases, including AP. However, the effects of miR-92b-3p on AP process and its mechanism remain not been fully clarified. The expression levels of miR-92b-3p and tumor necrosis factor receptor-associated factor-3 (TRAF3) were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The protein levels of TRAF3, tumor necrosis factor α (TNF-α) TNF-α, interleukin-6 (IL-6), phosphorylated mitogen-activated protein kinase kinase 3 (p-MKK3), MKK3, p38 and phosphorylated p38 (p-p38) were detected by western blot. The concentration of TNF-α and IL-6 in the medium was measured using ELISA kits. The possible binding sites of miR-92b-3p and TRAF3 were predicted by TargetScan and verified by dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay. The expression level of miR-92b-3p was decreased and TRAF3 expression was increased in AR42J cells stimulated with caerulein. Moreover, the protein levels of pro-inflammatory cytokines (TNF-α and IL-6) were markedly elevated, and the expression levels of autophagy-related markers Beclin1 as well as the ratio of LC3-II/I were obviously increased in AR42J cells treated with caerulein. In addition, overexpression of miR-92b-3p or knockdown of TRAF3 significantly suppressed the release of pro-inflammatory cytokines and autophagy in caerulein-induced AR42J cells. Furthermore, TRAF3 was a direct target of miR-92b-3p and its upregulation reversed the effects of miR-92b-3p overexpression on inflammatory response and autophagy. Besides, overexpression of miR-92b-3p inhibited the activation of the MKK3-p38 pathway by affecting TRAF3 expression. In conclusion, miR-92b-3p attenuated inflammatory response and autophagy by downregulating TRAF3 and suppressing MKK3-p38 pathway in caerulein-induced AR42J cells, providing a novel avenue for treatment of AP.

IL-10-1082G>A polymorphism, use of opioids and age affect the course of acute pancreatitis.

We aimed to determine the association of two of the most important functional polymorphisms of IL-8 and IL-10 with the clinical course and outcome of acute pancreatitis. Ninety-three patients with acute pancreatitis were genotyped for IL-8-251T>A and IL-10-1082G>A using PCR-RFLP. The severity of the disease was determined based on the Atlanta Classification system. In patients treated with opioids, the odds for severe form of acute pancreatitis, its complications, and death were increased. Advanced age was associated with higher odds of organ/multiple organ failure and other systemic complications. Multivariate logistic regression analyses confirmed the observed effect of age and use of opioids, and revealed higher odds for the development of severe form of acute pancreatitis [P = 0.017, odds ratio (OR): 4.324, 95% confidence interval (CI): 1.305-14.323], its complications in general (P = 0.011, OR: 4.936, 95% CI: 1.442-16.897), pancreatic necrosis (P = 0.032, OR: 3.922, 95% CI: 1.122-13.707) and systemic inflammatory response syndrome (P = 0.037, OR: 3.838, 95% CI: 1.085-13.583) in the absence of IL-10-1082G>A variant allele. The effect of IL-8 -251T>A on acute pancreatitis severity or mortality was not detected. Our study suggests the IL-10 -1082A allele as a protective factor in acute pancreatitis. Opioid analgesics treatment in acute pancreatitis is associated with severity, complications and mortality, while advanced age increases the risk of systemic complications.

Comparison of early and delayed cholecystectomy for biliary pancreatitis: A meta-analysis

BackgroundBiliary stones are the most common etiology of acute pancreatitis Cholecystectomy has been accepted as a popular treatment for acute biliary pancreatitis (ABP) to reduce the risk of recurrent complications. However, the precise time of intervention still remains controversial. ObjectiveThe aim of this meta-analysis was to compare early and delayed cholecystectomy and determine the most precise timing of cholecystectomy following gallstone pancreatitis. MethodSearch the publications on comparison the efficacy of early cholecystectomy comparison with delayed cholecystectomy in treatment outcomes of ABP to October, 2018. After rigorous reviewing on quality, the data was extracted from eligible trials. All trials analyzed the summary hazard ratios (HRs) of the endpoints of interest, including survival data and individual postoperative complications. ResultsA total of 9 trials were met our inclusion criteria. The pooled results indicate that postoperative complications、readmission rate、conversion to an open procedure and cholecystectomy-related morbidity/mortality did not have statistical significance (P > 0.05) between the early and delayed cholecystectomy. While, the length of hospital stay was shorter for the early cholecystectomy group than the delayed group in all included studies. ConclusionsAlthough the efficacy of delayed intervention in terms of inflammation reduction is definite, their adverse events are often major limitations. In the present study, an early cholecystectomy may result in a significantly shortened hospital stays without increased complications or mortality.

Clinical Effect and Safety of Endoscopic Ultrasound-Guided Laparoscopic Catheter Drainage for Severe Acute Pancreatitis

In order to study the clinical effect and safety of endoscopic ultrasound-guided laparoscopic catheter drainage for severe acute pancreatitis, the patients with severe acute pancreatitis were selected as the research objects, the laparoscopic catheter drainage under the guidance of endoscopic ultrasound was carried out, and the efficacy and safety of the operation were evaluated. The results showed that after endoscopic ultrasound-guided laparoscopic catheterization and drainage, the number of C-reactive protein, procalcitonin and white blood cells was decreased, and the inflammation was improved after treatment; the body temperature of 45% patients returned to normal on the first day after operation, and 55% patients returned to normal on the third day after operation; only 1 case of patients followed up had infectious necrosis of pancreas. In summary, endoscopic ultrasound-guided laparoscopic catheter drainage is a safe and effective treatment for severe acute pancreatitis.

Study on mechanism of curcumin in treatment of acute pancreatitis based on regulation of PI3K-Akt signaling pathway by miR-198

Curcumin was used to interfere with acute pancreatitis model rats to explore its possible mechanism. One hundred and twenty rats were randomly divided into blank group, model group, model+curcumin group, model+mock+curcumin group, model+antagonist+curcumin group and model+curcumin+LY294002 group, with 20 rats in each group. The wet/dry weight ratio of pancreatic tissue was measured and the pathological changes of pancreas were observed by HE staining. The apoptosis was detected by TUNEL staining; the levels of serum amylase, lipase, Bcl-2 and Bax were detected by ELISA, and the levels of PI3 K, Akt and p-Akt in pancreatic tissue were measured by Western blot. HE staining showed that curcumin could improve the pathological changes of pancreas and reduce the pathological score of pancreas, while ELISA results showed that curcumin could decrease the levels of amylase, lipase and Bax in peripheral serum and increase the concentration of Bcl-2. Western blot results showed that the expression levels of PI3 K and p-Akt in pancreatic tissue of model rats were up-regulated after the intervention of curcumin, and the apoptosis rate of pancreatic cells decreased in TUNEL staining. The above effects could be weakened by miR-198 antagonist and PI3 K-Akt signal pathway inhibitor LY294002. In conclusion, curcumin has an ideal effect on acute pancreatitis, and its mechanism may be mediated by miR-198-PI3 K-Akt axis.

Immuno-Oriented Therapy In The Comprehensive Treatment Of Acute Pancreatitis

Immuno-Oriented Therapy In The Comprehensive Treatment Of Acute Pancreatitis

Effects of Egr1 on pancreatic acinar intracellular trypsinogen activation and the associated ceRNA network.

Acute pancreatitis (AP) is a common digestive disorder with high morbidity and mortality. The present study aimed to investigate the expression of early growth response protein 1 (Egr1), and the effect of competing endogenous (ce)RNA network on trypsinogen activation. Pancreatic acinar intracellular trypsinogen activation (PAITA) is an important event in the early stage of AP; however, the underlying mechanisms remain unclear. The present study used taurolithocholic acid 3-sulfate (TLC-S)-treated AR42J cells (pancreatic cell line) to establish a PAITA model. A gene microarray and bioinformatics analysis was performed to identify the potential key targets in PAITA. The results demonstrated that Egr1, an important transcription factor, was significantly overexpressed in PAITA. In Egr1 small interfering (si)RNA-transfected cells, Egr1 expression was decreased and trypsinogen activation was significantly decreased compared with negative control siRNA-transfected cells, indicating that in TLC-S-induced PAITA, overexpression of Egr1 enhanced trypsinogen activation. A ceRNA network [mRNA-microRNA (miRNA/miR)-long non-coding (lnc)RNA] generated using the PAITA model revealed that the effects of Egr1 on PAITA may be regulated by multiple ceRNA pairs, and the lncRNAs (including NONRATT022624 and NONRATT031002) and miRNAs [including Rattus norvegicus (rno)-miR-214-3p and rno-miR-764-5p] included in the ceRNA pairs may serve roles in PAITA by regulating the expression of Egr1. The results of the present study may provide novel targets for researching the underlying mechanisms of, and developing treatments for AP.

Procalcitonin, C-reactive Protein, and Neutrophil Ratio Contribute to the Diagnosis and Prognosis of Severe Acute Pancreatitis

We aimed to explore the significance of procalcitonin (PCT), C-reactive protein (CRP) and neutrophil ratio (N%) in the early diagnosis, treatment, and prognosis of severe acute pancreatitis (SAP). A total of 104 patients with SAP (SAP group) and 101 patients with mild acute pancreatitis (MAP) (MAP group) admitted to Affiliated Hospital of Jining Medical University, Jining, China were enrolled. The PCT and CRP in serum were detected by a full-automatic biochemical analyzer, and N% in peripheral blood was measured by a hemocyte analyzer. The peripheral blood PCT, CRP, and N% in the SAP group were significantly higher than those in the MAP group (P<0.001). Multivariate Logistic regression analysis showed that acute physiology and chronic health evaluation II (APACHE II) score, Ranson score, PCT, CRP, and N% were independent risk factors for SAP. The receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of PCT, CRP, and N% in diagnosing SAP were 0.906, 0.840, and 0.834 respectively, while that of combined detection was 0.972. The AUC of PCT, CRP, and N% in diagnosing SAP death were 0.907, 0.900, and 0.894, respectively. Peripheral blood PCT, CRP, and N% contribute to the diagnosis and prognosis of SAP.

Stage approach in surgical treatment of acute pancreatitis.

The article deals with the problem of diagnosis and treatment of acute pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity with a high risk of complications, the mortality rate of which reaches 5.5%, and in acute pancreatitis it varies within 40-70%. The purpose of this work is to improve the results of surgical treatment of patients with acute pancreatitis. The results of treatment of 112 patients with acute pancreatitis, who were hospitalized in the procedure of ambulance in the Department of Surgery No. 2 of the Bogomolets National Medical University in 2009-2019 period are analyzed. Severe disease course was observed in 83 (74.1%) patients, moderate – in 29 (25.9%) patients. In the early phase of the disease, endoscopic operations were performed in 44 (39.3%) patients, and laparotomy was performed in 12 (10.7%) patients with advanced purulent peritonitis. In the late phase 15 (13.4%) patients underwent laparotomy, necrsequestrectomy, abdominization of the pancreas, drainage of the abdominal cavity and retroperitoneal space, 36 (32.1%) patients were treated with ultrasound-guided puncture treatments. In the case of progression of the disease and ineffective drainage under ultrasound control, 5 (4.5%) patients were treated with retroperitoneoscopically assisted necrsequestrectomy, combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy was performed in 3 (2.7%) patients, and in 2 (1.8%) patients – open laparotomy, abdominization, necrsequestrectomy, drainage of the abdominal cavity and retroperitoneal space. The surgical intervention in the late phase of the disease was 21±4.2 days from the onset of the disease. A stage approach in the treatment of acute pancreatitis was applied to 80 (71.4%) patients in the main group. The comparison group consisted of 32 (28.6%) patients who underwent laparotomy and laparoscopic interventions in the early and late periods of the disease without prior use of endoscopic interventions or drainage operations under ultrasound control. In the main group the length of stay in the hospital was 21,3±4,2 days, in the comparison group – 48.2±5.3 days respectively. In 42 (95.5%) patients who underwent endoscopic surgery, a positive clinical effect, rapid regression of symptoms of acute pancreatitis was achieved. In two (4.5%) patients who underwent endoscopic interventions, the disease progressed with the development of an abscess of the omental pouch, they underwent puncture drainage under ultrasound control. When using puncture drainage operations under ultrasound control in 26 (72.2%) patients, a positive result was achieved, the abscess cavity decreased by 63±6.2% within 7 days. In 10 (27.8%) patients due to the progression of the disease, the following stage of treatment was performed: retroperitoneoscopically assisted necrsequestrectomy (5 (13.9%) patients), combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy (3 (8.3%) patients), and open laparotomy, abdominization, necrosequestrectomy, drainage of the abdominal cavity and retroperitoneal space (2 (5.6%) patients). Complications in the main group developed in two (2.5%) patients, the mortality rate was 2.5% (two patients). In the comparison group, complications developed in 8 (25%) patients, the mortality rate was 18.8% (6 patients). The use of minimally invasive endoscopic interventions, draining surgeries under ultrasound control followed by combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy or open laparotomy reduces the length of hospital stay of patients from 48.2±5.3 days (comparison group) to 21.3±4.2 days (main group) (p&lt;0.0001, t=28.346) and the number of complications by 22.5% (p=0.0002, χ2=14.104, CI 9.2333-39.7022). The use of a stage approach in the surgical treatment of acute pancreatitis reduces mortality by 16.3% (p=0.0026, χ2 =9.058, CI 4.6571-32.9639).

Treatment of hyperlipidemic acute pancreatitis with modified Dachengqi decoction combining with conventional therapy based on “six-hollow-organs to be unblocked” theory

The increase of triglyceride (TG) can induce coronary heart disease, atherosclerosis, pancreatitis and other diseases and is the most common inducing factor of acute pancreatitis (AP) second only to biliary tract disease and drinking. The pathogenesis of hyperlipidemic acute pancreatitis (HLAP) is not exactly clear, but it may be related to the toxic effect of the increase of free fatty acids produced by TG decomposition on the pancreas itself, microcirculation disorder of the pancreas, and calcium overload. At present, non-surgical therapy is the main treatment for HLAP. The key to preventing recurrence is to reduce blood lipids, change the diet structure, and reduce weight. This study aimed to treat HLAP with modified Dachengqi decoction combined with conventional therapy, based on the "six-hollow-organs to be unblocked" theory. Forty patients with HLAP who received treatment in the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine and Puding County Hospital of Traditional Chinese Medicine from September 2016 to August 2019 were selected and divided into a control group and an intervention group, each with 20 cases, following a random number table. The control group was treated with conventional therapy while the intervention group was treated with modified Dachengqi decoction combined with conventional therapy. After treatment, the cure rate and the total effective rate were 60% and 95% respectively in the intervention group, and 25% and 75% respectively in the control group (P<0.05). The TG, serum amylase, leukocyte count, and neutrophil ratio of the two groups decreased significantly after treatment, and there was a greater decrease in the intervention group than that in the control group, with this being significantly different between the two groups. The gastrointestinal function score, total score of the acute physiology and chronic health evaluation II (APACHE II), and the pain score of the visual analog scale (VAS) decreased markedly in the two groups after the treatment, with scores in the intervention group being significantly lower than those in the control group (P<0.05). Modified Dachengqi decoction combined with conventional therapy has a better therapeutic effect on HLAP than conventional therapy.

Effect of Diclofenac Suppository on Treatment of Acute Biliary Pancreatitis

Effect of Diclofenac Suppository on Treatment of Acute Biliary Pancreatitis

Treatment of acute pancreatitis with pancreatic duct decompression via ERCP: A case report series.

Acute pancreatitis is a common disorder in the gastrointestinal system, which is characterized by an increasing incidence and a high mortality. Currently, symptomatic treatment becomes the predominant option for the treatment of acute pancreatitis. To date, there is little knowledge on the treatment of acute pancreatitis through alleviation of pancreatic ductal hypertension and removal of pancreatic ductal obstruction. Endoscopic retrograde cholangiopancreatography (ERCP), an effective treatment for acute biliary pancreatitis, may alleviate the obstruction and edema in the common channel of the bile duct and pancreatic duct, to achieve the indirect treatment of acute pancreatitis, and may achieve the removal of intrapancreatic ductal obstruction and reduction in the intrapancreatic ductal pressure. Hereby, we report 3 cases with acute pancreatitis that were successfully treated by the pancreatic duct decompression via ERCP in one single center from China. Our data demonstrate that pancreatic duct decompression via ERCP is effective for the treatment of acute pancreatitis, which may shorten the course of acute pancreatitis through alleviating pain, shortening fasting duration and controlling the inflammatory reactions. It is recommended to use further prospective, randomized, controlled clinical trials to evaluate the efficacy and safety of pancreatic duct decompression via ERCP for acute pancreatitis.

Intravenous fluid resuscitation in the management of acute pancreatitis.

In the absence of proven effective pharmacologic therapy in acute pancreatitis, and given its simplicity, wide availability, and perceived safety, intravenous fluid resuscitation remains the cornerstone in the early treatment of acute pancreatitis. Herein, we will review the rationale of fluid therapy, critically appraise the published literature, and summarize recent studies. Several observational studies and small clinical trials have raised concern about the efficacy and safety of aggressive fluid resuscitation. Early aggressive fluid therapy among acute pancreatitis patients with predicted mild severity appears to have the highest benefit, whereas aggressive resuscitation in patients with predicted severe disease might be futile and deleterious. Lactated Ringer's solution is the preferred fluid type based on animal studies, clinical trials, and meta-analyses. There is a wide variation of fluid resuscitation approaches in current guideline recommendations, quality indicators, and worldwide practice patterns. There is lack of high-quality data that supports the use of early aggressive fluid resuscitation. Large, well designed, multicenter randomized controlled trials are needed to determine the optimal timing, fluid type, volume, rate, and duration of fluid resuscitation in acute pancreatitis.

Combined Surgical Tactics with Step-up Approach in the Treatment of Infected Acute Pancreatitis

Objective. To evaluate the results of treatment using minimally invasive interventions and open necrectomy in patients with infected acute pancreatitis.&#x0D; Materials and methods. A retrospective cohort two-centered analysis was performed in 211 patients with infected acute pancreatitis who divided into two groups: the first included 101 patients, in the treatment of which used open surgery; the second included 110 patients, in the treatment of which used treatment tactic step-up approach.&#x0D; Results. In the first group used open necrosectomy with drainage for postoperative lavage (75 patients, 74.3%), including open packing with planned re-laparotomy (8 patients, 7.9%), and omentobursostomy for necrosectomy after surgery (18 patients, 17.8%). Postoperative complications occurred in 58 (57.4%), after the surgery 34 (33.7%) patients was died: 30 had a thirty-day mortality, and 4 had a ninety-day mortality. In the second group group, 72 (65.5%) patients were treated by percutaneous catheter drainage, 6 (5.5%) by video-assisted retroperitoneal debridement and drainage, 5 (4.5%) by through the wall of the stomach or duodenum in the infected pseudocyst and open necrosectomy was performed on 27 (24.5%) patients. Postoperative complications occurred in 37 (33.6%) patients, after the surgery 19 (17.3%) was died: 15 had a thirty -day mortality and 4 had a ninety-day mortality. In the regression analysis, only the presence of multiple organ dysfunction before (AUC = 0.867) and after surgery (AUC = 0.930) significantly affected postoperative mortality, but the effect of the prevalence of pancreatic necrosis (AUC = 0.693) on mortality was limited. Differences were likely between groups (χ2=7.282, p=0.026).&#x0D; Conclusion. The surgical treatment should be initiated with a minimally invasive procedures and combination these operations with open surgery was able to reduce complications and mortality in the patients with infected acute pancreatitis.

A novel function of IRF9 in acute pancreatitis by modulating cell apoptosis, proliferation, migration, and suppressing SIRT1-p53.

Acute pancreatitis (AP) is an inflammatory disease caused by theabnormalactivation of pancreaticenzymes in the pancreas, with a considerablyhighmorbidityandmortality. However, the etiological factor and pathogenesis of AP are still unclear. This study was aimed to explore the role and mechanism of interferon regulatory factor 9 (IRF9) in the occurrence of AP and to provide experimental and theoretical foundation for AP diagnosis and treatment. AP model in vitro was established by caerulein-induced group. Small interfering RNA (siRNA) was designed and constructed to silence IRF9 gene. After siRNA transfected and caerulein treated successfully, the expression levels of IRF9, SIRT1, and acetylated p53 (Ac-p53) were determined by qRT-PCR and Western blot. The apoptosis, proliferation, and migration of AR42J cells were checked by flow cytometry, MTT, and transwell assay. Dual-luciferase reporter assay was implemented to validate the regulatory effect of IRF9 on SIRT1. Here, our study showed that the expression of IRF9 and Ac-p53 was increased, SIRT1 was decreased, and cell apoptosis, proliferation, and migration of AR42J cells were increased after caerulein induced. IRF9 gene silencing upregulated SIRT1, downregulated Ac-p53, and inhibited cell apoptosis, proliferation, and migration. Dual-Luciferase reporter assay showed that IRF9 could negatively regulate SIRT1. The potential mechanism was that IRF9 could modulate cell apoptosis, proliferation, migration, and bind the promoter of SIRT1 to repress SIRT1-p53. It hinted that IRF9 showed a novel function in AP by modulating cell apoptosis, proliferation, migration, and suppressing SIRT1-p53. IRF9 might be a good potential treatment target for AP.

Plasmapheresis Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis: A Case Report

Hypertriglyceridemia is the third most common etiology for acute pancreatitis (AP), after alcohol and gallstones. Clinical evidence is relatively weak in its support of plasmapheresis for the treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). We report a case of severe HTG-AP in a young man who was successfully treated with plasmapheresis. The patient achieved full resolution of symptoms within 48 hours from presentation and was discharged two days later. To our knowledge, no other report in literatures shows such dramatic response to plasmapheresis.

Efficacy of intra-arterial lidocaine infusion in the treatment of cerulein-induced acute pancreatitis.

Disturbances in pancreatic microcirculation, beginning with vasoconstriction, are crucial in early pancreatitis and progression to necrotizing pancreatitis. Thus, vascular-targeted treatment aiming to restore a sufficient level of microcirculation through vasodilation would possibly reduce the severity of pancreatitis. Lidocaine is an anti-arrhythmic and local anesthetic drug, which also acts as a vasodilator at higher concentrations. To evaluate the efficacy of intra-arterial infusion of lidocaine into the celiac trunk in treatment of cerulein-induced acute pancreatitis. Wistar rats (n = 20) were randomly divided into 2 equal groups: the control group (NaCl group, n = 10) and the study group (lidocaine group, n = 10). All subjects underwent surgical intervention with intra-arterial infusion of 0.9% NaCl (control group) or 1% lidocaine hydrochloride (study group) into the celiac trunk. Blood samples were collected 5 times at regular intervals from each rat for amylase and lipase measurements. Histopathological analysis of the pancreas was performed. A total number of 16 rats (control group n = 7, study group n = 9) were included. In the postoperative course, the study group (lidocaine group) revealed lower values of serum amylase and lipase levels compared to the control group (NaCl group), except the values at the 1st treatment point, which appeared 1 h after intraoperative drug injection. Significantly lower treatment endpoint levels of pancreatic enzymes were seen in the lidocaine group. Moreover, no differences were observed between the 1st and the last treatment point in the control group; however, these differences were significant for both enzymes in the study group. Histopathology revealed reduced pancreatitis severity in the study group compared to the controls. Intra-arterial lidocaine infusion into the celiac trunk decreases pancreatitis severity. What is more, this study demonstrates the relevance of early vasodilation in the therapy of acute pancreatitis.