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Objective:To analyse the clinical efficacy and outcome of early abdominal paracentesis drainage (APD) in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 107 SAP patients with massive abdominal fluid in Shanghai General People Hospital from May 2017 to December 2021 were collected and analyzed. Patients were divided into APD group ( n=56) and NO-APD group ( n=51) according to whether they underwent APD or not within 3 days after admission. The APD group was then divided into abdominal compartment syndrome (ACS) subgroup ( n=29) and NO-ACS subgroup ( n=27) according to whether ACS had occurred or not at the time of puncture. Patients' general data, the duration of systemic inflammatory response (SIRS), length of ICU stay, the trends of intra-abdominal pressure and inflammatory indicators (white blood cell count and the content of C-reactive protein) within 1-3 days after admission, incidence of infection complication, step-up therapy, discharge or death were recorded. Results:The intra-abdominal pressure were 18.6±5.6mmHg , 13.7±4.2mmHg (1 mmHg=0.133 kpa) in APD group and NO-APD group, respectively. The intra-abdominal pressure of APD group was significantly higher than that of NO-APD group, and the difference was statistically significant ( P=0.000). Compared with NO-APD group, the duration of SIRS was significantly shortened in APD group [3(2, 4) days vs 4(3, 6) days, P=0.029]. On day 1, 2 and 3 after admission, the intra-abdominal pressure was 18.6±5.6 mmHg, 16.4±4.7 mmHg and 13.5±3.9 mmHg in APD group, and was 13.7±4.2 mmHg, 12.3±3.6 mmHg and 11.0±2.6 mmHg in NO-APD group, respectively. The intra-abdominal pressure of the APD group dropped faster than the NO-APD group ( P=0.004). The white blood cell count was (14.8±4.8), (10.5±4.5) and (9.0±3.8)×10 9/L in APD group, and was (14.2±5.4), (12.3±7.3), (11.7±5.3)×10 9/L in NO-APD group, respectively. Compared with the NO-APD group, the decrease rate of white blood cell count was faster in APD group ( P=0.006). The C-reactive protein content was (153.6±47.1), (150.4±10.5) and (108.8±49.4)mg/L in APD group, and were (174.8±31.1), (191.6±29.4) and (186.8±45.5)mg/L in NO-APD group . The content of C-reactive protein in APD group decreased significantly, while that in NO-APD group did not decrease. There was a significant difference between the two groups ( P=0.009). In the subgroup comparisons, the duration of SIRS in the ACS subgroup was significant longer than that in the NO-ACS subgroup [4(3, 5) days vs 2(1, 3)days, P=0.000]. Compared between the two groups and two subgroups respectively, there were no statistically significant differences on length of ICU stay, infection complication rate, advanced treatment rate and mortality. Conclusions:For SAP patients with abdominal fluid, APD in the early stage could shorten the duration of SIRS, decrease intra-abdominal pressure rapidly, improve inflammatory indicators, but could not improve the clinical outcome.
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Objective:To investigate the protective mechanism of topoisomerase I inhibitor on pancreatic acinar cells and lung during acute pancreatitis (AP) in mice.Methods:Eighteen Balb/C male mice were randomly divided into three groups using random number method: control group, AP group and CPT+ AP group. AP model was established by intraperitoneal injection of caerulein and lipopolysaccharide. CPT+ AP group received intraperitoneal injection of camptothecin (CPT, 50 mg/kg) before AP induction. Mice in control group were intraperitoneal injected with an equal volume of normal saline. The pathological examinations of pancreas and lung tissue were analyzed. The serum levels of amylase and lipase were detected by enzyme linked immunosorbent assay (ELISA) and the mRNA expression of IL-1 and IL-6 were analyzed by reverse transcription-polymerase chain reaction (RT-PCR); the infiltration of CD 45+ cells in pancreas and lung tissue as well as the expression of phosphorylated mixed lineage kinase domain-like protein(MLKL) in pancreas were detected by immunohistochemistry; the apoptosis index of pancreatic cells was analyzed by TUNEL assay. Results:The pathological scores of pancreas and lung tissue, serum levels of amylase and lipase in CPT+ AP group were [(2.30±0.31), (2.29±0.34), (1742.33±183.51)U/L and (46.90±2.17)U/L], which were significantly lower than those in AP group [(5.06±0.88), (3.40±0.09), (2385.33±383.10)U/L and (69.13±9.76)U/L]; the mRNA expression of IL-1 and IL-6 in pancreatic tissue were 95.79±48.11, 255.50±213.32, which were also remarkably lower than those in AP group (212.35±80.61, 1006.80±509.06); the infiltration of CD 45+ inflammatory cells in pancreas and lung were (14.25±5.32, 29.20±4.44)/high power field, which were notably lower than those in AP group (59.83±13.67, 58.25±5.91)/high power field; the apoptosis index of pancreatic cells was significantly higher than that in AP group [(3.64±1.16)% vs (1.92±0.29)%]; the histochemistry score of phosphorylated MLKL protein in pancreatic tissue was significantly lower than that in AP group (1.75±0.20 vs 4.53±1.28), and the differences were statistically significant (all P value <0.05). Conclusions:Topoisomerase I inhibitor could induce the apoptosis of pancreatic acinar cells and inhibit the death mode of necrotic pancreatic acinar cells during AP remodeling, thus reducing pancreatic local injury and AP-associated lung injury.
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Objective To investigate the alteration of C/EBP α,C/EBP β and endoplasmic reticulum stress (ERS) related molecules (IRE1α and sXBP1) expression in pancreatic tissues in rats with hypertriglyceridemia related acute pancreatitis.Methods Ninety six Sprague Dawley (SD) rats were divided into 4 groups:control group,hypertriglyceridemia (HTG) group (n =24,fed with high fat diet for 2 weeks),AP group (n =24),HTG + AP group (n =24),and AP was induced by peritoneal injection of cerulein.The rats were sacrificed at 3,6,9,24 h after AP induction,respectively.The pathological changes of the pancreatic tissues were observed and scored by HE staining.Plasma levels of IL-1β,IL-6 and TNF-α were measured by ELISA.The expression of IRE1α,sXBP1,C/EBPoα,C/EBPβ mRNA were analyzed by real time PCR.The expressions of IRE1α,sXBP1,NF-kB,C/EBPα and C/EBPβ protein were determined by Western Blot.The expressions of C/EBPα and C/EBPβ proteins were also determined by immunohitochemistry.Results After two weeks of high fat diet,serum levels of triglyceride(TG) and total cholesterol (TC) in HTG group,HTG + AP group were much higher than those of the control group,and the difference was statistically significant (P ＜ 0.05).The pancreatic tissue injury was more severe in HTG + AP group,particularly at 9 h (P ＜ 0.05).And plasma IL-1β,IL-6 and TNF-α levels were also much higher in HTG + AP group when compared with that of AP group,the differences were all significant at 9 h (P=0.011;P=0.034;P =0.027).After AP induction,IRE1,sXBP1,C/EBP and C/EBPβ mRNA began to be up-regulated at 3 h,and IRE1 mRNA reached the highest level at 24 h,sXBP1 mRNA at 9 h,while C/EBP and C/EBPβ mRNA reached the highest level at 6 h.Compared with AP group,IRE1,sXBP1,C/EBP and C/EBPβ mRNA levels were much higher in HTG + AP group.In addition,as to IRE1 and sXBP1 mRNA,the difference was significant at 3,6,9,24 h,and C/EBP mRNA at 6,9,24 h,C/EBPβ mRNA at 6 and 9 h (P ＜ 0.05).After AP induction,IRE1α,sXBP1 and NF-kB proteins in the pancreatic tissue began to be up-regulated at 3 h,and all reached the highest level at 9 h.IRE1α,sXBP1 and NF-kB proteins were up-regulated more obviously in HTG + AP group,and the up-regulation in HTG + AP group was higher than that in AP group,and the high expressions of C/EBPα and C/EBPβ proteins could only be detected at 6 and 9 h in the HTG + AP group,while there was no expression detected in AP group.Conclusions C/EBPα,C/EBPβ,IRE1α and sXBP1 may be involved in the pathogenesis of HTG related AP,and IRE1α/sXBP1 pathway and C/EBPoα,C/EBPβ may mediate the pathologic injury and inflammation process of HTG related AP.
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Objective: To observe the therapeutic effect of nicorandil on microvascular angina pectoris (MAP). Methods: A total of 60 MAP patients were randomly divided into nicorandil group (n=30) and routine treatment group (n=30), and they were treated for 12 weeks. Onset times and duration of angina pectoris, changes of related parameters of ECG treadmill exercise test before and after treatment, and total effective rate were compared between two groups. Results: Compared with before treatment, there were significant reductions in onset times and duration of angina pectoris and maximum depression extent of ST segment (P<0.05 or <0.01) and significant increase in total exercise time (P<0.01) after treatment in both groups; compared with routine treatment group, there were significant reductions in onset times of angina pectoris [(10.3±1.6) times/week vs. (9.6±1.7) times/week] and maximum depression of ST segment [(0.8±0.3)mm vs. (0.6±0.2)mm], and significant increase in total exercise time [(7.8±1.4) min vs. (9.4±1.6) min] and total effective rate (73.3% vs. 93.3%) in nicorandil group, P<0.05 or <0.01. Conclusion: Nicorandil possesses significant therapeutic effect on microvascular angina pectoris, and it is worth further study.
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Objective:To observe the emergency treatment effect of levosimendan combined noninvasive mechanical ventilation on acute heart failure during emergency treatment period .Methods :According to random number table , 120 cases with acute heart failure were randomly and equally divided into routine treatment group and levosimendan group (levosimendan + noninvasive mechanical ventilation ) .Improvements of arterial blood gas [partial pressure of carbon dioxide and oxygen (PaCO2 ,PaO2 ) ,pH etc .] after 72h ,change of N terminal pro brain natriuretic pep-tide (NTpro-BNP ) level 4d after hospitalization and mortality rate were observed and compared between two groups .Results:After treatment ,PaO2 ,mean arterial pressure and NTpro-BNP level of the two groups significant-ly improved compared with before treatment ;compared with routine treatment group ,there was significant rise in PaO2 [ (78.2 ± 9.4) mmHg vs .(86.2 ± 10.5) mmHg] and significant reductions in mean arterial pressure [ (86.3 ± 8.2) mmHg vs .(82.2 ± 9.0) mmHg] and NTpro-BNP level [ (4340.5 ± 540.7) pg/ml vs .(4012.1 ± 426.3) pg/ml] in levosimendan group , P<0.01 all;total effective rate of levosimendan group was significantly higher than that of routine treatment group (86.7% vs .76.6% , P=0.047);after three-month follow-up ,mortality rate of le-vosimendan group was significantly lower than that of routine treatment group (11.7% vs .20.0% , P= 0.026 ) . Conclusion:Emergency treatment effect of levosimendan combined noninvasive mechanical ventilation on acute heart failure is significant ,which is worthy of further research and extension .
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Objective To examine the expression of CD9 protein in pancreatic cancer tissues and adjacent tissues,and to analyze its relation with the progress and prognosis of pancreatic cancer.Methods From September 2005 to December 2009,surgical resected cancer tissues and adjacent tissues of 90 patients with pancreatic cancer and their clinical data were collected.The expression of CD9 protein in pancreatic cancer tissues and adjacent tissues was detected by immunohistochemistry,and its relationship with clinicopathological features was analyzed.Chi-square test was performed for comparison of ratios between groups.Overall survival (OS) analysis of 90 patients after surgery was performed.Results The high expression rate of CD9 protein (64.4％,58/90) in cancer tissue was significantly higher than that in cancer adjacent tissue (45.6％,41/90),the difference has statistically significant (χ2 =6.847,P＜0.05).CD9 protein was highly expressed in most of pancreatic cancer tissue which was well differentiated or without lymph node metastasis (74.6％ (50/67) vs 39.1％ (9/23),χz =9.554,P＜0.01; 50.0％(17/34) vs 73.2％(41/56),χ2 =5.856,P＜0.05 respectively).However,the expression of CD9 was not correlated with gender and age (both P＞0.05).OS and progression-free survival (PFS) of the patients with CD9 highly expressed were significantly longer than those with low expression of CD9 (median OS:33.0 months vs 7.0 months,χ2 =15.400 P＜0.01.Median PFS:30.5 months vs 5.0 months,χ2 =13.750,P＜0.01).Conclusion CD9 protein is a kind of protein related with the invasive ability of pancreatic cancer,which may play a role in progression and metastasis of pancreatic cancer and can help to determine the prognosis to a certain extent.
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Objective To investigate the role of pancreatic β cell on pancreatic regeneration following experimental acute pancreatitis.Methods Eighty-seven SD male rats were randomly divided into four groups:control group ( n =15 ),STZ group ( n =24),L-Arg group ( n =24 ),STZ + Arg group ( n =24).60 mg/kg of STZ was administrated by intraperitoneal injection to induce the diabetes model.2.5 g/kg body weight of LArg was administrated by intraperitoneal injection to induce the acute pancreatitis model.The rats were sacrificed 1,3,5,7 d later and the serum levels of amylase and glucose were measured.Relative pancreatic weight (pancreatic weight/body weight) were measured.Pancreatic tissue underwent routine pathologic examination,and the percentage of area of necrosis and tissue transformation was calculated.The expression of Reg4 and insulin was performed by immunofluorescence.Results Serum level of glucose significantly increased after STZ injection.After L-Arg injection,serum level of amylase significantly increased,and there was pancreatic tissue edema,necrosis,infiltration of inflammatory cells,which suggested the successful model induction.The percentage of area of necrosis in STZ + L-Arg group was (71.6 ± 6.0) ％ at the 3rd day,which were significantly higher than (42.3 ± 4.0 ) ％ in L-Arg group; the percentage of area of transformation was (45.6 ± 5.4) ％,which were significantly lower than (78.5 ± 6.4) ％ in L-Arg group.Expression of Reg4 in pancreatic islets of STZ + L-Arg group was significantly lower than those in L-Arg group.Conclusions STZ impairs pancreatic β cells,aggravates pancreatic damage following L-arginine induced pancreatitis and inhibits pancreatic regeneration.
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Objective To investigate the potential role of MCP-1/CCL2 in experimental acute necrotizing pancreatitis (ANP) and complications. Methods 60 SD male rats were randomly divided into 3 groups: sham operation group ( n = 20 ), ANP group ( n = 20 ) and MCP-1 group ( n = 20 ). ANP model was induced by retrograde infusion of 3.5% sodium taurocholate, MCP-1 group received subcutaneous injection of MCP-1 antibody 0 h and 6 h after ANP induction. The serum levels of amylase, MCP-1, D-lactic acid,histological changes and the expression of MCP-1 mRNA of lung, small intestine and pancreas, the expression of MCP-1 protein in pancreas, MPO levels of small intestine MPO were determined. Results The serum levels of amylase, MCP-1, D-lactic acid in MCP-1 group at 12 h were (4666 ±412)U/L, (39.53 ±8.25)pg/ml and (6.3 ±2.2)mg/L, which were significantly lower than those in ANP group [ (9611 ±363)U/L, (63.42 ±9.32) pg/ml, (9.3 ± 2. 1 ) mg/L, P< 0.05 ) ]; the expression of MCP-1 mRNA in pancreas, small intestine and lung were 0.431 ± 0.009, 0. 211 ± 0.018 and 0.442 ± 0.017, which were significantly lower than those in ANP group [ (0.624 ±0. 010, 0. 523 ±0. 019 and 0. 569 ±0. 024, P <0.05) ]; the expression of MCP-1 protein in pancreas was 2.0 ± 0. 1, which was significantly lower than that in ANP group (4. 0 ± 0. 2, P <0.05). Lung and small intestine MPO were (11.1 ±3.0)U/g and ( 19.2 ±2.0)U/g, which were significantly lower than those in ANP group[(39.2±3.1)U/g and(13.1±2.1)U/g, P<0.05]. Conclusions Early blockade of MCP-1 not only attenuates the severity of ANP, but also decreases the degree of acute lung injury and intestine barrier dysfunction.
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Objective To investigate the effect of cytokines on pancreatic function in patients after acute pancreatitis(AP) and its mechanisms. Methods Fifty-nine patients (mild in 25 and severe in 34) after AP and 20 healthy controls were enrolled in the study. Serum levels of cytokines including hepatocyte growth factor (HGF), epidermal growth factor(EGF), basic fibroblast growth factor (bFGF), regeneration protein(Reg)-1 and Reg-4 were determined using enzyme-linked immunosorbent assay (ELISA). Fasting blood-glucose, insulin, C-peptide and fecal elastase 1 (FE1) were detected for evluation of endocrine and exocrine pancreatic function. The association of pancreatic function with clinical parameters and serum cytokines was analyzed. Results The expression of FE1 was lower in patients [(205.9±18.3) μg/g] after AP in comparison with the controls [(333.9±19.7) μg/g, P<0. 01], but levels of fasting blood-glucose, C-peptide and insulin were higher in patients group (P<0.01). Serum level of HGF was higher in patients with insufficient pancreatic exoerine [(983.76±372.65) pg/ml] than those with normal exocrine function [(263.44±110. 35) pg/ml]. Meanwhile,EGF level was higher in patients with DM after AP [(704.41±190. 37) pg/ml] than those without DM [(360. 03±48.39) pg/mh P<0.05]. There was a negatively correlation between FE1 and HGF (P ＜0. 01). The abnormal fasting blood glucose was correlated with CT grading (P<0. 05).Conclusions The patients after AP develope insufficient exocrine and endocrine function. Serum EGF and HGF may be associated with restoration of pancreatic endocrine and exocrine function.