A case report of gastrointestinal hemorrhage caused by small intestinal hemangioma.

RATIONALE: Small intestinal hemangioma is a rare condition and very difficult to diagnose preoperatively. It can occur in all segments of the small intestine, but jejunum is common. Its common symptoms are gastrointestinal bleeding and chronic anemia, while intussusception, intestinal obstruction and perforation are rare. In recent years, the popularization and application of capsule endoscopy, computed tomographic enterography and double-balloon enteroscopy play vital roles in the diagnosis and management of small bowel bleeding. We report a case of gastrointestinal hemorrhage caused by of the small intestine hemangioma. PATIENT CONCERNS: A 56-year-old male complaint of hematochezia for 1 day with dizziness, fatigue, and vomiting of gastric contents. DIAGNOSIS: Based on the clinical, laboratory, imaging tests, endoscopy, laparoscopic approach and pathological examination, the patient was diagnosed with small intestinal hemangioma. INTERVENTIONS: Segmental resection was performed for the small intestinal hemangioma by a laparoscopic approach. OUTCOMES: The patient was discharged without operation complications, and his hemoglobin increased to 130 g/L at the second month after the operation. LESSONS: Small intestinal hemangioma is a rare condition without specific symptoms and can cause gastrointestinal bleeding. The possibility of small intestinal hemangioma should be considered with unexplained gastrointestinal bleeding. Surgical resection is the preferred treatment option for symptomatic hemangiomas. Furthermore, double-balloon enteroscopy can increase the diagnostic yield. Applying endoscopic titanium clip combined with Indian ink marking can obtain an accurate positioning before surgery.

Ghrelin inhibits IKKß/NF-κB activation and reduces pro-inflammatory cytokine production in pancreatic acinar AR42J cells treated with cerulein.

BACKGROUND: Previous studies have provided conflicting results regarding whether the serum ghrelin concentration can reflect the severity of acute pancreatitis (AP). The present study examined the correlation between the serum ghrelin concentration and AP severity in animal models and investigated whether altered ghrelin expression in pancreatic acinar cells influences IKKß/NF-κB signaling and pro-inflammatory cytokine production. METHODS: Mild or severe AP was induced in rats by intraperitoneal injection of cerulein or retrograde cholangiopancreatic duct injection of sodium taurocholate, respectively. After successful model induction, serum ghrelin, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) concentrations were determined by enzyme-linked immunosorbent assay, and IKKß/NF-κB activation was assessed by immunohistochemistry. Subsequently, stable overexpression or knockdown of ghrelin in AR42J cells was achieved by lentiviral transfection. After transfected cells and control cells were treated with cerulein for 24 h, the TNF-α and IL-1ß levels in the supernatants were determined by enzyme-linked immunosorbent assay, and the expression levels of p-p65, IKKß, and p-IKKß were detected by Western blotting. RESULTS: In rat AP models, AP severity was correlated with increased IKKß/NF-κB activation, pro-inflammatory cytokine production, and ghrelin secretion. The levels of pro-inflammatory cytokines TNF-α and IL-1ß as well as IKKß/NF-κB signaling activity were increased upon knockdown of ghrelin in the AP acinar cell model and decreased with ghrelin overexpression. CONCLUSIONS: Serum ghrelin is related to the severity of AP. Ghrelin may play a protective role in the pathogenesis of AP by inhibiting the pro-inflammatory cytokines and the activation of the IKKß/NF-κB signaling pathway.

An improved method for the isolation and culture of rat pancreatic ductal epithelial cells.

BACKGROUND: This aim of this study was to explore a novel method that can be used to isolate and culture rat pancreatic ductal epithelial cells. METHODS: Retrograde injection of indigo carmine solution into the bile duct of rats revealed the main pancreatic duct, which was isolated using the naked eye (without using a stereomicroscope). The main pancreatic duct was sequentially digested with three enzymes, and the digested cells were cultured in RPMI-1640 medium containing 10-15% fetal bovine serum. After 72 h, the primary pancreatic ductal epithelial cells started to adhere to the wall. The cells reached 70-80% confluence after approximately 7 days and were subsequently digested with 0.25% trypsin and subcultured. Cells of the second and fourth passages were harvested. Cytokeratin (CK)-7 and CK-19 protein expressions in the cells and pancreatic tissue were detected by Western blot analysis. q-PCR was employed to examine CK-7, CK-19, somatostatin, amylase, insulin, and glucagon mRNA expression in the cells and pancreatic tissue after the main pancreatic duct was removed. RESULTS: The rats had one or two main pancreatic ducts meeting the bile ducts at a right or an acute angle. Rat pancreatic ductal epithelial cells isolated by this method grew well and showed a cobblestone-like appearance via microscopy. Western blot analysis showed that both the second and fourth passages of pancreatic ductal epithelial cells expressed CK-7 and CK-19 protein. The q-PCR results showed the expression of CK-7 and CK-19 genes in the second and fourth passages of pancreatic ductal epithelial cells, while the somatostatin, amylase, insulin, and glucagon genes were not expressed. The pancreatic tissue harvested after the removal of the main pancreatic duct did not express CK-7 or CK-19, while the somatostatin, amylase, insulin, and glucagon genes were expressed. CONCLUSIONS: The preliminary results show that this method can be applied to successfully isolate and culture rat pancreatic ductal epithelial cells.

Serum ghrelin, but not obestatin, is a potential predictor of acute pancreatitis severity.

The roles of ghrelin and obestatin in AP remain controversial.This study investigates the effects and the predictive value of serum ghrelin and obestatin levels in the early stage of AP.A total of 193 consecutive patients with AP and 24 healthy controls were included. Patients were divided into mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP) groups. Serum levels of ghrelin and obestatin were measured on the first, third, and fifth days of hospitalization. The predictive value of serum ghrelin and obestatin levels on the first day in AP was examined using receiver-operating characteristic (ROC) curves.On the first day of hospitalization, the mean serum ghrelin level was significantly lower in patients with AP than in controls (P < .01). The serum ghrelin concentration decreased with increasing AP severity and was lower in patients with SAP than in those with MAP and MSAP (P < .05). It increased gradually from the first to the fifth day after treatment. ROC curves demonstrated that the serum ghrelin level on the first day had some predictive value for AP severity (area under the ROC curve = 0.646), with an optimal cut-off value of 87.83 pg/mL. Logistic regression showed that the serum ghrelin level had independent predictive value for non-MAP (odds ratio = 10.94; 95% confidence interval, 5.08-23.55; P < .01). The serum obestatin level did not differ significantly between patients with AP and controls and had the limited predictive value for non-MAP (area under the ROC curve = 0.564). However, the serum obestatin concentration showed a "warning" effect regarding AP etiology; on the first day of treatment, it was significantly lower in patients with AP of hypertriglyceridemic etiology than in those with AP of biliary, alcohol-related, and other etiologies (P = .05, P = .031, and P = .029, respectively).Serum ghrelin and obestatin levels may be related to the progression of AP in the early stage. Only the serum ghrelin level is a potential predictor of AP severity in the early stage. Obestatin may be involved in the pathogenesis of AP caused by hypertriglyceridemia.