ObjectiveTo summary the effect of parenteral nutrition combined with enteral nutrition on patients with severe acute pancreatitis. MethodsThe clinical data of 200 patients with severe acute pancreatitis admitted in our hospital in recent 10 years were retrospectively analyzed. Of which 88 cases were treated by traditional nutritional support therapy (traditional nutrition group), the rest of 112 cases of patients with early parenteral nutrition to later period gradually combined with enteral nutrition comprehensive nutritional support strategy (comprehensive nutrition group). ResultsThe APACHEⅡscores and serum level of C-reactive protein (CRP) of patients in comprehensive nutrition group were significantly lower than patients in traditional nutrition group (P < 0.05), while the serum albumin level was significantly higher than that of traditional nutrition group (P < 0.05). In the incidence of complications and mortality, the average length of stay and total cost of comprehensive nutrition group were significantly lower than patients with traditional nutrition group (P < 0.05), the cure rate was significantly higher than that of traditional nutrition group (P < 0.05). ConclusionThe combination of parenteral nutrition and enteral nutrition of nutrition support model not only can shorten the duration of symptoms but also alleviate the burden of patients and reduce complications and mortality.
Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
ObjectiveTo understand the current progress of programmed cell death in the pathogenesis of acute pancreatitis, and to provide reference for the pathogenesis and treatment of acute pancreatitis.MethodThe research progress of acute pancreatitis and programmed cell death in recent years was reviewed by reading relevant literatures at home and abroad in recent years.ResultsProgrammed cell death was defined as controlled cell death performed by intracellular procedures, including apoptosis, autophagy, programmed necrosis, and coronation. The pattern of death of pancreatic acinar cells mainly includes apoptosis and programmed necrosis. Although the pathogenesis of acute pancreatitis had not yet been fully clarified, it was known that through the study of programmed cell death, it could help us to understand the pathogenesis and pathogenesis of acute pancreatitis and provide more effective treatment methods.ConclusionsProgrammed cell death is very important for acute pancreatitis. The mechanism of programmed cell death in acute pancreatitis is necessary for the treatment and prevention of it.
ObjectiveTo investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis.MethodsThe clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized.ResultsThe patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery.ConclusionsSAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.
ObjectiveTo summarize the research progress of mesenchymal stem cells in acute pancreatitis animal models, and to explore the potential of mesenchymal stem cells in the treatment of acute pancreatitis.MethodWecollected domestic and foreign studies on mesenchymal stem cells in acute pancreatitis animal models and made a review.ResultsIn the animal model of acute pancreatitis, the infusion of mesenchymal stem cells could reduce the expression of inflammatory factors, regulate the expression of immune cells, inhibit pancreatic cell apoptosis and autophagy, resist oxidative stress, and promote angiogenesis. Mesenchymal stem cells had a relieving effect on acute pancreatitis.ConclusionThe infusion of mesenchymal stem cells can relieve acute pancreatitis in animal models, and has great potential in the clinical application of acute pancreatitis.
Acute pancreatitis (AP) is a common clinical emergency of the abdomen with increasing incidence and lack of effective treatment. Traditional Chinese medicine, as a treasure of the Chinese people, has been used in the treatment of AP for decades with favorable therapeutic effects. Currently, clinical trials and experimental studies have shown that traditional Chinese medicine has the effects of inhibiting pancreatic enzyme activity, anti-inflammation, promoting gastrointestinal dynamics, as well as delaying the progress of AP, improving clinical symptoms, reducing related complications, and reducing the mortality rate. Therefore, traditional Chinese medicine has considerable clinic value in treating AP. Based on the related research progress and clinical practice of our team, the authors summarized the targets and mechanism of traditional Chinese medicine in treating AP.
ObjectiveTo study the expression of zonula occluden-1 (ZO-1) in ileum tissues and the possible mechanism of intestinal mucosal barrier injury in rats with severe acute pancreatitis (SAP). MethodsFifty SD male rats were randomly divided into sham operation group and SAP group, then SAP group was divided into four subgroups with 10 rats in each subgroup according to the sampling time of 3, 6, 12, and 24 h. The SAP model was made by injecting 5% bovine sodium deoxycholate into biliarypancreatic duct with Aho’s method. The rats were killed at 3, 6, 12, and 24 h after making model. The rats in the sham operation group were killed directly. Tumor necrosis factor-α (TNF-α), diamine oxidase (DAO), and histological changes in pancreatic and intestinal pathologies were observed. At the same time, the ZO-1 protein and mRNA expressions of ileum tissues were detected by immunohistochemistry and RT-PCR, respectively. ResultsCompared with the sham operation group 〔TNF-α: (10.83±0.96) ng/L; DAO: (354.79±3.67) U/L; ZO-1 protein: (10.40±0.45) score; ZO-1 mRNA: 0.878±0.014 8〕, the levels of TNF-α at different time 〔3 h: (125.30±0.94) ng/L; 6 h: (181.89±4.93) ng/L; 12 h: (230.58±1.28) ng/L; 24 h: (198.89±4.83) ng/L〕 were significantly higher (Plt;0.05), the activities of DAO 〔3 h: (235.77±0.67) U/L; 6 h: (117.22±5.58) U/L; 12 h: (106.69±1.39) U/L; 24 h: (91.18±1.09) U/L〕 were significantly lower (Plt;0.05), ZO-1 protein 〔3 h: (8.70±0.22) score; 6 h: (3.73±0.19) score; 12 h: (3.92±0.22) score; 24 h: (4.29±0.30) score〕 and mRNA (3 h: 0.806±0.020 7; 6 h: 0.370±0.015 8; 12 h: 0.502±0.019 2; 24 h: 0.562±0.030 3) expressions of the ileum tissues were significantly lower (Plt;0.05) in the SAP group; Meanwhile, the necrosis of ileum mucous membrane chorioepithelium, angiorrhexis and hemorrhage, and inflammatory cell infiltration in the pancreatic and ileum tissues were also observed. ConclusionThe decrease of expression of ZO-1 in ileum tissues is one of the vital causes for mucosal barrier injury in SAP, probably through acts the excessive release of inflammatory cytokines TNF-α and the decrease of DAO activity.
ObjectiveTo determine value of texture analysis based on bi-phasic enhanced CT images in diagnosis of acute pancreatitis (AP) with acute renal injury (AKI).MethodsA total of 62 patients with clinically proven AP including 39 patients with AKI and 23 patients without AKI were analyzed retrospectively. The region of interest (ROI) was chosen at the axial CT-enhanced images of bilateral kidneys using the ITK-Snap software and the texture analysis was performed by the Analysis-Kinetics (A.K.) analysis software. Using the Analysis of Variance, Mann-Whitney U test, Spearman correlation analysis and LASSO regression to reduce the features dimension, and screening out the textures by the logistic regression. The receiver operating characteristic (ROC) curve was established to determine the diagnostic performance of the features.ResultsIn the total of 396 image histological features originally extracted from the texture analysis, 6 features were finally screened out through the dimensionality reduction, involving the Haralick correlation, Inertia, Mean value, Cluster prominence, Short run high grey level emphasis, and Surface area. The area under curve (AUC), threshold, sensitivity, specificity, and accuracy in diagnosing of AP with AKI respectively was 0.926, 0.619, 89.4%, 71.4% and 82.7% by the Haralick correlation; which respectively was 0.790, 0.665, 59.6%, 82.1%, 68.0% by the Inertia; which respectively was 0.983, 0.662, 89.4%, 100%, 93.3% by the Mean value; which respectively was 0.903, 0.696, 80.9%, 85.7%, 82.7% by the Cluster prominence; which respectively was 0.980, 0.778, 76.6%, 100%, 85.3% by the Short run high grey level emphasis; which respectively was 0.819, 0.604, 78.7%, 75.0%, 77.3% by the Surface area.ConclusionTextures of contrast-enhanced CT images have better resolving ability and higher accuracy in diagnosis of AP with AKI and diagnostic efficiency of Mean value is the best.
ObjectiveTo explore clinical effect of enteral nutrition (EN) through nasojejunal tube in severe acute pancreatitis (SAP).MethodsThe clinical and pathological data of 76 patients with SAP who met the inclusion criteria and treated in the Third People’s Hospital of Henan Province from June 2015 to December 2018 were retrospectively collected. According to the nutritional support therapy adopted in the course of treatment, the patients were divided into an EN group (n=44) and a parenteral nutrition group (PN group, n=32), the patients in the EN group were given the EN through the nasojejunal tube and the patients in the PN group were given the routine PN. The APACHE Ⅱ and SOFA scores, nutritional status, and immune function were observed before the treatment and on week 2 after the treatment in the two groups.ResultsThere were no significant differences in the general data of the gender, age, body mass index, etc. between the two groups (P>0.050). ① The score of APACHEⅡ or SOFA score on week 2 after the treatment in both groups was significantly lower than that before the treatment (P<0.050), which in the EN group was significantly lower than that in the PN group on week 2 after the treatment (P<0.050). ② The levels of albumin and prealbumin were increased significantly and the hemoglobin level was decreased (P<0.050) on week 2 after the treatment as compared with those before the treatment in the two groups (P<0.050), which in the EN group were significantly higher than those in the PN group on week 2 after the treatment (P<0.050). ③ The CD4, CD8, and CD4/CD8 and IgG, IgM, and IgA on week 2 after the treatment were significantly lower than those before the treatment in these two groups (P<0.050), which in the EN group were significantly higher than those in the PN group on week 2 after the treatment (P<0.050). ④ The levels of endotoxin, D-lactic acid, diamine oxidase, and serum high mobility group protein B1 on week 2 after the treatment were significantly lower than those before the treatment in the two groups (P<0.050), and which in the EN group were significantly lower than those of the PN group on week 2 after the treatment (P<0.050). ⑤ The complications rate in the EN group was significantly lower than that in the PN group [20.45% (9/44) versus 53.13% (17/32), χ2=8.786, P=0.003].ConclusionEN through nasojejunal tube has a good effect on patients with SAP, which is helpful to improve their immune and nutritional status.
Acute pancreatitis (AP) is an acute abdominal disease characterised by inflammation of the pancreas. Acute severe upper abdominal pain is the leading symptom and primary reason for emergence hospital admission of AP patients. Nowadays, more and more research has focused on the cross-talk between the exocrine pancreas and pancreatic projecting neurons (neurogenic inflammation) for pain in AP. Elucidating the molecular mechanisms of neurogenic inflammation for pain in AP will provide insights into targeted analgesics development in this setting.