Acute necrotic collection (ANC) is an early, local complication of necrotizing pancreatitis, and guidelines recommend a deliberate delay in treating ANC. In patients with early persistent organ failure, such delay may be harmful. This study aimed to assess whether early intervention for ANC confers clinical benefits in this patient population. This is a multicenter, open-label, randomized controlled trial. At 7 days after disease onset, patients with ANC and persistent organ failure were screened for: (1) organ failure lasting longer than 7 days; (2) organ failure worsening in severity; or (3) new-onset organ failure. If one or more criteria were met, they were randomized to receive either early percutaneous catheter drainage or standard care. The primary outcome was a composite of major complications and/or death during the index admission. Overall, 120 patients were randomized to early intervention (N = 63) or standard care (N = 57). There was no difference in the primary composite outcome (33.3

BACKGROUND:The aim of this study was to summarize the optimal strategy for early feeding in patients with acute pancreatitis.METHODS:The search was undertaken in electronic databases, which compared early with delayed feeding in acute pancreatitis. The primary outcome was the length of hospital stay (LOHS). The second outcomes were intolerance of refeeding, mortality, and total cost of each patient. This meta-analysis followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guideline. Research is registered by PROSPERO, CRD42020192133.RESULTS:A total of 20 trials involving 2168 patients were included, randomly assigned to the early feeding group (N = 1033) and delayed feeding group (N = 1135). The LOHS was significantly lower in the early feeding group than the delayed feeding group (mean difference: -2.35, 95% CI: -2.89 to -1.80; P < 0.0001), no matter the mild or severe subgroup ( Pint = 0.69). The secondary outcome of feeding intolerance and mortality were no significant difference (risk ratio: 0.96, 0.40 to 2.16, P = 0.87 and 0.91, 0.57 to 1.46, P = 0.69; respectively). Moreover, the hospitalization cost was significantly less in the early feeding group, resulting in an average savings of 50%. In patients with severe pancreatitis, early feeding after 24 hours may be beneficial ( Pint = 0.001).CONCLUSION:Early oral feeding can significantly reduce the LOHS and hospitalization costs in patients with acute pancreatitis without increasing feeding intolerance or mortality. In patients with severe pancreatitis, early feeding after 24 hours may be beneficial.

目的 分析经皮穿刺置管引流术(percutaneous catheter drainage,PCD)治疗急性胰腺炎合并感染性坏死后仍需外科手术干预的危险因素.方法 采用回顾性病例对照研究的方法.收集2008年9月至2018年4月第四军医大学西京消化病医院收治的321例行PCD治疗的急性胰腺炎合并感染性坏死病人的病例资料.采用Logistic回归模型分析PCD后仍需外科手术干预的独立危险因素.结果 纳入的321例病人中,234例通过PCD治愈,87例需进一步手术干预.单因素分析结果显示:CT严重指数(CTSI)、多脏器衰竭、胰腺坏死范围、延迟肠内营养、多重耐药菌感染是PCD后需手术干预的相关因素(P＜0.05).多因素分析结果显示:CTSI、多脏器衰竭、胰腺坏死范围＞50％、多重耐药菌感染是PCD后需手术干预的独立危险因素(P＜0.05).结论 部分急性胰腺炎合并感染性坏死的病人可通过PCD治愈从而避免外科手术干预.CTSI、多器官功能衰竭、引流液多重耐药菌感染、胰腺坏死面积＞50％是PCD后需手术干预的独立危险因素.

Objective To systemically review andquantify the incidence of oral feeding intolerance in acute pancreatitis. Methods Randomized controlled trials that reported the oral feeding intolerance rates of acute pancreatitis were searchedfrom PubMed, EMBASE, Medline, Cochrane Library, WanFang, CNKI, CMCC and VIP dal,abase wilh the" Acute pancreatitis " " Feeding intolerance" " Incidence" " Meta- analysis "from January 2002 to May 2017. Date were analyzed by using R 3. 4. 0 software. The heterogeneity of data were analyzed using 12test. Results Eleven randomized controlled trials including 658 cases were enrolled in Meta-analysis. The incidence of oral feeding of intolerance was 12. 2% . The result of subgroup analysis showed that there were no significant difference in the incidence of oral feeding intolerance when region, sample size and published year were taken into analysis (P > 0. 05). The oral feeding intolerance rate of mild acute pancreatitis was lower than that when moderately severe acute pancreatitis and severe acute pancreatitis were, included (8. 2% and 19. 9% , respectively; P = 0. 002 7). Conclusion Oral feeding intolerance affects approximately l in 8 patients with acute pancreatitis. The incidence of oral feeding intolerance of patients with severe acute pancreatitis is higher than that of patients with mild acute pancreatitis

Fatty liver (FL) is one of the risk factors for acute pancreatitis and is also indicative of a worse prognosis as compared to acute pancreatitis without fatty liver (AP). The aim of the present study was to analyze, at the hepatic level, the differentially expressed genes (DEGs) between acute pancreatitis with fatty liver (APFL) rats and AP rats. GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analyses of these DEGs indicated that PPARα signalling pathway and fatty acid degradation pathway may be involved in the pathological process of APFL, which indicated that fatty liver may aggravate pancreatitis through these pathways. Moreover, the excessive activation of JAK/STAT signaling pathway and toll-like receptor signaling pathway was also found in APFL group as shown in heat map. In conclusion, the inhibition of PPARα signaling pathway and the fatty acid degradation pathway may lead to the further disorder of lipid metabolism, which can aggravate pancreatitis.

The associations between red and processed meat consumption and the risk of colorectal cancer types have not been conclusively defined. We performed a systematic review and meta-analysis to analyze these associations. We searched PubMed and EMBASE to identify studies published from inception through September 2016. Dose-response, subgroup and subtype analyses of colorectal cancer (colon cancer, proximal colon cancer, distal colon cancer and rectal cancer) were performed. We ultimately selected 60 eligible studies. Positive associations were observed for colorectal cancer in case-control studies (red meat, P<0.01; processed meat, P<0.01) and cohort studies (red meat, P<0.01; processed meat, P<0.01). However, subtype analyses yielded null results for distal colon cancer in case-control studies (P=0.41) and cohort studies (P=0.18) for red meat and null results for proximal colon cancer in case-control studies (P=0.13) and cohort studies (P=0.39) for processed meat. Additionally, although the results of case-control studies were positive (red meat, P<0.01; processed meat, P=0.04) for rectal cancer, there were no positive associations between red (P=0.34) and processed meat (P=0.06) consumption and the risk in cohort studies. In a systematic review and meta-analysis, we found consumption of red and processed meat was associated with the risk of overall colorectal cancer but not rectal cancer. Additionally, there were no associations between the consumption of red meat and distal colon cancer risk and between the consumption of processed meat and proximal colon cancer risk.

The feasible of minimally invasive pancreaticoduodenectomy (MIPD) remains controversial when compared with open pancreaticoduodenectomy (OPD). We conducted a systemic review and meta-analysis to summarise the available evidence to compare MIPD vs OPD. We systemically searched PubMed, EMBASE and Web of Science for studies published through February 2016. The primary endpoint was postoperative pancreatic fistula (POPF, grade B/C). A total of 27 studies involving 14,231 patients (2,377 MIPD and 11,854 OPD) were included. MIPD was associated with longer operative times (P < 0.01) and increased mortality (P < 0.01), but decreased estimated blood loss (P < 0.01), decreased delayed gastric emptying (P < 0.01), increased R0 resection rate (P < 0.01), decreased wound infection (P = 0.03) and shorter hospital stays (P < 0.01). There were no significant differences in BMI (P = 0.43), tumor size (P = 0.17), lymph nodes harvest (P = 0.57), POPF (P = 0.84), reoperation (P = 0.25) and 5-year survival rates (P = 0.82) for MIPD compared with OPD. Although there was an increased operative cost (P < 0.01) for MIPD compared with OPD, the postoperative cost was less (P < 0.01) with the similar total costs (P = 0.28). MIPD can be a reasonable alternative to OPD with the potential advantage of being minimally invasive. However, MIPD should be performed in high-volume centers and more randomized-controlled trials are needed to evaluate the appropriate indications of MIPD.

Objective To explore the mechanism of acute pancrea titis (AP) aggravating liver damage.Methods SD rats were randomly divided into negative control (NC) and AP group.We use the method of sodium taurocholate retrograde pancreatic duct injection to establish the model of AP.After 6 h of anesthesia,the blood were collected from the inferior vena cava to detect the levels of serum amylase and lipase.The liver tissue was collected imnediately in order to extract total RNA.The genes and related pathways were analyzed by RNA-seq.Results Compared to NC group,the levels of serum amylase [(8 964.65 ±401.23) U/L] and lipase [(2 350.00 ± 201.90) U/L] were significantly higher in AP group (P ＜0.05);the pancreatic water content in AP group [(79.42 ± 1.21) ％] were significantly higher than NC group [(70.14 ± 1.02) ％];RNA-seq results showed that there were 2249 differently expressed genes between AP and NC group,among which 564 genes were up-regulated and 1685 genes were down-regulated.Kyoto gene and genome encyclopedia (KEGG) analysis results from high scores to low scores were:metabolic pathway、cytokine pathway、chemokine signaling pathway、Toll-like receptor signaling pathway.Conclusion Cytokine pathway,Toll-like receptor signaling pathway may be involved in the mechanism of AP aggravating liver damage.

Background: To investigate the accuracy of resistin, leptin and adiponectin levels in predicting persistent organ failure in patients with acute pancreatitis (AP).Methods: Data from 90 consecutive patients admitted to our hospital for AP were retrospectively collected from an ongoing prospective cohort study. The levels of adiponectin, leptin and resistin were measured and compared between patients with and without persistent organ failure. The accuracy of the adipokines in predicting persistent organ failure were compared with the patients' Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and were separately investigated in overweight and non overweight groups.Results: Persistent organ failure occurred in 26.7% of the patients. The levels of resistin were significantly increased in AP patients with persistent organ failure, in both the overweight and the non-overweight subgroups. Resistin and APACHE-II score predicted persistent organ failure with comparable areas under the curve (AUC) of 0.72 and 0.75, respectively (p = 0.66). Resistin demonstrated similar accuracy with the APACHE-II score in predicting persistent organ failure in the overweight (0.69 vs. 0.66, p = 0.82) and non-overweight (0.76 vs. 0.87, p = 0.39) subgroups. There was no correlation between adiponectin and persistent organ failure, but a weak correlation between leptin and persistent organ failure was demonstrated.Conclusions: Resistin and leptin levels, rather than adiponectin, correlate with persistent organ failure in patients with AR (C) 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Objective To investigate the role of endoplasmic reticulum stress and nitrative stress in obese rats with acute pancreatitis.Methods SD rats were randomly divided into normal control group (NC),acute pancreatitis group (AP) and obesity + acute pancreatitis group (OB + AP),We evaluated the severity of AP biochemically and morphologically.The expression of inositol requiring enzyme-1α (IRE-Iα),glucoseregulated protein (GRP)-78,CCAAT enhancer binding protein (CHOP),inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) was assayed by Western blotting.Results Compared with AP group,serum amylase and lipase levels were significantly higher in OB + AP group.Compared with AP group,the edema and inflammatory cell infiltration of pancreas were more obvious,and the pulmonary hemorrhage and alveolar epithelial hyperplasia were more severe in OB + AP group.Compared with AP group,the expression of endoplasmic reticulum stress markers IRE-1α [(0.65 ±0.03) vs.(0.46 ±0.04)],GRP-78 [(0.85 ±0.03) vs.(0.43 ±0.03)],CHOP [(0.62 ± 0.03) vs.(0.41 ± 0.02)] and nitrosative stress marker iNOS [(1.01 ± 0.10) vs.(0.36 ±0.04)] was higher in OB + AP group (P ＜ 0.05),while the expression of eNOS [(0.36 ± O.03) vs.(0.69 ± 0.04)] was decreased (P ＜ 0.05).Immunohistochemistry showed that 3-nitrotyrosine was expressed in both AP and OB + AP group,but not in NC group.Conclusion Ror SD rats,obesity can aggravate pancreatitis by increasing the degree of endoplasmic reticulum stress and nitrative stress.

目的:探讨苦参注射液与普瑞巴林合用的镇痛效果,为临床用药提供实验依据.方法:通过结扎L5脊神经建立大鼠神经病理性疼痛模型.按照痛阈值将模型成功大鼠随机分为3组,分别为肌肉注射苦参注射液、口服普瑞巴林、苦参注射液和普瑞巴林联合用药.采用Von Frey纤维丝测定机械痛阈值,热板法测定热痛阈值,比较3组大鼠的机械痛阈值和热痛阈值的差异.结果:苦参注射液组大鼠机械痛镇痛效果第7天出现,热痛镇痛效果第21天出现,大鼠机械痛阈值和热痛阈值显著升高.口服普瑞巴林组大鼠机械痛阈值和热痛阈值在30分钟内显著升高,但机械痛阈值在给药第8天时下降到给药前水平,热痛阈值给药第5天时下降到给药前水平.联合使用苦参注射液和普瑞巴林,大鼠机械痛阈值和热痛阈值于给药后第1天显著升高,镇痛效果一直维持至实验结束(第28天).结论:苦参注射液镇痛起效慢,不易产生耐受性.普瑞巴林镇痛起效快,但容易产生耐受.二者联合使用既可短时间内起到镇痛效果,并且不易产生耐受.

B10 cells are specific B cell subsets with the capacity of producing IL-10 to inhibit immune responses. Several studies have demonstrated that B10 cells are correlated with some immune and inflammatory diseases, such as experimental autoimmune encephalomyelitis (EAE), collagen-induced arthritis (CA), colitis and contact hypersensitivity. However, its role in severe acute pancreatitis (SAP) has not been clearly demonstrated yet.

Objective To identify whether hepatic steatosis is the exposure factor of severe acute pancreatitis (SAP) and to investigate the prognostic efficacy of combining hepatic steatosis with APACHE-Ⅱ score in predicting the severity of SAP.Methods Clinicopathological data of 148 patient diagnosed as acute pancreatitis in Xijing Hospital from April 2011 to September 2013 were retrospectively analyzed.There were 41 severe acute pancreatitis(SAP) patients and 107 mild acute pancreatitis (MAP).The prognosis of patients with and without hepatic steatosis were compared in the subgroups of patients with APACHE-Ⅱ scores ＜ and ≥8.The sensitivity,specificity,ROC curve of combining hepatic steatosis with APACHE-Ⅱ score in predicting SAP were evaluated.Results Hepatic steatosis was independently correlated with SAP (OR =5.33,P =0.003).The incidence of SAP with hepatic steatosis is 5.33 times higher than the incidence of SAP without hepatic steatosis.In patients with an APACHE-Ⅱ score ＜ 8,those with hepatic steatosis had a higher incidence of SAP (34.5％ vs.6.9,P ＜ 0.001) and systemic complications (31％ vs.5.7％,P＜0.001).ln patients with an APACHE-lⅡ score ≥8,those with hepatic steatosis also had a higher incidence of SAP (100％ vs.65％,P =0.029) and systemic complications (100％ vs.65％,P =0.029).The sensitivity and specificity of APACHE-Ⅱ score was 61.0％ and 93.5％,the ROC curve area was 0.772.The sensitivity and specificity of hepatic steatosis was 53.7％ and 82.2％,the ROC curve area was 0.680.The sensitivity and specificity of combining hepatic steatosis with APACHE-Ⅱ score was 85.4％ and 75.5％,the ROC curve area was 0.861.Conclusions Hepatic steatosis correlates with a worse prognosis of AP.Combining hepatic steatosis with APACHE-Ⅱ score can improve the ability of predicting SAP.

Objective To explore the severity of acute pancreatitis induced by intraperitoneal injection of 50 μg/kg caerulein at different doses in mice.Methods Acute pancreatitis (AP) was induced by intraperitoneal infection of 50 μg/kg caerulein at 3,6,9,12times,respectively.We evaluated the severity of AP biochemically and morphologically.Results Conventional doses of caerulein (50 μg/kg) were injected with 3,6,9,12 times,the level of serum amylase in experimental group were significantly higher than that in control group (P ＜ 0.05),peaked in the 9 times [(25 966.67 ± 3 787.02) U/L] ;pancreatic water content in the experimental group was significantly higher than that in control group (P ＜ 0.05),peaked in the 6 times [(81.13 ± 1.03) ％] ; pancreatic tissue hematoxylin and eosin (HE) staining showed that pancreas was slightly edema and infiltration of inflammatory cells at 3 times,which showed a large amount of neutrophil infiltration and obvious edema at the 6 times,and pancreatic leaflet margin appeared a small amount necrosis at the 9 times,and the acinar necrosis foci could be seen in large range an the 12 times (histopathological score 8.20 ±0.84),the microscope exhibited altered necrotizing pancreatitis.Conclnsion Conventional caerulein doses (50 μg/kg) may induce acute edematous pancreatitis by 6 times of intraperitoneal injection in mice,and 12 times may induce acute necrotizing pancreatitis.

Hepatic steatosis (HS) can exacerbate acute pancreatitis (AP). This study aimed to investigate the relation between α1-antitrypsin (AAT) and acute pancreatitis when patients have HS. Using proteomic profiling, we identified 18 differently expressed proteins pots in the serum of rats with or without HS after surgical establishment of AP. AAT was found to be one of the significantly down-regulated proteins. AAT levels were significantly lower in hepatic steatosis acute pancreatitis (HSAP) than in non-HSAP (NHSAP) (P < 0.001). To explore the clinical significance of these observations, we measured the levels of AAT in the serum of 240 patients with HSAP, NHSAP, fatty liver disease (FLD), or no disease. Compared with healthy controls, serum AAT levels in patients with NHSAP were significantly higher (P < 0.01), while in patients with HSAP serum AAT levels were significantly lower (P < 0.01). Further studies showed that acute physiology and chronic health evaluation (APACHE-II) scores were negatively correlated with serum AAT levels (r = −0.85, P < 0.01). In conclusion, low serum levels of AAT in patients with HSAP are correlated with disease severity and AAT may represent a potential target for therapies aiming to improve pancreatitis.

Objective To investigate the the efficacy of step-up approach for retroperitoneal infection in patients with severe acute pancreatitis.Methods The clinical data of 94 patients with SAP complicated with retroperitoneal infection who were admitted to our hospital were analyzed retrospectively.Patients were divided into 2 groups:routine therapy group(38 patients) and step-up approach group(56 patients).The demographic characteristic,operation complications,hospital stays and mortality were compared between the two groups.Results Compared with routine therapy group,the step-up approach group had lower incidence of operation complications (6/56 vs 12/38,P =0.029) and mortality (4/56 vs 8/38,P =0.047),higher rate of new-onset diabetes (10/56 vs 6/38,P =0.048).Conclusions Compared with the routine therapy,the step-up approach reduces the incidence of postoperative complications and the rate of mortality.

The strong up-regulation of inflammatory mediators has been reported to play a key role in acute pancreatitis (AP). Elevated serum levels of interleukin-1β (IL-1β) are associated with the development of AP. However, the precise effect and mechanism of IL-1β in AP remains obscure. In this study, we investigated the potential role and mechanism of IL-1β in AP. We measured autophagy activation in response to IL-1β in AR42J cells. The disrupting effects of IL-1β on cellular Ca(2+) were observed. To determine whether the disruption of Ca(2+) signaling has protective effects in vivo during AP, male C57BL/6 mice were treated with cerulein to induce AP. We found that the treatment of AR42J cells with IL-1β triggered autophagy and that the autophagic flux was impaired. In addition, IL-1β induced Ca(2+) release from the ER. Furthermore, the expression of the ER stress markers GRP78 and IRE1 also increased. 2APB, an antagonist of the InsP3 receptor, inhibited increased expression of autophagy markers. Subsequent biochemical assays revealed that co-culture with IL-1β could induce the activation of trypsinogen to trypsin and reduce the viability of acinar cells. Pathological changes of the pancreas were also observed in vivo. We found that the pathological injuries of the pancreas were significantly alleviated in mice co-treated with 2APB. Taken together, our results indicate that IL-1β can induce trypsin activation and decrease cellular viability in pancreatic acinar cells. These effects depend on impaired autophagy via intracellular calcium changes. Ca(2+) signaling may become a promising therapeutic target in the treatment of pancreatitis.

Human leukocyte antigen G (HLA-G) is a non-classical HLA class I molecule thought to play a key role in maternal-fetal tolerance and cancer immune evasion. This study aimed to investigate the HLA-G expression in lesion sections and plasma sHLA-G levels of primary esophageal squamous cell carcinoma (ESCC) patients and its clinical significance in diagnosis and prognosis of ESCC. 60 ESCC patients and 28 healthy controls were recruited, and the positive expression of HLA-G in ESCC lesions and adjacent normal tissues were 70% (42/60) and 8.6% (5/60) (P < 0.05), respectively, while no expression was found in normal controls. HLA-G1 and HLA-G5 were determined to be dominating isoforms measured by RT-PCR. There was a significant difference in plasma sHLA-G levels between patients with ESCC (15.04 U/ml, range 4.33-250.00 U/ml) and healthy controls (6.81 U/ml, range 0-29.27 U/ml) (P < 0.01). The plasma IL-10 level was higher in ESCC patients than the controls (23.86 pg/ml vs. 12.81 pg/ml, P < 0.01). HLA-G expression in lesion tissues was correlated with cancer cell differentiation (P = 0.033), lymph node metastasis (P = 0.035) of ESCC. However, no obvious correlations were demonstrated between the plasma sHLA-G levels and the clinicopathological parameters. There was a significant correlation between sHLA-G and IL-10 expression (r = 0.353, P = 0.006) in patients with Esophageal squamous cell carcinoma. HLA-G positive expression showed poorer prognosis of ESCC. HLA-G positive expression might serve as a potential marker in the diagnosis or prediction of ESCC. (C) 2014 Elsevier B.V. All rights reserved.

Purpose: The purpose of this study is to investigate the accuracy of currently used scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis (AP).Materials and methods: In this retrospective study, 127 consecutive patients with AP and organ failure were included. Patients were divided into transient and persistent organ failure groups. The Acute Physiology and Chronic Health Examination II score, bedside index of severity in acute pancreatitis, harmless acute pancreatitis score, and modified Marshall scores within the first 24 hours of organ failure were collected, and their accuracy in predicting transient organ failure was assessed.Results: Transient organ failure occurred in 46 patients (36.2%). Fewer patients with transient organ failure initiated with multiple organ failure (13.0% vs 37.0%, P = .004) and renal failure (17.4% vs 44.4%, P = .002). In predicting transient organ failure, the area under the curves of the 4 scoring systems is from 0.66 to 0.71. The area under the curve of serum amylase was 0.78, which was slightly better than that of the modified Marshall and Acute Physiology and Chronic Health Examination II score and was significantly better than that of the bedside index of severity in acute pancreatitis and harmless acute pancreatitis score (P < .05).Conclusions: Current scoring systems are not accurate enough in differentiating transient and persistent organ failure in patients with AP. (C) 2014 Elsevier Inc. All rights reserved.

全氟辛酸(PFOA)是聚四氟乙烯等化工产品的关键原材料,作为一种啮齿动物的致癌剂,PFOA是引起环境污染的重要全氟化合物.本研究旨在观察全氟辛酸在大鼠胰腺炎模型中的炎症调节作用.一、材料与方法1.实验分组:60只雌性SD大鼠随机分为6组:(1)对照组;(2)雨蛙素(CRL)组:雨蛙素以4 nmol/(kg·h)的速度于颈静脉插管给药2h.对照组用磷酸盐缓冲液(PBS)给药;(3)PFOA组:颈静脉给药20 min前皮下注射PFOA(150 mg/kg);(4)氯苯丁酯组:颈静脉给药20 min前皮下注射PPAR-α激动剂氯苯丁酯(100 mg/kg);(5) CRL +PFOA组:皮下注射PFOA,雨蛙素持续给药2h;(6) CRL+氯苯丁酯组:大鼠皮下注射氯苯丁酯,雨蛙素持续给药2h。