Impact of metabolic syndrome components on clinical outcomes in hypertriglyceridemia-induced acute pancreatitis

BACKGROUND The incidence of hypertriglyceridemia(HTG)-induced acute pancreatitis(AP)is steadily increasing in China,becoming the second leading cause of AP.Clinical complications and outcomes associated with HTG-AP are generally more severe than those seen in AP caused by other etiologies.HTG-AP is closely linked to metabolic dysfunction and frequently coexists with metabolic syndrome or its components.However,the impact of metabolic syndrome components on HTGAP clinical outcomes remains unclear.AIM To investigate the impact of metabolic syndrome component burden on clinical outcomes in HTG-AP.METHODS In this retrospective study of 255 patients diagnosed with HTG-AP at the First Affiliated Hospital of Guangxi Medical University,we collected data on patient demographics,clinical scores,complications,and clinical outcomes.Subsequently,we analyzed the influence of the presence and number of individual metabolic syndrome components,including obesity,hyperglycemia,hypertension,and low high-density lipoprotein cholesterol(HDL-C),on the aforementioned parameters in HTG-AP patients.RESULTS This study found that metabolic syndrome components were associated with an increased risk of various complications in HTG-AP,with low HDL-C being the most significant risk factor for clinical outcomes.The risk of complications increased with the number of metabolic syndrome components.Adjusted for age and sex,patients with highcomponent metabolic syndrome had significantly higher risks of renal failure[odds ratio(OR)=3.02,95%CI:1.12-8.11)],SAP(OR=5.05,95%CI:2.04-12.49),and intensive care unit admission(OR=6.41,95%CI:2.42-16.97)compared to those without metabolic syndrome.CONCLUSION The coexistence of multiple metabolic syndrome components can synergistically worsen the clinical course of HTGAP,making it crucial to monitor these components for effective disease management.

超声内镜引导下无水乙醇注射法与外科手术法治疗良性胰岛素瘤的对比研究

目的评估超声内镜(EUS)引导下无水乙醇注射法治疗良性胰岛素瘤的疗效与安全性,并与外科手术治疗法相比较。方法回顾性分析2011年4月-2016年2月在广西医科大学第一附属医院经EUS引导下无水乙醇注射法治疗或外科手术法治疗的38例良性胰岛素瘤临床资料。结果 97.4%(37/38)的患者有典型的Whipple三联征,82.9%(29/35)患者低血糖发作时胰岛素释放指数(I/G)>0.3。术前B超、CT、磁共振成像(MRI)、正电子发射计算机断层显像(PET/CT)和EUS定位诊断胰岛素瘤阳性率分别为50.0%、67.6%、66.7%、75.0%和89.7%。18例行EUS引导下无水乙醇注射治疗(EUS-FNI组),20例行外科手术治疗(外科手术组),EUS-FNI组术后均无并发症发生,外科手术组中40.0%(8/20)患者出现并发症。与外科手术组相比,EUS-FNI组在手术时间、术中出血、术后并发症、术后住院时间和住院总费用上均明显降低(P<0.05)。所有患者均得到随访,EUS-FNI组最后一次无水乙醇注射治疗后所有患者血糖平稳在正常范围;外科手术组20例患者中,90.0%(18/20)患者术后无低血糖症状再发作,监测血糖在正常范围,10.0%(2/20)患者术后低血糖症状发作较术前减少。结论 EUS引导下无水乙醇注射法治疗良性胰岛素瘤安全、有效。与外科手术法相比,具有微创、经济、并发症少和术后恢复快等优势。

双气囊小肠镜对小肠疾病诊断的临床价值分析

目的探讨双气囊小肠镜(DBE)对于小肠疾病诊断的临床应用价值。方法选取2008年1月-2016年5月广西医科大学第一附属医院收治的231例疑似小肠疾病且行DBE检查的患者。记录检查所见、诊断结果及并发症等情况。结果 231例患者共行257次小肠镜检查,包括经口检查112例,经肛检查93例,双向入镜检查26例。小肠疾病检出阳性率64.9%(150/231)。其中,非特异性肠炎33例,占总病例数的14.3%,克罗恩病27例(11.7%),溃疡19例(8.2%),血管病变13例(5.6%),间质瘤12例(5.2%)。腹痛104例,确诊62例,阳性率59.6%(62/104),不明原因消化道出血94例,确诊63例,阳性率67.0%(63/94)。所有患者中,有1例出现小肠穿孔,其余患者均无严重并发症出现。结论 DBE对小肠疾病阳性检出率高,相对安全可靠,对临床疑似小肠疾病患者的诊断和治疗具有一定的临床应用价值。

Crosstalk network among multiple inflammatory mediators in liver fibrosis

Liver fibrosis is the common pathological basis of all chronic liver diseases,and is the necessary stage for the progression of chronic liver disease to cirrhosis.As one of pathogenic factors,inflammation plays a predominant role in liver fibrosis via communication and interaction between inflammatory cells,cytokines,and the related signaling pathways.Damaged hepatocytes induce an increase in proinflammatory factors,thereby inducing the development of inflammation.In addition,it has been reported that inflammatory response related signaling pathway is the main signal transduction pathway for the development of liver fibrosis.The crosstalk regulatory network leads to hepatic stellate cell activation and proinflammatory cytokine production,which in turn initiate the fibrotic response.Compared with the past,the research on the pathogenesis of liver fibrosis has been greatly developed.However,the liver fibrosis mechanism is complex and many pathways involved need to be further studied.This review mainly focuses on the crosstalk regulatory network among inflammatory cells,cytokines,and the related signaling pathways in the pathogenesis of chronic inflammatory liver diseases.Moreover,we also summarize the recent studies on the mechanisms underlying liver fibrosis and clinical efforts on the targeted therapies against the fibrotic response.

Interleukin-22 ameliorates liver fibrogenesis by attenuating hepatic stellate cell activation and downregulating the levels of inflammatory cytokines

AIM:To investigate the effect of interleukin(IL)-22 onhepatic fibrosis in mice and the possible mechanism involved.METHODS:Liver fibrosis was induced in male BALB/c mice by CCl4.Recombinant IL-22(rm IL-22) was administered intraperitoneally in CCl4-treated mice.Fibrosis was assessed by histology and Masson staining.The activation of hepatic stellate cells(HSCs) was investigated by analysis of α-smooth muscle actin expression.The frequencies of T helper(Th) 22 cells,Th17 cells and Th1 cells,the expression of inflammatory cytokines [IL-22,IL-17 A,interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),IL-6,IL-1b] and transcription factors [aryl hydrocarbon receptor(AHR),RAR-related orphan receptor(RORγt),T-bet] m RNA in the liver were investigated.In addition,the plasma levels of IL-22,IL-17 A,IFN-γ,TNF-α,IL-6 and IL-1b were evaluated.RESULTS:Significant elevations in circulating Th22 cells,Th17 cells,Th1 cells,IL-22,IL-17 A,and IFN-γ were observed in the hepatic fibrosis group compared with the control group(P < 0.01).Treatment with rm IL-22 in mice with hepatic fibrosis ameliorated the severity of hepatic fibrosis,which was confirmed by lower hepatic fibrosis pathological scores(P < 0.01).Rm IL-22 decreased the frequencies of Th22 cells(6.71% ± 0.97% vs 8.09% ± 0.74%,P < 0.01),Th17 cells(4.34% ± 0.37% vs 5.71% ± 0.24%,P < 0.01),Th1 cells(3.09% ± 0.49% vs 4.91% ± 0.73%,P < 0.01),and the levels of IL-22(56.23 ± 3.08 vs 70.29 ± 3.01,P < 0.01),IL-17A(30.74 ± 2.77 vs 45.68 ± 2.71,P < 0.01),and IFN-γ(74.78 ± 2.61 vs 124.89 ± 2.82,P < 0.01).Down-regulation of IL-22,IL-17 A,IFN-γ,TNF-α,IL-6,IL-1b,AHR RORγt,and T-bet gene expression in the liver was observed in the rm IL-22 group(P < 0.01).CONCLUSION:The frequencies of Th22,Th17 andTh1 cells are elevated in hepatic fibrosis.Rm IL-22 can attenuate HSC activation and down-regulate the levels of inflammatory cytokines,thereby ameliorating liver fibrogenesis.

Assessment by meta-analysis of interferon-gamma for the diagnosis of tuberculous peritonitis

AIM:To investigate the performance and diagnostic accuracy of interferon-gamma(IFN-γ) for tuberculous peritonitis(TBP) by meta-analysis.METHODS:A systematic search of English language studies was performed.We searched the following electronic databases:MEDLINE,EMBASE,Web of Science,BIOSIS,LILACS and the Cochrane Library.The Standards for Reporting Diagnostic Accuracy initiative and Quality Assessment for Studies of Diagnostic Accuracy tool were used to assess the methodological quality of the studies.Sensitivity,specificity,and other measures of the accuracy of IFN-γ concentration in the diagnosis of peritoneal effusion were pooled using random-effects models.Receiver operating characteristic(ROC) curves were applied to summarize overall test performance.Two reviewers independently judged study eligibility while screening the citations.RESULTS:Six studies met the inclusion criteria.The average inter-rater agreement between the two reviewers for items in the quality checklist was 0.92.Analysis of IFN-γ level for TBP diagnosis yielded a summary estimate:sensitivity,0.93(95%CI,0.87-0.97);specificity,0.99(95%CI,0.97-1.00);positive likelihood ratio(PLR),41.49(95%CI,18.80-91.55);negative likelihood ratio(NLR),0.11(95%CI,0.06-0.19);and diagnostic odds ratio(DOR),678.02(95%CI,209.91-2190.09).χ 2 values of the sensitivity,specificity,PLR,NLR and DOR were 5.66(P = 0.3407),6.37(P = 0.2715),1.38(P = 0.9265),5.46(P = 0.3621) and 1.42(P = 0.9220),respectively.The summary receiver ROC curve was positioned near the desirable upper left corner and the maximum joint sensitivity and specificity was 0.97.The area under the curve was 0.99.The evaluation of publication bias was not significant(P = 0.922).CONCLUSION:IFN-γ may be a sensitive and specific marker for the accurate diagnosis of TBP.The level of IFN-γ may contribute to the accurate differentiation of tuberculosis(TB) ascites from non-TB ascites.

Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis

AIM: To evaluate the utility of carbohydrate antigen19-9(CA19-9) for differential diagnosis of pancreatic carcinoma and chronic pancreatitis.METHODS: We searched the literature for studies reporting the sensitivity, specificity, and other accuracy measures of serum CA19-9 levels for differentiating pancreatic carcinoma and chronic pancreatitis.Pooled analysis was performed using random-effects models, and receiver operating characteristic(ROC) curves were generated.Study quality was assessed using Standards for Reporting Diagnostic Accuracy and Quality Assessment for Studies of Diagnostic Accuracy tools.RESULTS: A total of 34 studies involving 3125 patients with pancreatic carcinoma and 2061 patients with chronic pancreatitis were included.Pooled analysis of the ability of CA19-9 level to differentiate pancreatic carcinoma and chronic pancreatitis showed the following effect estimates: sensitivity, 0.81(95%CI: 0.80-0.83); specificity, 0.81(95%CI: 0.79-0.82); positive likelihood ratio, 4.08(95%CI: 3.39-4.91); negative likelihood ratio, 0.24(95%CI: 0.21-0.28); and diagnostic odds ratio, 19.31(95%CI: 14.40-25.90).The area under the ROC curve was 0.88.No significant publication bias was detected.CONCLUSION: Elevated CA19-9 by itself is insufficient for differentiating pancreatic carcinoma and chronic pancreatitis, however, it increases suspicion of pancreatic carcinoma and may complement other clinical findings to improve diagnostic accuracy.

Association of interleukin-10 polymorphisms with risk of irritable bowel syndrome:A meta-analysis

AIM:To clarify the current understanding of the association between interleukin-10(IL-10)polymorphisms and the risk of irritable bowel syndrome(IBS).METHODS:We searched for studies in any language recorded in PubMed,Embase and Cochrane library before August 2013.The associations under allele contrast model,codominant model,dominant model,and recessive model were analyzed.The strengths of the association between IL-10 polymorphisms and IBS risk were estimated using odds ratios(OR)with 95%confidence interval(CI).Fixed effects model was used to pool the result if the test of heterogeneity was not significant,otherwise the random-effect model was selected.RESULTS:Eight case-control studies analyzing three single-nucleotide polymorphisms rs1800870(-1082 A/G),rs1800871(-819C/T),and rs1800872(-592A/C)of the IL-10 gene,which involved 928 cases and 1363 controls,were eligible for our analysis.The results showed that rs1800870 polymorphisms were associated with a decreased risk of IBS(GG+GA vs AA:OR=0.80,95%CI:0.66-0.96),(AA+GA vs GG:OR=0.68,95%CI:0.52-0.90).Subgroup analysis revealed such association only existed in Caucasian ethnicity(AA+GA vs GG,OR=0.70,95%CI:0.55-0.89).The rs1800872 polymorphisms were associated with an increased risk of IBS in Asian ethnicity(CC vs GG:OR=1.29,95%CI:1.01-1.16).There were no associations between rs1800871 polymorphisms and the IBS risk.CONCLUSION:The results suggest that IL-10 rs1800870confers susceptibility to the risk of IBS in Caucasian ethnicity,and the rs1800872 may associate with IBS risk in Asians.However,no significant associations are found between rs1800871 and IBS risk.

Role and recruitment of Th9 cells in liver cirrhosis patients

Objective:To investigate the role of T helper 9(Th9) cells in liver cirrhosis(LC) patients and whether chemokine receptor type 6(CCR6)/chemokine ligand 20(CCL20) axis is involving in the recruitment of Th9 cells into liver.Methods:Peripheral blood and liver tissue from 30 LC patients and 18 normal controls were recruited.The frequency of Th9 cells and CCR4,CCR6 in the peripheral blood was tested by flow cytometry.Serum interleukin(IL)-9 and CCL20 levels were tested by enzyme-linked immunosorbent assay.Immunohistochemical staining was used to detect a-smooth muscle actin,CCR6 and CCL20 expression in liver tissue.Results:The frequency of Th9 cells in LC patients was significantly increased compared with controls(P < 0.05).The serum IL-9 level and CCL20 level increased markedly in LC patients compared with controls(P < 0.05),and IL-9 was positively correlated to Th9 cells and CCL20.Furthermore,the frequency of Th9 cells was correlated to prothrombin time,total bilirubin level,hyaluronic acid and type IV collagen in LC patients.We also found that Th9 cells in LC patients expressed higher frequency of CCR4+,CCR6+(P < 0.05).Compared with normal controls,the expression of CCR6 and CCL20 in LC tissue were significantly elevated(P < 0.05).The expression of a-smooth muscle actin was correlated to the CCR6 and CCL20 in liver tissue of LC patients.Conclusions:This study suggests that Th9 cells may participate in the pathogenesis of LC,and the recruitment of Th9 cells into liver tissue might be through CCL20/CCR6 axis.

Role of Th9 cells and Th17 cells in the pathogenesis of malignant ascites

Objective: To assess the role of Th9 and Th17 cells in malignant ascites(MA).Methods: MA from 30 hepatic carcinoma patients and benign ascites from 30 cirrhotic patients were collected. Corresponding peripheral blood samples from these hepatic carcinoma and cirrhotic patients as well as 30 healthy subjects were collected. The frequency of Th9 and Th17 cells was tested by flow cytometry. Serum levels of interleukin(IL)-9 and IL-17 were examined by ELISA.Results: The observed frequency of Th9 and Th17 cells, and the IL-9 and IL-17 serum levels were significantly higher in MA patients than those in cirrhotic patients and healthy control samples(P < 0.05). Moreover, the Th9 cells demonstrated positive correlation with Th17 cells as well as IL-9 in MA patients; however, this positive correlation was not observed in the cirrhotic patients or healthy control samples. The frequency of Th9 and Th17 cells was distinctly higher in MA patients presenting with stage III or IV malignancy and with lymph node or distant metastasis than those in patients in stage I or II and without distant metastasis(P < 0.05).Conclusions: The increased frequency of Th9 and Th17 cells in MA patients suggests that these two T cell subsets play a synergistic role in MA pathogenesis. This study also demonstrated that Th9 and Th17 cells may perform their biological functions in conjunction with IL-9 production.

Magnetic resonance cholangiography in assessing biliary anatomy in living donors:A meta-analysis

AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic bibliographic databases prior to March 2013.Studies with diagnostic results and fulfilled inclusion criteria were included.The methodological quality of the studies was assessed.Sensitivity,specificity and other measures of the accuracy of MRC for diagnosis of biliary anatomy in LDLT donors were summarized using a random-effects model or a fixed-effects model.Summary receiver operating characteristic(SROC)curves were used to summarize overall test performance.Publication bias was assessed using Deek’s funnel plot asymmetry test.Sensitivity analysis was adopted to explore the potential sources of heterogeneity.RESULTS:Twelve studies involving 869 subjects were eligible to the analysis.The scores of Quality Assessment of Diagnostic Accuracy Studies for the included studies ranged from 11 to 14.The summary estimates of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic OR of MRC in diagnosis of biliary anatomy in LDLT donor were 0.88(95%CI:0.84-0.92),0.95(95%CI:0.93-0.97),15.33(95%CI:10.70-21.95),0.15(95%CI:0.11-0.20)and 130.77(95%CI:75.91-225.27),respectively.No significant heterogeneity was detected in all the above four measures.Area under SROC curve was 0.971.Little publication bias was noted across the studies(P=0.557).Sensitivity analysis excluding a study with possible heterogeneity got a similar overall result,which suggested the little influence of this study on the overall results.CONCLUSION:Our results suggest that MRC is a high specificity but moderate sensitivity technique in diagnosis of biliary anatomy in LDLT donors.