BACKGROUND Acute pancreatitis is the leading cause of hospitalization for acute gastrointestinal disease worldwide.The effects of probiotics in mild acute pancreatitis have not been studied.We hypothesized that the ad...BACKGROUND Acute pancreatitis is the leading cause of hospitalization for acute gastrointestinal disease worldwide.The effects of probiotics in mild acute pancreatitis have not been studied.We hypothesized that the administration of probiotics may accelerate the recovery of intestinal function and shorten the length of hospital stay(LOS)in patients with mild pancreatitis.AIM To investigate the value of probiotics in reducing the LOS in patients with mild acute pancreatitis.METHODS We conducted a double-blind randomized clinical trial to evaluate the effects of probiotics administered to patients with mild acute pancreatitis at a tertiary medical center.The patients were given probiotics capsules(a mixed preparation of Bacillus subtilis and Enterococcus faecium)or placebo.The primary study endpoint was the LOS.The secondary endpoints included time to abdominal pain relief,recurrent abdominal pain,and time to successful oral feeding.RESULTS A total of 128 patients were included,with 64 patients in each arm.The severity of illness and the etiological distribution of disease were similar in the two groups.There was a significant reduction in the LOS in the probiotics treatment group vs the placebo group(5.36±0.15 vs 6.02±0.17 d,P<0.05).The probiotics group was associated with a shorter time to abdominal pain relief and time to successful oral feeding(P<0.01 for both)than the placebo group.No statistical difference was found in recurrent abdominal pain between the two groups.CONCLUSION The study results showed that the administration of probiotics capsules is associated with a shorter duration of hospitalization in patients with mild acute pancreatitis.展开更多
The safety and feasibility of early laparoscopic cholecystectomy(LC)for acute cholecystitis with mild pancreatitis were explored.A total of 973 patients with acute pancreatitis,including 651 mild cases and 322 moderat...The safety and feasibility of early laparoscopic cholecystectomy(LC)for acute cholecystitis with mild pancreatitis were explored.A total of 973 patients with acute pancreatitis,including 651 mild cases and 322 moderate or severe cases were retrospectively studied from July 2014 to December 2018 in our department.And 426 mild pancreatitis cases with acute cholecystitis were enrolled in this study,of which 328 patients underwent LC during the same-admission(early LC group),and 98 patients underwent LC a period of time after conservative treatment(delayed LC group).Clinical characteristics,operative findings and complications were recorded and followed up.The two groups were comparable in age,gender,the grade of American Society of Anesthesiologist(ASA),biochemical findings and Balthazar computer tomography(CT)rating(P>0.05).The operation interval and hospital stay in early LC group were significantly shorter than in delayed LC group(5.83+1.62 vs.41.3618.44 days;11.38+2.43 vs.16.49+3.48 days,P<0.01).There was no significant difference in the average operation time between the two groups.No preoperative biliary related events recurred in early LC group but there were 21 cases of preoperative biliary related events in delayed LC group(P<0.01).There was no significant difference in conversion rate(3.85 vs.5.10%,P=0.41)and surgical complication rate(3.95 vs.4.08%,P-0.95)between early LC group and delayed LC group.During the postoperative follow-up period of 375 cases,biliary related events recurred in 4 cases in early LC group and 3 cases in delayed LC group(P=0.37).The effect of early LC during the same-admission is better than delayed LC for acute cholecystitis with mild pancreatitis.展开更多
AIM To evaluate the numbers of different subsets of monocytes and their associations with the values of clinical measures in mild acute pancreatitis(MAP) patients.METHODS The study included one group of 13 healthy con...AIM To evaluate the numbers of different subsets of monocytes and their associations with the values of clinical measures in mild acute pancreatitis(MAP) patients.METHODS The study included one group of 13 healthy controls and another group of 24 patients with new-onset MAP. The numbers of different subsets of monocytes were examined in these two groups of subjects by flow cytometry. The concentrations of plasma interleukin(IL)-10 and IL-12 were determined by cytometric bead array. The acute physiology and chronic health evaluation(APACHE) II scores of individual patients were evaluated, and the levels of plasma C-reactive protein(CRP) as well as the activities of amylase and lipase were measured. RESULTS In comparison with that in the controls, significantly increased numbers of CD14+CD163-, CD14+CD163-MAC387+ M1 monocytes, but significantly reduced numbers of CD14+CD163+IL-10+ M2 monocytes were detected in the MAP patients(P < 0.01 or P < 0.05). Furthermore, significantly higher levels of plasma IL-10 and IL-12 were observed in the MAP patients(P < 0.01 for all). More importantly, the levels of plasma CRP were positively correlated with the numbers of CD14+CD163-(R = 0.5009, P = 0.0127) and CD14+CD163-MAC387+(R = 0.5079, P = 0.0113) M1 monocytes and CD14+CD163+CD115+ M2 monocytes(R = 0.4565, P = 0.0249) in the patients. The APACHE II scores correlated with the numbers of CD14+CD163+CD115+(R = 0.4581, P = 0.0244) monocytes and the levels of plasma IL-10(R = 0.4178, P = 0.0422) in the MAP patients. However, there was no significant association among other measures tested in this population. CONCLUSION Increased numbers of CD14+CD163- and CD14+ CD163-MAC387+ monocytes may contribute to the pathogenesis of MAP, and increased numbers of CD14+CD163+CD115+ monocytes may be a biomarker for evaluating the severity of MAP.展开更多
Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess ...Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day readmission.Methods:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and 2014.Differences in cholecystectomy rates were computed on the basis of various characteristics.We conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same admission.Results:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with sphincterotomy.We observed a decreasing trend in both procedures during the study period(P<0.001).In multivariate analysis,odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy(odds ratio,0.78;95%confidence interval,0.74–0.84)or cholecystectomy(odds ratio,0.37;95%confidence interval,0.35–0.39).Conclusions:For patients with MABP,cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day readmission.Despite this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study period.Further research is needed to understand the implications and reasons underlying this deviation from guidelines.展开更多
背景轻症急性胰腺炎(MAP)有一定的概率转变为重症急性胰腺炎(SAP),SAP一旦发生,将对患者造成较大的危害,探讨MAP与SAP的转化机制对临床诊治急性胰腺炎(AP)具有一定意义。目的探讨MAP与SAP的差异代谢物,寻找异常代谢通路,探索区别MAP和SA...背景轻症急性胰腺炎(MAP)有一定的概率转变为重症急性胰腺炎(SAP),SAP一旦发生,将对患者造成较大的危害,探讨MAP与SAP的转化机制对临床诊治急性胰腺炎(AP)具有一定意义。目的探讨MAP与SAP的差异代谢物,寻找异常代谢通路,探索区别MAP和SAP的潜在生物标志物,为SAP的早期诊断、治疗提供参考依据。方法收集2020年8月至2021年3月于湖南省人民医院住院的AP患者68例为研究对象,根据2012年修订版亚特兰大分类(RAC)标准分为MAP组40例、SAP组28例,利用液相色谱-串联质谱法(LC-MS),通过单变量分析[t检验、差异倍数(FC)],多变量分析[主成分分析(PCA)、偏最小二乘判别分析(PLS-DA)],最终以变量权重值(variable important in projection,VIP)>1、FC>1.5且P<0.05筛选出两组间的差异代谢物,分析两组间差异代谢物及代谢通路。结果经PCA、PLS-DA分析发现MAP与SAP代谢物轮廓具有明显差异。结合VIP>1、FC>1.5且P<0.05,在两组之间筛选出50种差异代谢物,5条代谢通路,其中牛磺酸和亚牛磺酸代谢、萜类骨架生物合成为影响最大的两条代谢通路;结合受试者工作特征(ROC)曲线进行分析发现,ROC曲线下面积(AUC)>0.9的差异代谢物有8种,分别为:2-苯基-1,3-丙二醇单氨基甲酸酯、苯海拉明N-葡萄糖醛酸、rac-5,6-环氧-视黄酰-β-D-葡萄糖醛酸、六氟异丙醇、NNAL-N-葡萄糖醛酸、赤藓醇四硝酸酯、3-羟基丁酸、四氢脱氧皮质酮,其中在SAP患者中表达升高的有:2-苯基-1,3-丙二醇单氨基甲酸酯、rac-5,6-环氧-视黄酰-β-D-葡萄糖醛酸、六氟异丙醇、赤藓醇四硝酸酯、3-羟基丁酸、四氢脱氧皮质酮,表达下调的有:苯海拉明N-葡萄糖醛酸、NNAL-N-葡萄糖醛酸。结论MAP与SAP患者的血清代谢物存在明显差异,其中2-苯基-1,3-丙二醇单氨基甲酸酯、苯海拉明N-葡萄糖醛酸、rac-5,6-环氧-视黄酰-β-D-葡萄糖醛酸、六氟异丙醇、NNAL-N-葡萄糖醛酸、赤藓醇四硝酸酯、3-羟基丁酸、四氢脱氧皮质酮对MAP和SAP的鉴别诊断效能较高,可能为区别二者的潜在生物标志物。展开更多
目的 基于网络药理学分析余甘子治疗轻症急性胰腺炎作用机制,为临床的药物使用、动物实验、新药提取提供依据。方法 采用TCMSP(Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform)数据库获取余甘子的...目的 基于网络药理学分析余甘子治疗轻症急性胰腺炎作用机制,为临床的药物使用、动物实验、新药提取提供依据。方法 采用TCMSP(Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform)数据库获取余甘子的主要活性成分及主要靶点;通过Gencards据库获取轻症急性胰腺炎的疾病靶点;利用Venny平台获取余甘子和轻症急性胰腺炎的共同靶点;在String数据库构建PPI蛋白数据网络;用Metascape平台采用GO与KEGG分析;用Cytoscape 3.7.2软件构建“靶点-通路”网络,分析重要通路;最终获取治疗轻症急性胰腺炎最重要的靶点。结果 余甘子治疗轻症急性胰腺炎的主要活性成分是鞣花酸、儿茶素、山柰酚、槲皮素;关键靶点有MAPK1、RELA、AKT1、JUN、TNF、IL6;主要生物过程有对无机物的反应、运动的正向调节、对激素的反应、对细菌源性分子的反应、对活性氧的反应;主要作用于蛋白激酶活性、蛋白质同源二聚化活性、磷酸转移酶活性,醇基为受体、DNA转录因子结合、蛋白质丝氨酸/苏氨酸/酪氨酸激酶活性等分子功能;主要富集的通路有癌症的途径、糖尿病并发症中的AGE-RAGE信号通路、PI3K-Akt信号通路、癌症中的蛋白多糖、肿瘤坏死因子信号通路、MAPK信号通路等。结论 通过网络药理学研究初步揭示了余甘子治疗轻症急性胰腺炎是多成分、多靶点、多通路共同作用的结果,为余甘子的药用提供了一定临床依据。展开更多
基金National Natural Science Foundation of China,No.81370364.
文摘BACKGROUND Acute pancreatitis is the leading cause of hospitalization for acute gastrointestinal disease worldwide.The effects of probiotics in mild acute pancreatitis have not been studied.We hypothesized that the administration of probiotics may accelerate the recovery of intestinal function and shorten the length of hospital stay(LOS)in patients with mild pancreatitis.AIM To investigate the value of probiotics in reducing the LOS in patients with mild acute pancreatitis.METHODS We conducted a double-blind randomized clinical trial to evaluate the effects of probiotics administered to patients with mild acute pancreatitis at a tertiary medical center.The patients were given probiotics capsules(a mixed preparation of Bacillus subtilis and Enterococcus faecium)or placebo.The primary study endpoint was the LOS.The secondary endpoints included time to abdominal pain relief,recurrent abdominal pain,and time to successful oral feeding.RESULTS A total of 128 patients were included,with 64 patients in each arm.The severity of illness and the etiological distribution of disease were similar in the two groups.There was a significant reduction in the LOS in the probiotics treatment group vs the placebo group(5.36±0.15 vs 6.02±0.17 d,P<0.05).The probiotics group was associated with a shorter time to abdominal pain relief and time to successful oral feeding(P<0.01 for both)than the placebo group.No statistical difference was found in recurrent abdominal pain between the two groups.CONCLUSION The study results showed that the administration of probiotics capsules is associated with a shorter duration of hospitalization in patients with mild acute pancreatitis.
基金This project was supported by the Scientific Research Project of Hubei Provincial Health and Family Planning Commission(No.wJ2017c0002)。
文摘The safety and feasibility of early laparoscopic cholecystectomy(LC)for acute cholecystitis with mild pancreatitis were explored.A total of 973 patients with acute pancreatitis,including 651 mild cases and 322 moderate or severe cases were retrospectively studied from July 2014 to December 2018 in our department.And 426 mild pancreatitis cases with acute cholecystitis were enrolled in this study,of which 328 patients underwent LC during the same-admission(early LC group),and 98 patients underwent LC a period of time after conservative treatment(delayed LC group).Clinical characteristics,operative findings and complications were recorded and followed up.The two groups were comparable in age,gender,the grade of American Society of Anesthesiologist(ASA),biochemical findings and Balthazar computer tomography(CT)rating(P>0.05).The operation interval and hospital stay in early LC group were significantly shorter than in delayed LC group(5.83+1.62 vs.41.3618.44 days;11.38+2.43 vs.16.49+3.48 days,P<0.01).There was no significant difference in the average operation time between the two groups.No preoperative biliary related events recurred in early LC group but there were 21 cases of preoperative biliary related events in delayed LC group(P<0.01).There was no significant difference in conversion rate(3.85 vs.5.10%,P=0.41)and surgical complication rate(3.95 vs.4.08%,P-0.95)between early LC group and delayed LC group.During the postoperative follow-up period of 375 cases,biliary related events recurred in 4 cases in early LC group and 3 cases in delayed LC group(P=0.37).The effect of early LC during the same-admission is better than delayed LC for acute cholecystitis with mild pancreatitis.
文摘AIM To evaluate the numbers of different subsets of monocytes and their associations with the values of clinical measures in mild acute pancreatitis(MAP) patients.METHODS The study included one group of 13 healthy controls and another group of 24 patients with new-onset MAP. The numbers of different subsets of monocytes were examined in these two groups of subjects by flow cytometry. The concentrations of plasma interleukin(IL)-10 and IL-12 were determined by cytometric bead array. The acute physiology and chronic health evaluation(APACHE) II scores of individual patients were evaluated, and the levels of plasma C-reactive protein(CRP) as well as the activities of amylase and lipase were measured. RESULTS In comparison with that in the controls, significantly increased numbers of CD14+CD163-, CD14+CD163-MAC387+ M1 monocytes, but significantly reduced numbers of CD14+CD163+IL-10+ M2 monocytes were detected in the MAP patients(P < 0.01 or P < 0.05). Furthermore, significantly higher levels of plasma IL-10 and IL-12 were observed in the MAP patients(P < 0.01 for all). More importantly, the levels of plasma CRP were positively correlated with the numbers of CD14+CD163-(R = 0.5009, P = 0.0127) and CD14+CD163-MAC387+(R = 0.5079, P = 0.0113) M1 monocytes and CD14+CD163+CD115+ M2 monocytes(R = 0.4565, P = 0.0249) in the patients. The APACHE II scores correlated with the numbers of CD14+CD163+CD115+(R = 0.4581, P = 0.0244) monocytes and the levels of plasma IL-10(R = 0.4178, P = 0.0422) in the MAP patients. However, there was no significant association among other measures tested in this population. CONCLUSION Increased numbers of CD14+CD163- and CD14+ CD163-MAC387+ monocytes may contribute to the pathogenesis of MAP, and increased numbers of CD14+CD163+CD115+ monocytes may be a biomarker for evaluating the severity of MAP.
文摘Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day readmission.Methods:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and 2014.Differences in cholecystectomy rates were computed on the basis of various characteristics.We conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same admission.Results:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with sphincterotomy.We observed a decreasing trend in both procedures during the study period(P<0.001).In multivariate analysis,odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy(odds ratio,0.78;95%confidence interval,0.74–0.84)or cholecystectomy(odds ratio,0.37;95%confidence interval,0.35–0.39).Conclusions:For patients with MABP,cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day readmission.Despite this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study period.Further research is needed to understand the implications and reasons underlying this deviation from guidelines.
文摘背景轻症急性胰腺炎(MAP)有一定的概率转变为重症急性胰腺炎(SAP),SAP一旦发生,将对患者造成较大的危害,探讨MAP与SAP的转化机制对临床诊治急性胰腺炎(AP)具有一定意义。目的探讨MAP与SAP的差异代谢物,寻找异常代谢通路,探索区别MAP和SAP的潜在生物标志物,为SAP的早期诊断、治疗提供参考依据。方法收集2020年8月至2021年3月于湖南省人民医院住院的AP患者68例为研究对象,根据2012年修订版亚特兰大分类(RAC)标准分为MAP组40例、SAP组28例,利用液相色谱-串联质谱法(LC-MS),通过单变量分析[t检验、差异倍数(FC)],多变量分析[主成分分析(PCA)、偏最小二乘判别分析(PLS-DA)],最终以变量权重值(variable important in projection,VIP)>1、FC>1.5且P<0.05筛选出两组间的差异代谢物,分析两组间差异代谢物及代谢通路。结果经PCA、PLS-DA分析发现MAP与SAP代谢物轮廓具有明显差异。结合VIP>1、FC>1.5且P<0.05,在两组之间筛选出50种差异代谢物,5条代谢通路,其中牛磺酸和亚牛磺酸代谢、萜类骨架生物合成为影响最大的两条代谢通路;结合受试者工作特征(ROC)曲线进行分析发现,ROC曲线下面积(AUC)>0.9的差异代谢物有8种,分别为:2-苯基-1,3-丙二醇单氨基甲酸酯、苯海拉明N-葡萄糖醛酸、rac-5,6-环氧-视黄酰-β-D-葡萄糖醛酸、六氟异丙醇、NNAL-N-葡萄糖醛酸、赤藓醇四硝酸酯、3-羟基丁酸、四氢脱氧皮质酮,其中在SAP患者中表达升高的有:2-苯基-1,3-丙二醇单氨基甲酸酯、rac-5,6-环氧-视黄酰-β-D-葡萄糖醛酸、六氟异丙醇、赤藓醇四硝酸酯、3-羟基丁酸、四氢脱氧皮质酮,表达下调的有:苯海拉明N-葡萄糖醛酸、NNAL-N-葡萄糖醛酸。结论MAP与SAP患者的血清代谢物存在明显差异,其中2-苯基-1,3-丙二醇单氨基甲酸酯、苯海拉明N-葡萄糖醛酸、rac-5,6-环氧-视黄酰-β-D-葡萄糖醛酸、六氟异丙醇、NNAL-N-葡萄糖醛酸、赤藓醇四硝酸酯、3-羟基丁酸、四氢脱氧皮质酮对MAP和SAP的鉴别诊断效能较高,可能为区别二者的潜在生物标志物。
文摘目的 基于网络药理学分析余甘子治疗轻症急性胰腺炎作用机制,为临床的药物使用、动物实验、新药提取提供依据。方法 采用TCMSP(Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform)数据库获取余甘子的主要活性成分及主要靶点;通过Gencards据库获取轻症急性胰腺炎的疾病靶点;利用Venny平台获取余甘子和轻症急性胰腺炎的共同靶点;在String数据库构建PPI蛋白数据网络;用Metascape平台采用GO与KEGG分析;用Cytoscape 3.7.2软件构建“靶点-通路”网络,分析重要通路;最终获取治疗轻症急性胰腺炎最重要的靶点。结果 余甘子治疗轻症急性胰腺炎的主要活性成分是鞣花酸、儿茶素、山柰酚、槲皮素;关键靶点有MAPK1、RELA、AKT1、JUN、TNF、IL6;主要生物过程有对无机物的反应、运动的正向调节、对激素的反应、对细菌源性分子的反应、对活性氧的反应;主要作用于蛋白激酶活性、蛋白质同源二聚化活性、磷酸转移酶活性,醇基为受体、DNA转录因子结合、蛋白质丝氨酸/苏氨酸/酪氨酸激酶活性等分子功能;主要富集的通路有癌症的途径、糖尿病并发症中的AGE-RAGE信号通路、PI3K-Akt信号通路、癌症中的蛋白多糖、肿瘤坏死因子信号通路、MAPK信号通路等。结论 通过网络药理学研究初步揭示了余甘子治疗轻症急性胰腺炎是多成分、多靶点、多通路共同作用的结果,为余甘子的药用提供了一定临床依据。
