Shiqi Wang

Overweight Is an Additional Prognostic Factor in Acute Pancreatitis: A Meta-Analysis

Background/Aims: It is generally accepted that there is a correlation between obesity and poor outcome in acute pancreatitis (AP); however, the relationship between overweight and the prognosis of AP is unknown. The aim of this study was to determine the correlation between overweight and the prognosis of AP. Methods: MEDLINE and PubMed were searched using the terms ‘acute pancreatitis’, ‘obesity’, ‘overweight’, and ‘body mass index’ (‘BMI’). All prospective clinical studies correlating BMI and AP were included. Obesity and overweight were defined as BMI ≧30 and from 25 to 30, respectively. A meta-analysis was performed with the endpoints severe AP (SAP), local complications, systemic complications, and mortality. Results: Eight studies including 939 patients were found. The incidence rates of SAP (OR 2.48, 95% CI 1.34–4.60), local complications (OR 2.58, 95% CI 1.20–5.57), and mortality (OR 3.81, 95% CI 1.22–11.83) were increased in overweight patients with AP. No difference was detected in the incidence of systemic complications between the normal-weight and overweight patients (OR 1.62, 95% CI 0.76–3.43). In addition, the correlation between obesity and poor prognosis was again confirmed. Conclusion: Overweight is an additional prognostic factor of severity, local complications, and mortality in AP.

Effect of umbilical cord mesenchymal stem cells on treatment of severe acute pancreatitis in rats.

BACKGROUND AIMS The aim of this study was to investigate the effect of umbilical cord mesenchymal stem cells (UCMSCs) on severe acute pancreatitis (SAP) in rats. METHODS SAP was established in rats by retrograde pancreatic duct injection of sodium taurocholate. In one group, 5 × 10(6) cells/kg of UCMSC suspension was injected into the tail vein 0 h, 1 h, 6 h and 12 h after the induction of SAP. In other groups, different doses of UCMSC suspension (5 × 10(4) cells/kg, 5 × 10(5) cells/kg, 5 × 10(6) cells/kg or 1 × 10(7) cells/kg) were administered at 1 h. Serum amylase was assayed at 12 h. Mortality, ascites, serum tumor necrosis factor-α, interferon-γ (assayed using enzyme-linked immunosorbent assay) and the wet-dry weight of the pancreas gland were assessed at 48 h. Pathologic changes of pancreatic and pulmonary tissues were observed. RESULTS Mortality in rats receiving 5 × 10(6) cells/kg of UCMSCs at 0 h was 10% compared with 58% in the SAP control group. Ascites, serum amylase and wet-dry pancreatic weight significantly decreased, and production of tumor necrosis factor-α and interferon-γ were reduced. Pathologic injuries of pancreatic and pulmonary tissues were markedly alleviated. Administration of UCMSCs (5 × 10(5) cells/kg, 5 × 10(6) cells/kg or 1 × 10(7) cells/kg) at 1 h or 5 × 10(6) cells/kg at 6 h significantly reduced the severity of SAP. The effect was less marked at 12 h and with lower concentrations of UCMSCs. CONCLUSIONS UCMSCs significantly decreased pancreatic injury caused by SAP in a time-dependent and dose-dependent way.

The ability of current scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis

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.

Regulatory B10 cells play a protective role in severe acute pancreatitis

BackgroundB10 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.PurposeIn this study, we show that B10 cells can inhibit inflammation of severe acute pancreatitis (SAP).Materials and methodsBlood from 17 patients with SAP and 22 age-matched healthy volunteers were collected to detect the proportion of B10 cells. CD19−/− mice were used as B10 cell-deficient mice. Amylase and lipase levels, pancreatic edema and HE staining were tested to assess the severity of SAP.ResultsCD19−/− mice, which lack B10 cells, suffered a more severe inflammation in pancreas compared with wild-type mice after caerulein injection. The frequency of B10 cells was decreased both in SAP patients and SAP animal models. Adoptive transfer of B10 cells ameliorates inflammatory injury of pancreatitis in CD19−/− mice.ConclusionThus, we identified B10 cells as a protective factor for SAP and provided a novel target for SAP treatment.

Is Continuous Venovenous Hemofiltration Effective Against Severe Acute Pancreatitis

Our aim was to investigate the efficacy of continuous venovenous hemofiltration (CVVH) in treating severe acute pancreatitis (SAP). A literature search was performed using PubMed (1992-present), and all studies investigating the efficacy of CVVH in treating SAP were included. Four comparative studies and seven case series comprising a total of 354 patients were included. The overall mortality rate of patients receiving CVVH was 20% (55/275). A decreased mortality rate and decreased serum cytokine levels were reported in the CVVH groups in only two studies. The starting time point, substitution fluid flow rate, filter membrane type, hemofilter change interval, anticoagulation, and sustaining times of CVVH varied among the studies, and the impact of these parameters on the efficacy of CVVH was poorly reported. High-volume CVVH, when started early, was demonstrated to be more effective in eliminating cytokines in only one study. After the application of CVVH, the patient conditions started to improve between the 6th and 72nd hours. In conclusion, no solid clinical evidence has proven the efficacy of CVVH in treating SAP. High-volume CVVH that is started early and sustained for at least 72 h may be adopted to investigate the efficacy of CVVH for treating SAP.

The day when infection is confirmed is a better time point for mortality prediction in patients with severe acute pancreatitis.

Objectives The objective of the study was to compare the accuracy of predictive methods for mortality in patients with severe acute pancreatitis (SAP) on admission and on the day when infection was confirmed. Methods Medical records of patients admitted for SAP in our hospital during January 2000 to November 2010 were retrospectively reviewed. Among those with infectious complications, time when infection was confirmed (TIC) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission and at the time when infection was confirmed (APACHE II OTIC) were studied. The correlations among the APACHE II score on admission, APACHE II OTIC score, and TIC were analyzed. The predictive accuracy was assessed by the area under the receiver operating characteristic curve. Results Time when infection was confirmed correlated negatively with the APACHE II score on admission and the APACHE II OTIC score (P < 0.05). The optimum cutoff value and the corresponding areas under the receiver operating characteristic curve for APACHE II score on admission, APACHE II OTIC score, and TIC were greater than 8, greater than 5, 12 days or less, and 0.67 (95% confidence interval [CI], 0.54–0.77), 0.84 (95% CI, 0.73–0.91), and 0.73 (95% CI, 0.61–0.82), respectively. Compared with the APACHE II score on admission, the APACHE II OTIC score was more accurate in predicting mortality (P = 0.029). Conclusions The time when infection is confirmed is a better time point for the reassessment of the outcome in patients with SAP.

RNA sequence analysis of rat acute experimental pancreatitis with and without fatty liver: a gene expression profiling comparative study

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.

Hepatic steatosis depresses alpha-1-antitrypsin levels in human and rat acute 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.

Early Classic Hemofiltration Exhibits No Benefits in Severe Acute Pancreatitis With Early Organ Failure: A Retrospective Case-Matched Study

Continuous venovenous hemofiltration (CVVH) is an important organ supportive technique. This study aimed to evaluate the impact of early classic CVVH on the outcomes of severe acute pancreatitis (SAP) patients with early organ failure (EOF). Between 2008 and 2012, a total of 44 SAP patients with EOF were admitted to our department. The 44 patients were classified into two groups according to whether they received early classic CVVH (2 L/h, initiated within 24 h after admission): 25 patients received early CVVH (ECVVH group), and 19 patients did not receive early CVVH (control group). The two groups were matched for age and Acute Physiology and Chronic Health Evaluation II scores. The severity of organ dysfunctions was evaluated by Sequential Organ Failure Assessment (SOFA) scores. Each group included 19 patients. The baseline characters between the two groups were balanced. The SOFA scores in the ECVVH group increased compared with those in the control group. The time to weaning from mechanical ventilation was significantly longer in the ECVVH group (log-rank test: χ(2)  = 4.007, P = 0.045). Renal support was also significantly prolonged in the ECVVH group (the number of patients receiving CVVH 72 h after admission: 10 vs. 3, respectively, P = 0.038). Nine patients died in the ECVVH group versus six patients in the control group (P = 0.508). In conclusion, our study failed to prove that early classic CVVH had any benefits on the outcomes of SAP patients with EOF. Unexpectedly, early classic CVVH worsened organ functional capacity. However, it is possible that CVVH using advanced techniques may be beneficial in SAP patients with EOF.

No associations between fruit and vegetable consumption and pancreatic cancer risk: a meta-analysis of prospective studies

The associations between fruit and vegetable consumption and pancreatic cancer risk are inconclusive. We conducted a meta-analysis of prospective studies to investigate the associations. The search was conducted systemically using the PubMed and EMBASE databases up to March 2017. Relative risks and 95% confidence intervals for the highest versus lowest consumption and dose-response analyses were assessed. Subtype and subgroup analyses were performed. Twelve studies were eligible. The summary relative risks of the highest versus lowest consumption were 0.95 (0.80–1.12) for total fruits and vegetables without heterogeneity (I2 = 0%, P = 0.44), 0.96 (0.82–1.12) for fruits without low heterogeneity (I2 = 37%, P = 0.12) and 0.94 (0.84–1.06) for vegetables with low heterogeneity (I2 = 9%, P = 0.36). Dose-response analyses also showed no significantly inverse associations for each 100 g/day increase; the summary relative risks were 1.00 (0.98–1.02) for total fruits and vegetables, 1.01 (0.97–1.05) for fruits and 1.00 (0.97–1.03) for vegetables. The results of subtype analyses were consistent with the fruit and vegetable analyses; the relative risks were 0.97 (0.80–1.17) for citrus fruit without low heterogeneity (I2 = 39%, P = 0.15) and 0.89 (0.76–1.05) for cruciferous vegetables without low heterogeneity (I2 = 14%, P = 0.32). In conclusion, this meta-analysis does not support significant associations between fruit and vegetable consumption and pancreatic cancer risk.