In order to observe activity of tumor necrosis factor (TNF) in the serum, pancreatic histopathological damage, as well as their relationships in acute necrotizing pancreatitis (ANP), thirty five SD rats were randomly divided into 7 groups according to their sampling time with 5 in each group. ANP was induced by retrograde infusion of 5% sodium taurocholate through biliopancreatic duct in 6 experimental groups (Group B1～B6).Blood and pancreatic tissue samples were obtained at hour 0,0.5,2,4,6 or 8 respectively when the animals were sacrificed.Results showed that serum level of TNF activity rose significantly in Group B2,and reached the maximal value in Group B4.The pancreatic histopathological damage in ANP rats was getting worse along with time. Serum TNF activity had close relation to pancreatic histopathological score (r=0.63, Ｐ＜0.01),suggesting that serum TNF may play an important role in the process of deterioration of pancreatic tissue damage during ANP.
Objective To study the effect on expression of high mobility group box-1 （HMGB1） mRNA for the expression of zonula occludens-1 （ZO-1） in ileum tissues， and to explore the possible mechanism of intestinal mucosal barrier injury in rats with acute necrotizing pancreatitis （ANP）. Methods Ninety-six male Wistar rats were divided randomly （random number method） into ANP group， ethyl pyruvate （EP）group， and sham operation group. Eight rats of 3 groups were killed to get abdominal aortic blood and ileal tissues at 6， 12， 24， and 48h after operation， respectively.The levels of plasma amylase （AMY） ， D-lactate acid， and the activity of malonyl dialdehyde （MDA） in the ileum tissues were determined by using automatic biochemical analyzer， improved enzymatic spectrophotometry， and thiobarbituric acid （TAB） colorimetry respectively. The pathological changes of ileum tissues were observed under microscopy by HE staining， the expression of ZO-1 protein in ileum tissues was observed by immunohistochemistry （SP method）， and the expressions of HMGB1 mRNA and ZO-1 mRNA in ileum tissues were detected by reverse transcription-polymerase chain reaction （RT-PCR）. Results Compared with ANP group at the same time， levels of AMY， D-lactate acid， and MDA in ileum tissues of EP group were all significantly lower （P＜0.05）. The expression level of HMGB1 mRNA increased at 6 h while ZO-1 mRNA decreased in ANP group. Compared with ANP group at the same time， the expression level of HMGB1 mRNA of EP group was significantly lower while ZO-1 mRNA was higher （P＜0.05）， and the pathological damage in ileum tissues was lighter. Conclusions The decreased expression of ZO-1 in ileum tissues is one of the vitalcauses for intestinal mucosal barrier injury in ANP， and it probably occurs in case of the excessive expression of HMGB1.
Objective To investigate the etiology, symptoms, diagnosis, surgical treatment, and outcomes of acute necrotizing mediastinitis (ANM) in order to guide future diagnosis and treatment of ANM. Methods The clinical data of patients with ANM referred to West China Hospital, Sichuan University from March 2012 to April 2021 were retrospectively analyzed. The etiology, clinical manifestations, demographic characteristics, bacterial culture results, surgical approach and prognostic factors of these patients were summarized. ResultsA total of 176 patients were enrolled in this study. The median age was 60 ( 0-84) years. There were 124 (70.5%) males and 52 (29.5%) females. The most common origin of infection was neck (n=66, 37.5%). The most common symptom was fever (n=85, 48.3%). Streptococcus constellatus represented the most common pathogens in secretion culture. Surgical treatment was administered to 119 (67.6%) patients through different approaches, including 54 (30.7%) patients of cervical approach, 9 (5.1%) patients of thoracotomy, 18 (10.2%) patients of video-assisted thoracoscopic surgery (VATS), 7 (4.0%) patients of cervical combined with thoracotomy, 30 (17.0%) patients of cervical combined with VATS, and 1 (0.6%) patient of subxiphoid approach. Among this cohort, 144 (81.8%) patients were cured, while 32 (18.1%) patients died. Age-adjusted Charlson comorbidity index (OR=2.95, P=0.022), perioperative sepsis (OR=2.84, P=0.024), and non-surgical treatment (OR=2.41, P=0.043) were identified as independent predictors of poor outcomes. Conclusion For patients with corresponding history and manifestations of ANM, it is crucial to go through imaging examination to confirm the presence of an abscess and guide the selection of surgical approach. Once the diagnosis of ANM is made, it is imperative to promptly perform surgical intervention for effective drainage. Our study highlights the significance of age-adjusted Charlson comorbidity index, perioperative sepsis and surgical treatment in predicting patients’ outcomes.
Objective To investigate protective effect of apocynin, the inhibitor of NADPH oxidase Ⅱ (NOX2), on lung injury induced by acute necrotic pancreatitis (ANP) in rat. Methods Forty SPF adult male Wistar rats were randomly divided into 4 groups: shame operation group (SO group, n=10), ANP model group (ANP group, n=12), apocynin treated group (APO group, n=10), and apocynin control group (APO-CON group, n=8). The ANP models were induced by the retrograde injection of 5% sodium taurocholate through the biliopancreatic duct in the ANP group and the APO group. The apocynin was injected at 30 min before the induction of ANP models in the APO group. The pancreas and duodenum of rats were just flipped and the apocynin and the 10% DMSO (2 mL/kg) were injected in the APO-CON group and SO group respectively. All the rats were sacrificed at 12 h after the operation. The blood samples were collected by the inferior vena cava puncture, and the levels of serum amylase and lipase were measured by the auto-chemistry analyzer. The lung tissues were harvested and the integrated optical densities (IODs) of the nuclear factor-κB (NF-κB), tumor necrosis factor-α (TNF-α), and NOX2 were detected by the immunohistochemistry assay. The IODs of the myeloperoxidase (MPO), Toll like receptor 4 (TLR4), and CD68 were detected by the immunofluorescence assay. The concentration of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were tested by the ELISA method. Results The levels of the serum amylase and lipase and the IODs of the NF-κB, TNF-α, NOX2, MPO, TLR4, CD68, and concentration of MDA of the lung tissues in the ANP group were significantly increased as compared with the SO group (P<0.05), these indices in the APO group were significantly decreased as compared with the ANP group (P<0.05). The SOD activity of the lung tissue in the ANP group was significantly decreased as compared with the SO group (P<0.05), which in the APO group was significantly increased as compared with the ANP group (P<0.05). Conclusion Apocynin can ameliorate lung injury induced by ANP through inhibiting activity of NOX2.
Objective To investigate the mechanism of dexamethasone in the treatment of acute necrotizing pancreatitis (ANP). Methods The ANP of 48 SD rats were induced by retrograde infusion of sodium taurocholate through biliopancreatic duct.After 30 minutes,the therapy group was administrated with dexamethasone at a dose of 0.2 mg/100 g alone. The control group was administrated with the same amount of 0.9% saline solution.At fourth hour and twelfth hour,8 rats of each group were sacrificed to examine the levels of serum tumor necrosis factor-alpha(TNFα) and serum amylase,to score the degree of pancreatic necrosis and to evaluate acinar cell apoptosis by in situ hybridization by terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end labeling(TUNEL). The survial period of 8 rats in each group were observed. Results In therapy group, the level of TNFα was (17.8±2.7) pg/ml and (8.5±1.6) pg/ml,the apoptosis index was （36.94±4.12）% and （ 32.79±3.31）%,the survival period was (33.4±21.5) h.While the control group with the indexes mentioned above were as follows: (53.6±18.7) pg/ml and (37.2±11.1) pg/ml ( P＜0.01),（4.37±1.24）% and （5.12±2.11）% （P＜0.01）,(14.6±5.7) h (P＜0.01) ,the histologic scoring for ANP between therapy group and control group was a significantly distinct (P＜0.01). Conclusion Dexamethasone can induce pancreatic acinar cell apoptosis in this model. Proper leves of TNFα may play an important role in regulating the apoptosis.Apoptosis can protect pancreas from necrosis in ANP.
Nineteen cats were randomly divided into two groups, 7 cats (group A) recieved about 200 times spotty injections of total of 2 ml of 94% alcohol in pancreatic parenchyma and 12 cats (group B) underwent intraductal alcohoh, partial obstruction of the main pancreatic duct (MPD) and intraparenchymal alcohol. Acute necrotizing pancreatitis occurred in all of the experimental cats after operation. 2 cats in group A (28.6%) died within 48 hours postoperatively. 4 cats in group B (33.3%) died, among them, 3 within 48 hours and 1 died after 2 weeks. Morphological and functional recovery of the exocrine pancreas were found in all the 5 survivals in group A, while 8 cats in group B developed chronic pancreatitis 15 weeks after the operation. The above results show that simple pancreatic necrosis can be recovered after eliminating the etiological factors and if these factors, whatever is primary or secondary still exist and continue to damage the pancreas, chronic pancreatitis may develop.
摘要:目的：探讨急性重症胰腺炎（SAP）早期不同种类液体复苏对其预后的影响。方法：应用随机对照的方法,分别对2007年12月~2009年10月同期入院的48例SAP患者,随机分成两组,试验组和对照组。试验组第一周内液体复苏采用晶体液和人工胶体（羟乙基淀粉）,对照组采用晶体液,其他治疗方法不变。然后统计其第一周死亡率、ARDS、多器官功能障碍综合征（MODS）发生率,对比两组患者呼吸频率、血氧饱和度和红细胞压积（HCT）差异,以及两组患者肠功能恢复时间、住院时间以及并发症发生率。结果：试验组的液体复苏较对照组显著改善SAP的各项指标（P＜005）。血清乳酸水平（15±05）mmol/L,红细胞压积(HCT)为（324±69）%,ScvO2为（817±152）%,病死率83%,MODS发生率333%,〖HT5”H〗结论:〖HT5”SS〗 SAP早期联合应用晶胶体进行液体复苏可有效恢复循环血容量和防止体液潴留,显著提高其治愈率。Abstract: Objective: To investigate the optimal strategy of fluid resuscitation in the early stage ofsevere acute pancreatitis.〖WT5”HZ〗Methods:〖WT5”BZ〗Fourfyeighs SAP patients who received treatment in our hospital from 12,2007 to 10,2009 were randomly divided into 2 groups (n=24) according to the different amounts of crystal and colloid inthe daily resuscitation,including crystal group,combined group(the ratio of crystal to colloid was 2 to 1).The levels of hematocrit(HCT),saturation of central vein oxygen ( ScvO2 ),serum lactic acid as well as the advent of negative fluid balance the amount of fluid contained in the third space,mortality rate and the incidence of multiple organ dysfunction syndrome(MODS) in different groups were compared.〖WT5”HZ〗Results:〖WT5”BZ〗 Compared with crystal group,all the parameters were significantly improved in combined group(P＜005).HCT in the group of patients was(324±69)%,ScvO2 was (817±152)%,lactic acid was(15±05)mmol/L,mortality rate was 83% and MODS incidence was 333%. Conclusion:In the early stage of SAP,fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space and significantly improve the prognosis of SAP.
This prospective animal study was designed to investigate the changes of plasma endothelin (ET) levels in acute necrotizing pancreatitis (ANP). Sprague-Dawley rats were randomly devided into 3 groups: acute necrotizing pancreatitis (ANP) group in which ANP was induced by infusion of 5% sodium taurocholate (STC) into biliopancreatic duct, sham operation (SO) group and platelet activating factor antagonist BN50739 (BN) group. Blood levels of ET and platelet activating factor (PAF) were detected. Pancreatic microcirculatory blood flow was measured and pancreatic histological scores were evaluated. Results showed that the pancreatic microcirculatory blood flow in ANP group was decreased to a great extent immediatly after induction of ANP and soon began to rise slowly for 3 hours and again decreased steadily after that. The blood levels of ET, PAF and histological scores in ANP group were significantly higher than those in SO group. In BN group, the blood flow was significantly improved and the levels of blood ET, PAF and histological scores were all significantly lower as compared to those in ANP group. It is concluded that ischemia/ reperfusion is present in the initiation of acute necrotizing pancreatitis induced by STC in the rat. This leads to injuries of endothelial cells and increase in the production of ET and PAF. I/R lesions,and interaction of ET and PAF lead to a vicious circle, thus augmenting the pathological changes in the pancreas.