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• Hypertriglyceridemia-induced acute pancreatitis recurrence rate is high. • High triglyceride (TG) level post attack is closely associated with recurrence. • Controlling TG below 5.65 mmol/L may be an effective strategy to prevent recurrence. • Glucose should be controlled below 7.0 mmol/L for preventing recurrence. • Long-term TG lowering drugs treatment decreases recurrence. Data on recurrent hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are scarce. To investigate the incidence and risk factors for recurrence of HTG-AP, and the effect of triglyceride (TG) lowering drugs post index attack on recurrence. This study was a prospective cohort study of adult patients with first episode of HTG-AP from December 2019 to February 2021 who were followed until recurrence or death, or February 2022. The cumulative incidence function and Fine and Gray's competing-risk model were applied to the analyses. A total of 317 patients were enrolled, and the 12-month and 18-month cumulative recurrence incidences were 8% and 22%, respectively. The cumulative recurrence incidence was 2 times higher in patients whose serum TG levels post index attack were ≥5.65 mmol/L (subdistribution hazard ratio [SHR], 2.00; 95% confidence interval [CI], 1.05–3.80; P = 0.034) compared to patients with TG <5.65 mmol/L. The recurrence rate was 3.3 times higher in patients whose glucose levels post index attack were ≥7.0 mmol/L (SHR, 3.31; 95% CI, 1.56–7.03; P = 0.002) than in patients with glucose <7.0 mmol/L). Compared to TG lowering drugs for less than 1 month post index attack, treatment for longer than 12 months decreased the incidence of recurrence by 75% (SHR, 0.25; 95% CI, 0.08–0.80; P = 0.019). The HTG-AP recurrence incidence is high and closely associated with high levels of TGs and glucose post index attack. Long-term TG lowering drugs treatment significantly decreases this recurrence. [ABSTRACT FROM AUTHOR]

Background Some studies have suggested an association between Helicobacter pylori infection and the risk of stroke, but the relationship remains controversial. The aim of this study was to obtain a more comprehensive estimate of H. pylori on the risk of stroke by performing a meta-analysis. Methods A computerized search of PubMed, EMBASE, and the Cochrane library (including CENTRAL) up to February 2014 was performed to identify eligible studies. Prospective studies reported that a multivariate-adjusted estimate for the association between H. pylori and stroke were included. A random-effects model was used to calculate the overall combined risk. Results Ten prospective observational studies (6 cohort studies, 4 nested case–control, or case–cohort studies within cohort studies) were included in the meta-analysis. The overall combined odds ratio for H. infection and stroke was .96 (95% confidence interval, .78-1.14). Similar results were yielded in patients with cytotoxin-associated gene-A seropositive strains. The combined estimates were robust across sensitivity analyses and had no observed publication bias. Conclusions In conclusion, our formal meta-analysis indicated no strong association between H. pylori infection and stroke, neither in those with cytotoxin-associated gene-A–positive infection. We believe that future epidemiologic studies of H. pylori and stroke are unlikely to be fruitful. [ABSTRACT FROM AUTHOR]

Abstract: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder, with increasing incidence and prevalence in the last one-half century. IBD patients suffer from autonomic vagal neuropathy and nerve dysfunction, with deficiency of acetylcholine in inflamed mucosa. Recent studies showed that death of enteric neuron in local tissue was induced during the process of IBD, which also played a crucial role in the pathogenesis of disease. Stem cells have been demonstrated a new biological treatment for IBD, therefore, we proposal that neural stem cells expressing choline acetyltransferase may enhance enteric neural cell regeneration, restore acetylcholine production in intestinal mucosa, and thus inhibit immune responses of IBD. [Copyright &y& Elsevier]

Background and Aims Idiopathic acute pancreatitis (IAP) poses a diagnostic challenge for gastroenterologists, because confirmation of the disease etiology has important implications for the selection of the best possible treatment and the prevention of possible recurrence or the development of chronic pancreatitis (CP). ERCP, EUS, and MRCP typically are used to diagnose IAP when conventional radiologic methods fail. However, their exact role in the diagnosis of IAP has not yet been determined. Methods We searched the PubMed, EMBASE, OVID, Cochrane Library (including CENTRAL), China National Knowledge Infrastructure (CNKI), and Wanfang databases from inception to April 2017. Studies involving the use of EUS and/or MRCP for the etiologic diagnosis of IAP were included. A meta-analysis was performed by using Review Manager Version 5.2 for comparative studies and R software 3.3.3 to determine diagnostic yield of the studies. Results Among the 34 studies that met the inclusion criteria (n = 2338), 7 studies used a combination of EUS and MRCP and totaled 249 patients. The results comparing EUS with MRCP showed a diagnostic yield of 153 of the 239 patients (64%) in the EUS group, which was higher than the yield of 82 of 238 patients (34%) in the MRCP group ( P < .001) in the 7 studies, and the diagnostic yield was 60% in the EUS group, 24% in the MRCP group, and 43% in the MRCP after secretin stimulation (S-MRCP) group. In our subgroup analysis of CP and biliary disease, EUS was superior to MRCP ( P < .001), but when comparing the efficacy of the modalities in the diagnosis of pancreatic divisum, S-MRCP was obviously superior to MRCP and EUS (12% vs 2% vs 2%). Conclusion EUS and MRCP should both be used in the diagnostic work-up of IAP as complementary techniques. EUS had a higher diagnostic accuracy than MRCP (64% vs 34%) in the etiologic diagnosis of IAP and should be preferred for establishing a possible biliary disease and CP diagnosis, whereas S-MRCP was superior to EUS and MRCP in diagnosing a possible anatomic alteration in the biliopancreatic duct system, such as pancreatic divisum. [ABSTRACT FROM AUTHOR]

Early prediction of persistent organ failure (POF) is important for triage and timely treatment of patients with acute pancreatitis (AP). All AP patients were consecutively admitted within 48 h of symptom onset. A nomogram was developed to predict POF on admission using data from a retrospective training cohort, validated by two prospective cohorts. The clinical utility of the nomogram was defined by concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC), while the performance by post-test probability. There were 816, 398, and 880 patients in the training, internal and external validation cohorts, respectively. Six independent predictors determined by logistic regression analysis were age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion and were included in the nomogram (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This nomogram had reasonable predictive ability (C-indexes 0.88/0.91/0.81 for each cohort) and promising clinical utility (DCA and CIC). The nomogram had a positive likelihood ratio and post-test probability of developing POF in the training, internal and external validation cohorts of 4.26/31.7%, 7.89/39.1%, and 2.75/41%, respectively, superior or equal to other prognostic scores. This nomogram can predict POF of AP patients and should be considered for clinical practice and trial allocation. [ABSTRACT FROM AUTHOR]

This study investigated risk factors for bleeding in patients with acute necrotizing pancreatitis (ANP) undergoing endoscopic necrosectomy (EN) and the effect of endoscopic haemostasis. 145 patients with ANP who underwent EN were recruited from January 2014 to December 2018. Patients with and without bleeding were allocated to the bleeding and nonbleeding groups, respectively. Multivariable logistic regression models were used to assess independent risk factors for bleeding. 39 patients (26.9%) experienced bleeding. The body mass index and culture-confirmed infectious pancreatic necrosis (IPN), renal failure and continuous renal replacement therapy rates were significantly higher in the bleeding group (all P < 0.01). In addition, the number of debridement procedures was significantly higher in the bleeding group (P = 0.004), accompanied by a higher mortality rate and greater hospitalization costs (all P < 0.05). Most cases of bleeding during EN were successfully stopped by endoscopic haemostasis (94.1%), but this was difficult to achieve after EN. Multivariate analysis revealed that renal failure (odds ratio [OR]: 3.77, P = 0.02), culture-confirmed IPN (OR: 3.19, P = 0.02), and ≥3 debridement procedures (OR: 12.92, P = 0.001) were associated with an increased bleeding risk. Renal failure, culture-confirmed IPN, and multiple debridement procedures were independent risk factors for bleeding in patients with ANP who underwent EN. [ABSTRACT FROM AUTHOR]

Purpose: To determine the correlation between the pancreatic necrosis volume (PNV) and readmission as well as reintervention.Method: This was a retrospective cohort study that included necrotizing pancreatitis (NP) patients who were examined with contrast-enhanced computed tomography (CT) one week before discharge. The PNV was calculated manually based on the postprocessing workstation software. Multivariate logistic regression analysis was employed to determine the independent risk factors for readmission and reintervention.Results: A total of 167 NP patients were included. Among them, 94 (56.3%) patients were readmitted after discharge, and 55 (32.9%) patients needed further invasive intervention. The median PNV of all patients was 376.6 (interquartile range (IQR), 129.3-820.5) cm3, and the PNV was significantly higher in patients needing readmission or reintervention. Multivariate analysis showed that PNV ≥ 620 cm3 (adjusted odds ratio (adjOR), 3.08; 95% confidence interval (CI), 1.47-6.43; P = 0.003) and modified computed tomography severity index (CTSI) score ≥ 7 points (adjOR, 6.36; 95% CI, 2.05-10.70; P = 0.001) were independently associated with readmission. Stent or drainage tube placement at discharge (adjOR, 2.94; 95% CI, 1.27-6.77; P = 0.011), PNV ≥ 620 cm3 (adjOR, 5.11; 95% CI, 2.19-11.95; P < 0.001), pancreatic parenchymal necrosis (adjOR, 3.37; 95% CI, 1.42-7.96; P = 0.006), and modified CTSI score ≥ 7 points (adjOR, 4.23; 95% CI, 1.46-12.27; P = 0.008) were independent risk factors for reintervention.Conclusions: The PNV is a useful tool for quantifying pancreatic necrosis and is strongly associated with readmission and reintervention. Additional prospective studies with larger sample sizes are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is characterized by excessive innate immune cell activation, which is responsible for tissue damage and induction of adaptive immune responses. All-trans retinoic acid (ATRA), the ligand of retinoic acid receptors (RAR), has been previously shown to regulate adaptive immune responses and restore Th17/Treg balance, while its role in regulation of innate immune cell function such as macrophages remains to be elucidated. The study was performed to explore the effect of ATRA on regulation of innate immune responses during dextran sulfate sodium (DSS) induced murine colitis. The mice with DSS colitis were administered with vehicle, ATRA, or LE135. Colitis was evaluated by clinical symptoms, tissue myeloperoxidase (MPO) activity, and the expressions of CD68 and nuclear factor (NF) κB p65, and tumor necrosis factor (TNF) level in inflamed colon. RAW 264.7 cells were pretreated with vehicle, ATRA, or LE135, followed by LPS challenge in vitro. ATRA administration ameliorates DSS-induced colitis evidenced with decreased TNF level and CD68 expression, while LE135 leads to exacerbation of colitis. ATRA treatment in vitro dampens LPS induced NF-κB activation and TNF production of RAW 264.7 cells. Together, our data show a crucial role of ATRA in the progress of acute colitis through inhibiting NF-κB activation, and suggest that ATRA represents a novel therapeutic approach for the management of IBD. [ABSTRACT FROM AUTHOR]