Chaowu Chen’s research while affiliated with Yangzhou University and other places

Background: Acute biliary pancreatitis (ABP) is the most common type of acute pancreatitis. However, the effect of serum triglyceride (TG) levels on the severity of ABP remains unclear. The aim of this study was to assess the correlation between serum TG levels and the severity of ABP. Methods: Data from 526 ABP patients was analyzed in this study. The patients were divided into normal and elevated groups according to the TG level measured within 24 h after admission, and the elevated group was further divided into mild, moderate, and severe elevated groups. The demographic data and clinical outcomes of each group were compared. Results: Of the 526 ABP patients, 394 were in the normal TG group and 132 were in the elevated TG group (36 mild, 57 moderate, and 39 severe). The elevated group was younger (51.5 ± 12.9 vs. 58.9 ± 13.9), predominantly male (66.7% vs. 45.2%), had more history of diabetes (22.7% vs. 12.4%) and hyperlipidemia (19.7% vs. 0.8%), and developed systemic inflammatory response syndrome (SIRS) (25.8% vs. 15.5%), persistent organ failure (POF) (11.4% vs. 2.8%), and local complications (62.9% vs. 42.1%) more frequently compared to the normal group (P < 0.05). The incidence of SIRS, POF, acute peripancreatic fluid collection (APFC), and acute necrotic collection (ANC) increased with increasing TG levels (P trend < 0.05). In multivariate analysis, TG was independently associated with POF, APFC, and ANC in increments of 100 mg/dl (P < 0.05), and there was a linear relationship between TG levels and POF, APFC, and ANC (non-linear P > 0.05, P overall <0.05). In addition, nonalcoholic fatty liver disease is not a risk factor for POF, ANC, and APFC in ABP patients. Conclusions: Elevated serum TG levels were independently associated with more severe ABP. The incidence of POF, APFC, and ANC in ABP patients increased with the increase of TG levels, with a linear relationship.

Acute pancreatitis (AP) is a common clinical gastrointestinal disorder with a high mortality rate for severe AP and lacks effective clinical treatment, which leads to considerable comorbidity and financial burden. Traditional Chinese medicine (TCM) has had the unique advantage of treating AP for a long time in China. Clinically, TCM formulas such as Da-cheng-qi decoction, Chai-qin-cheng-qi decoction, Qing-yi decoction, Da-chai-hu decoction, and Da-huang-fu-zi decoction are widely adminis-trated to AP patients. All of these TCM formulas can improve gastrointes-tinal function, regulate the inflammatory response, and enhance immunity, thus preventing complications, reducing the mortality rate and financial burden. This review will summarize the pharmacological activities and mechanisms of TCM formulas in alleviating AP. Abbreviations: AP-acute pancreatitis, SAP-severe acute pancreatitis, TCM-traditional Chinese medicine, DCQD-Da-cheng-qi decoction, QYD-Qing-yi decoction, CQCQD-Chai-qin-cheng-qi decoction, DCHD-Da-chai-hu decoction, DHFZD-Da-huang-fu-zi decoction, CRP-C-reactive protein, HMGB1-high-mobility group box 1 protein, NF-κB-nuclear factor-kappa B, SIRS-system inflammatory reaction syndrome, MODS-multiple organ dysfunction syndrome, IL-interleukin, AMY-amylase, LPS-lipase, TNF-α-tumor necrosis factor α, CD-the cluster of differentiation, Ig-immunoglobulin, NO-nitric oxide, VIP-vasoactive intestinal peptide, GAS-gastrin, MTL-motilin, ET-endotoxin, MCP-1-monocyte chemoattractant protein-1, TLR4-toll-like receptor 4, CCKR1-cholecystokinin receptor 1, AQP-aquaporin, PT-prothrombin time, APTT-activated partial thromboplastin time, FIB-fibrinogen, PLT-platelets (Pancreas 2021;50: 1348-1356) A cute pancreatitis (AP), as one of the common causes of acute abdomen, has an annual incidence that ranges from 13 to 45 per 100,000 persons, 1 whereas severe AP (SAP) has a high mortality rate of 30% to 50%. 2,3 The treatment of AP includes symptomatic support, drug therapy, aggressive intravenous fluid resuscitation , and enteral nutrition; however, effective clinical treatment is still lacking. 4 Traditional Chinese medicine (TCM) has the distinctive preponderance in treating AP for a long time in China. In 2015, the "Chinese Consensus on the Multidisciplinary Treatment (MDT) of Acute Pancreatitis" pointed out that the use of TCM can effectively relieve the inflammation of the pancreas 5 and recommended the administration of TCM formulas such as Da-cheng-qi decoction (DCQD) and Qing-yi decoction (QYD) in the acute phase of AP. At present, in addition to DCQD and QYD, the universally used TCM formulas for AP include Chai-qin-cheng-qi decoction (CQCQD), Da-chai-hu decoction (DCHD), and Da-huang-fu-zi decoction (DHFZD). To obtain a general understanding and explore the potential drugs, we summarized the TCM formulas and their active monomers that are extensively used in the treatment of AP and discussed their pharmacological activities and mechanisms in this review. TCM FORMULAS FOR AP Traditional Chinese medicine formulas have been reported to have clinical efficacy in AP, evidenced by results from abundant animal experiments and clinical studies summarized in Tables 1 and 2. Da-Cheng-Qi Decoction Da-cheng-qi decoction was originally documented in Shang Han Lun (Treatise on Febrile Diseases), a classic TCM masterpiece. It consists of Radix Et Rhizoma Rhei (Dahuang), Cortex Magnoliae Officinalis (Houpu), Fructus Aurantii Immaturus (Zhishi), and Natrii Sulphas (Mangxiao), 6 which is used for AP, intestinal obstruction, biliary tract infection, and others. 7 Mechanism of DCQD on AP Improves Gastrointestinal Function A multicenter randomized controlled trial of DCQD in SAP patients found that DCQD could decrease inflammatory mediators , such as C-reactive protein (CRP) and white blood cells, not only relieving abdominal pain and distension but also reducing hospitalization costs and shortening the length of hospital stay. 8 It could also promote the recovery of intestinal mucosal permeability and relieve intra-abdominal hypertension in SAP patients. 9,10 In the field of basic research, DCQD was conductive to repair and maintain the integrity of the enteric nerve network damaged by intestinal substances. 11 Da-cheng-qi decoction might promote intestinal function by reducing the expression of the 5-hydroxytryptamine 7

Background: The effect of comorbid hypertriglyceridemia (HTG) and abdominal obesity (AO) on acute pancreatitis (AP) remains unclear. The aim of this study was to explore the effect of comorbid HTG and AO and discuss which is the dominant disorder. Methods: In this study, 1219 AP patients who presented with HTG or AO were stratified into four groups: non-HTG + non-AO, HTG + non-AO, non-HTG + AO, and HTG + AO. Results: The 328 patients with comorbid HTG + AO were much younger (42.29 ± 11.77), mainly male (79.57%), and had higher TG levels, larger waist circumferences, and more past medical histories than the patients in the other three non-comorbid groups (P < 0.001). The comorbidity group developed more incidences of persistent organ failure and local complications (P < 0.05). Multivariate logistic regression analysis showed that AO (OR = 3.205, 95% CI = 1.570-6.544), mild HTG (OR = 2.746, 95% CI = 1.125-6.701), and moderate to very severe HTG (OR = 3.649, 95% CI = 1.403-9.493) were independent risk factors for persistent respiratory failure (P < 0.05). Age > 60 years (OR = 1.326, 95% CI = 1.047-1.679), AO (OR = 1.701, 95% CI = 1.308-2.212), diabetes mellitus (OR = 1.551, 95% CI = 1.063-2.261), mild HTG (OR = 1.549, 95% CI = 1.137-2.112), and moderate to very severe HTG (OR = 2.810, 95% CI = 1.926-4.100) were independent risk factors associated with local complications (P < 0.05). Moreover, HTG seemed to be more dangerous than AO. The higher the serum TG level was, the greater the likelihood of persistent respiratory failure and local complications.

Here we report a 60-year-old male with a polypoid lesion due to sigmoid diverticulitis treated by endoscopic double-band ligation without resection. The method offers a safe, simple and effective way for polypoid lesions caused by diverticulitis and avoids the risk of perforation.

Endoscopic treatment has become a preferred method for neuroendocrine tumors (NETs) of the gastrointestinal tract.Here we report a 72-year-old female with a duodenal neuroendocrine tumor treated by ligation-assisted endoscopic mucosal resection. This treatment was effectively used to cure the duodenal NETs and ensured complete resection without residual positive margins. This case report is rare.

Introduction: Visceral adipose tissue has been indicated closely connected with the severity of acute pancreatitis (AP). Visceral adiposity index (VAI) is a mathematical model that consists of waist circumference, body mass index, triglyceride and high-density lipoprotein cholesterol, which has been demonstrated to be a better indicator of visceral fat than other traditional indices. Methods: A retrospective analysis was conducted on a cohort of 1174 patients diagnosed with AP. These patients were categorized into two groups based on their VAI values: the normal VAI (NVAI) group and the elevated VAI (EVAI) group. Results: The EVAI group were much younger, mainly male and had higher incidence of severe acute pancreatitis (SAP) compared with the NVAI group (p < 0.001). The EVAI group developed higher incidences of persistent respiratory failure, acute peripancreatic fluid collection (APFC) and acute necrotic collection (ANC). The VAI level and the percentage of EVAI showed an increasing trend with the severity of AP (p < 0.001). EVAI was the most independent risk factor for persistent respiratory failure (OR = 6.405, 95% CI 2.317-17.705), APFC (OR = 2.093, 95% CI 1.255-3.578) and ANC (OR = 4.910, 95% CI 1.736-13.887). Conclusions: EVAI was strongly related to the severity of AP. It was the most independent risk factor of persistent respiratory failure, APFC and ANC.

A 47-year-old man with a history of ESMC resection of the left chest wall seven years ago was admitted to our hospital due to mid-upper abdominal pain and jaundice for more than 10 days. Laboratory tests showed elevated direct bilirubin, alanine aminotransferase, gamma-glutamyltranspeptidase, and alkaline phosphatase. Computed tomography (CT) of the abdomen revealed soft tissue mass in the head and body of the pancreas with irregularly shaped calcifications, and an enhanced scan showed heterogeneous enhancement. Combined with the patient's past medical history, the possibility of pancreatic metastasis of ESMC was considered. After anti-inflammatory, hepatoprotective, and cholagogical treatment jaundice improved, and ultrasound endoscopy-guided fine-needle aspiration (EUS-FNA) was performed to clarify the nature of the mass, which showed a 4.1*4.2 cm mixed echogenic area with internal calcification in the head of the pancreas. Aspiration pathology showed proliferation of short spindle and round cells into nests, the immunohistochemistry stain showed CD99 (+); CD34, CD117, Dog-1, and S-100 were negative. Pancreatic metastasis of ESMC was diagnosed. Four months later, endoscopic biliary metal stent drainage (EMBD) was performed when the patient developed obstructive jaundice again due to lesion progression. PET/CT at a 2-year follow-up showed multiple high-density calcifications and abnormally increased FDG metabolism throughout the body.

A previously healthy 56-year-old female was hospitalized with intermittent melena and transient syncope for 1-month duration. Physical examination on admission showed heart rate was 105 beats per minute and blood pressure was 89/55 mmHg. Her hemoglobin was 6.7 g/dl. She received fluid infusion, blood transfusion, acid suppression and hemostasis treatment. Abdominal enhanced computed tomography (CT) demonstrated a well-defined mass with uniform adipose density in the antrum measuring 4 × 5 cm. Gastroscopy revealed a giant submucosal tumor with superficial ulceration in anterior wall of the gastric antrum. Endoscopic ultrasound (EUS) showed a homogeneous, well-circumscribed, hyperechoic mass originated from the submucosa layer. Distal partial gastrectomy was performed. Postoperative histopathology examination of the resected specimen revealed the tumor was composed of closely arranged and uniformly shaped proliferative mature adipocytes, which located in the submucosa layer with superficial mucosal ulcer. The patient was diagnosed as giant gastric lipoma with superficial ulcer and no symptoms was observed in 3 months follow-up.