Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema

Serial serum amylase and blood glucose levels were measured in 68 hypothermic (rectal temperature 35°C or less) patients, including 15 who had hypothermic myxoedema (serum protein bound iodine 3·5 μg/100 ml or less). Raised amylase levels were found in 34 patients and probably reflected a mild acute pancreatitis. The high amylase levels correlated with low arterial PO₂ levels and significantly with high arterial PCO₂ levels and the base deficit but not with the severity or duration of the hypothermia. The acute pancreatitis does not explain why hypothermic patients with myxoedema have a poorer prognosis than those who are euthyroid. The pancreatitis occasionally contributed to the development, sometimes delayed, of diabetic ketoacidosis, blood glucose levels of over 120 mg/100 ml being found in 20 patients. There was a significant correlation between the raised serum amylase levels and the hyperglycaemia. Hypoglycaemia, sometimes profound, was found in 12 patients.     

Response of exocrine pancreas to corticosterone and aldosterone after adrenalectomy

The long-term effect of adrenalectomy (Adx) on the exocrine pancreas was examined in female adult rats. Pancreatic amylase concentration decrease to 50% of the control level starting 10 days after Adx, whereas the levels of trypsinogen and lipase remained unchanged. Replacement studies beginning 24 h after surgery with corticosterone (B, 1 mg/100 g body wt) or aldosterone (ALDO, 8 micrograms/100 g body wt) alone did not prevent the decline in amylase after Adx. However, when both hormones were administered together, pancreatic amylase concentration was maintained at a level similar to that of the control group. Serum corticosterone levels in the rats receiving B alone or B + ALDO were not different, and were comparable to levels found in normal rats. Both ALDO and B, given for 5 days starting 10 days after Adx, were required to restore amylase concentrations toward control values. When spironolactone (SPIRO, 3 mg/100 g body wt), a specific mineralocorticoid receptor blocker was administered bid together with ALDO + B, it blocked the increase in pancreatic amylase seen in ALDO + B treated rats but did not affect the serum corticosterone levels. These results suggest that mineralocorticoids are also involved in modulating the level of amylase in the rat exocrine pancreas.     

Circulatory turnover of pancreatic amylase.

Radiolabeled amylase and unlabeled pancreatic amylase were infused into pigs in order to determine the plasma half-life of the enzyme. Regardless of the parameter measured (radioactivity, enzyme activity or concentration), the plasma removal curves could be resolved into three components when subjected to tracer analysis. The plasma half-life was estimated to be approximately 3 hr. Through the use of a recently developed radioimmunoassay specific for porcine pancreatic amylase, the plasma concentration of amylase was calculated at 2.4 mug/ml. Knowing the plasma concentration and half-life of amylase we determined the circulatory turnover of the enzyme. Over a 2.4-hr period, 9.6 mug of pancreatic amylase/ml of plasma must re-enter the circulation to maintain the enzyme at constant levels.     

Radioimmunoassay for human salivary amylase

A radioimmunoassay (RIA) for human salivary amylase was developed. Human salivary amylase was purified from parotid saliva by a combination of Sephadex gel filtration and cation exchange chromatography. Purified salivary amylase was used both as the standard antigen and for the generation of ¹²⁵I-labeled amylase. Antibody to salivary amylase was raised in New Zealand white rabbits and used in a nonequilibrium double-antibody procedure for the RIA. The RIA was sensitive (10 ng/ml) and specific, displaying a limited cross-reactivity for pancreatic amylase (1%, $\text{w}\text{w}$). Analysis of patient sera by RIA shows that salivary amylase constitutes approximately 60% of the total serum amylase, that the salivary amylase found in the serum of patients with Sjögren's syndrome and macroamylasemia is immunologically indistinguishable from that of normal persons, and that salivary amylase can be evaluated by RIA in the serum of patients with pancreatitis.     

Protective effects of gabexate mesilate (FOY) against impaired pancreatic energy metabolism in rat acute pancreatitis induced by caerulein.

A supramaximal dose of caerulein (5 micrograms/kg.hr for 3.5 hours) caused edematous acute pancreatitis in rats, characterized by portal hyperamylasemia (32 +/- 3 U/ml) and pancreatic edema (pancreatic water content, 86 +/- 2%) [control group: amylase, 8 +/- 1 U/ml; water content, 74 +/- 2%]. In this model, increased portal levels of malate dehydrogenase (148 +/- 25 U/ml), increased mitochondrial fragility and impaired pancreatic energy charge level (0.77 +/- 0.05) were also observed [control group: malate dehydrogenase, 54 +/- 11 U/ml; energy charge level, 0.94 +/- 0.03]. Administration of gabexate mesilate, FOY, in a dose of 50 mg/kg.hr for 2 hours before and during the caerulein infusion had a significant protective effect against these pancreatic injuries (portal amylase level, 11 +/- 2 U/ml; MDH level, 72 +/- 19 U/ml; E.C., 0.89 +/- 0.02; water content, 76 +/- 2%). FOY in a dose of 20 mg/kg.hr was partially protective. These results indicate that subcellular organelle fragility and malfunction are closely related to the pathogenesis of acute pancreatitis and suggest the usefulness of FOY in the treatment of this disease.     

Production of alpha amylase by Bacillus licheniformis using an economical medium

The present study is concerned with the selection of new medium for the production of alpha amylase by Bacillus licheniformis. Different agricultural by-products such as wheat bran, sunflower meal, cotton seed meal, soybean meal, rice husk or rice bran were tested for the production of alpha amylase. Among different agricultural by-products evaluated, wheat bran was found to be the best basal and standardized medium for optimal production of alpha amylase. The production was increased 2-folds when soluble starch was replaced with pearl millet starch at 1% level and nutrient broth concentrations was reduced from 1% level to 0.5%. The newly selected fermentation medium containing (% w/v) wheat bran 1.25, nutrient broth 0.5, pearl millet starch 1.0, lactose 0.5, NaCl 0.5, CaCl2 0.2 in 100 ml of phosphate buffer. The kinetic values of Y(p/x), Y(p/s), and Q(p) indicated that the production of enzyme was greater in newly selected medium than the conventional more expensive medium.     

Diagnosis of cystic pancreatic lesions by cytologic examination and carcinoembryonic antigen and amylase assays of cyst contents.

The contents obtained by fine needle aspiration (FNA) from 41 pancreatic cysts in 32 patients were studied cytologically and assayed for amylase and carcinoembryonic antigen (CEA) levels, which have been shown to discriminate pancreatic pseudocysts from mucinous cystic neoplasms and necrotic cystic carcinomas. The results were correlated with the histopathologic findings following surgery or with a clinical and radiologic follow-up of up to two years. The clinical, radiologic and cytologic characteristics did not discriminate pseudocysts from cystic neoplasms. The amylase content of cysts was high in pseudocysts, cystic carcinomas and mucinous cystic neoplasms. The mean CEA content was highest in cystic carcinomas and mucinous cysts and low in pseudocysts. The cytologic diagnosis of mucinous cystic neoplasms and carcinomas had a sensitivity of 54% and a specificity of 91%. The diagnosis of these lesions based on a CEA level greater than 10 ng/ml had a sensitivity of 100% and a specificity of 81%. The adjunctive use of CEA content analysis enhanced the sensitivity of the cytologic diagnosis of mucinous cystic neoplasms and carcinomas to 100%.     

Production of amylase by newly isolated moderate halophile,Halobacillus sp. strain MA-2

Production of extracellular amylase was demonstrated under stress conditions of high temperature and high salinity in aerobically cultivated culture of a newly isolated moderately halophilic bacterium of spore-forming Halobacillus sp. strain MA-2 in medium containing starch, peptone, beef extract, and NaCl. The maximum amylase production was secreted in the presence of 15% (w/v) Na(2)SO(4) (3.2 U ml(-1)). The isolate was capable of producing amylase in the presence of NaCl, NaCH(3)COOH, or KCl, with the results NaCl>NaCH(3)COOH>KCl. Maximum amylase activity was exhibited in the medium containing 5% (w/v) NaCl (2.4 U ml(-1)). Various carbon sources induced enzyme production. The potential of different carbohydrates in the amylase production was in the order: dextrin>starch>maltose>lactose>glucose>sucrose. In the presence of sodium arsenate (100 mM), maximum production of the enzyme was observed at 3.0 U ml(-1). Copper sulfate (0.1 mM) decreased the amylase production considerately, while lead nitrate had no significant enhancement on amylase production (p<0.05). The pH, temperature, and aeration optima for enzyme production were 7.8, 30 degrees C, and 200 rpm, respectively, while the optimum pH and temperature for enzyme activity was 7.5-8.5 and 50 degrees C, respectively.     

Elevated Amylase and Lipase Levels in Patients Using Glucagonlike Peptide-1 Receptor Agonists or Dipeptidyl-Peptidase-4 Inhibitors In the Outpatient Setting

ObjectiveTo investigate the effects of glucagonlike peptidase-1 (GLP-1) receptor agonists and dipeptidyl-peptidase-4 (DPP-4) inhibitors on serum amylase and serum lipase levels in patients with type 2 diabetes.MethodsIn 90 patients with type 2 diabetes, treatment was initiated with a GLP-1 agonist or a DPP-4 inhibitor. A comparison group consisted of 33 patients with type2 diabetes and similar characteristics who were not prescribed these agents. Baseline serum amylase and lipase levels were measured in all patients and repeated periodically. We determined the percentage of patients with elevated levels of serum amylase or lipase (or both) in both groups.ResultsAmong all 90 patients who received a GLP-1 receptor agonist or a DPP-4 inhibitor, 32 (36%) had an increase in serum amylase or lipase (or both) in comparison with 6 of 33 patients (18%) with such increases in the comparison group. Interestingly, the serum lipase levels increased more than the serum amylase values in all groups. To ascertain that this was not a chance laboratory error, serum samples were submitted to a second independent laboratory, and the same results were obtained. Usually, use of the medication was discontinued when serum lipase or amylase values were found to be elevated at any level.ConclusionBoth GLP-1 receptor agonists and DPP-4 inhibitors are associated with increased levels of serum lipase more than serum amylase in many patients with type2 diabetes, possibly suggesting the presence of pancreatic inflammation. Whether this finding may potentially lead to acute pancreatitis or chronic pancreatitis, as reported in rat models, is currently unknown. Careful observation of patients taking these medications may be prudent. (Endocr Pract. 2012;18:472-477)     

Changes in prolactin levels caused by luteinizing hormone releasing hormone

The acute effects of luteinizing hormone releasing hormone (LHRH) on the release of prolactin (PRL) were investigated in 12 normal cycling women and 42 women with various menstrual disorders. LHRH (100 micrograms) was bolusly injected intramuscularly and PRL levels were measured immediately before the injection and at 30 minutes and 60 minutes after the injection. LHRH elicited an increase of more than 25% in PRL levels in 15 cases (27.8%) at both 30 minutes and 60 minutes after the injection, whereas PRL levels were decreased by more than 25% in 7 cases (13.0%). The PRL response to LHRH seemed to be related to basal PRL levels. Especially when the PRL concentration was 20 ng/ml or more, LHRH decreased PRL levels in 7 cases out of 16. On the other hand, LHRH increased PRL levels in the majority of cases with a PRL concentration less than 20 ng/ml. In conclusion, the LHRH injection occasionally alters PRL levels in either a positive or negative manner, depending upon the basal PRL levels.     

Transient severe insulin resistance in diabetic ketoacidosis (a report of four episodes)

Four episodes of transient severe insulin resistance in diabetic ketoacidosis, possibly of immunological origin, have been described. Severe insulin resistance was diagnosed when insulin requirement exceeded 100 units per hour. Treatment comprised of doubling the insulin dose intravenously every two hours till there was a satisfactory response and administration of steroids when 100 units per hour of insulin were being administered. Contrary to the usual response, ketosis responded first followed by hyperglycaemia. When insulin resistance was overcome, plasma glucose continued to fall despite witholding insulin and late hypoglycaemia occurred in three episodes.     

Effect of dietary fat on pancreatic lipase levels in the rat

The effect of dietary fat on levels of lipase and other enzymes in rat pancreas has been studied. It was possible to raise levels of lipase in animals by supplementing their commercial chow diet with added fat or by raising the level of fat in semipurified diets from 4% to 22%. Pancreatic amylase levels decreased in rats fed the high fat diets, whereas levels of chymotrypsinogen and trypsinogen were unaffected. The type of carbohydrate in the semipurified diets made no difference. Thus, the levels of enzymes in rats fed dextrose-containing diets or cornstarch-containing diets were similar. On the basis of the present data, and results of others, it would appear that levels of pancreatic lipase are increased when the fat content of the diet is raised from about 5% to 15-22%, but that little or no additional increase in lipase levels can be attained by any further increase in the amount of dietary fat.     

Changes in fetal organ flow during intrauterine mechanical ventilation with or without oxygen

To investigate whether the changes in circulation at birth are due to lung ventilation, changes in PaO2 or both we mechanically ventilated in utero the lungs of 10 fetal sheep (120-127 days of gestational age) five days after instrumentation under general anaesthesia. Electrocortical activity (ECoG), eye movements (EOG), electromyographic activity from diaphragm and posterior neck activity (EMG) and electrocardiogram (ECG) were recorded. Fetal catheters (artery and vein of the hindlimb, arteries of both forelimbs which in three occasions were advanced into the left ventricle, fetal trachea and amniotic cavity), and an endotracheal tube were placed. After recovery radioactive 15 mu microspheres (I125, Ce141, Sr85 and Sc46) were injected into the inferior vena cava or left ventricle during high voltage electrocortical activity before and after lung expansion with N2 and after expansion with O2 for two levels of PaO2. PaCO2 did not change. The percentage of spheres trapped in the lungs increased from 9.6% to 44% after expanding the lungs with N2 and to 90% when fetal PaO2 increased (P less than 0.001). Blood flow to different organs did not change during normoxic expansion but it decreased significantly to the brain (91 +/- 25 to 27 +/- 8 ml/min per 100g, [mean +/- SD]) placenta (160 +/- 57 to 54 +/- 33 ml/min/100g) and coronaries (239 +/- 91 to 117 +/- 60 ml/min per 100g) when PaO2 was increased. In conclusion fetal circulation responds to raised levels of PaO2 well before birth probably by a direct action of oxygen on the vessels.     

The calcium binding protein S100A9 is essential for pancreatic leukocyte infiltration and induces disruption of cell-cell contacts

Leukocyte infiltration is an early and critical event in the development of acute pancreatitis. However, the mechanism of leukocyte transmigration into the pancreas and the function of leukocytes in initiating acute pancreatitis are still poorly understood. Here, we studied the role of S100A9 (MRP14), a calcium binding protein specifically released by polymorph nuclear leukocytes (PMN), in the course of acute experimental pancreatitis. Acute pancreatitis was induced by repeated supramaximal caerulein injections in S100A9 deficient or S100A9 wild-type mice. We then determined S100A9 expression, trypsinogen activation peptide (TAP) levels, serum amylase and lipase activities, and tissue myeloperoxidase (MPO) activity. Cell-cell contact dissociation was analyzed in vitro with biovolume measurements of isolated acini after incubation with purified S100A8/A9 heterodimers, and in vivo as measurement of Evans Blue extravasation after intravenous application of S100A8/A9. Pancreatitis induced increased levels of S100A9 in the pancreas. However, infiltration of leukocytes and MPO activity in the lungs and pancreas during acute pancreatitis was decreased in S100A9-deficient mice and associated with significantly lower serum amylase and lipase activities as well as reduced intrapancreatic TAP-levels. Incubation of isolated pancreatic acini with purified S100A8/A9-heterodimers resulted in a rapid dissociation of acinar cell-cell contacts which was highly calcium-dependent. Consistent with these findings, in vivo application of S100A8/A9 in mice was in itself sufficient to induce pancreatic cell-cell contract dissociation as indicated by Evans Blue extravasation. These data show that the degree of intrapancreatic trypsinogen activation is influenced by the extent of leukocyte infiltration into the pancreas which, in turn, depends on the presence of S100A9 that is secreted from PMN. S100A9 directly affects leukocyte tissue invasion and mediates cell contact dissociation via its calcium binding properties.     

Adrenomedullin reduces the severity of cerulein-induced acute pancreatitis

We investigated the effect of Adrenomedullin (AM) on cerulein-induced acute pancreatitis in rats. AM treatment (100 ng/kg per rat, subcutaneous) after one hour of cerulein injection reduced the plasma amylase levels, pancreatic weight, pancreatic malondialdehyde (MDA) levels, and the severity of the lesions microscopically. These data suggest that AM has a protective effect on cerulein-induced acute pancreatitis. These could be due to anti-inflammatory properties of AM, inhibition of proinflammatory cytokine secretion, reducing the endothelial permeability increased by reactive oxygen species, endotoxins or cytokines.     

Use of highly specific antibodies against 17alpha-OH-progesterone in a simplified nonchromatographic RIA and in the simultaneous determination of four sex hormones in human plasma.

A highly specific antiserum raised against the 3(O-carboxymethyl)oxime of 17alpha-hydroxyprogesterone (17-OHP) was produced in rabbit and used in the development of a specific radioimmunoassay (RIA) for 17-OHP which included a celite chromatography. Methods allowing the measurement of plasma 17-OHP levels either separately or in combination with that of several plasma androgens (testosterone, delta4-androstenedione and dehydroepiandrosterone) are described. Moreover, RIA meabsurement of plasma 17-OHP levels with or without chromatographic (celite column) purification gave comparable results (mean +/- SD) in 29 normal adult males (118 +/- 34 ng/100 ml) and 35 normal adult females (follicular phase: 46+/- 16 ng/100 ml); luteal phase: 241 +/- 71 ng/100 ml).     

Lipids and carotid plaque in the Northern Manhattan Study (NOMAS)

Background

Heterogeneity in B-type natriuretic peptide (BNP) levels, especially among individuals with acute heart failure with normal left ventricular ejection fraction (HFNEF), can cause confusion in interpreting results. We investigated the characteristics of cases of acute HFNEF with only modestly elevated BNP.

Methods

One hundred forty-two patients with acute or acute exacerbation of chronic HFNEF were divided into two groups by BNP level: BNP < 100 pg/ml (NB group, n = 45) and BNP ≥ 100 pg/ml (B group, n = 97). We compared clinical findings, echocardiography results, and neurohormonal factors between these two groups.

Results

In the NB group, a history of open-heart surgery (OHS) was more frequent (71% vs. 22%, p < 0.0001) and hypertension was less frequent (p = 0.0005). Left atrial diameter (LAd) was higher (p = 0.0026), while interventricular septal thickness, posterior wall thickness, relative wall thickness, left ventricular mass index were lower (p = 0.0005, p = 0.0225, p = 0.0114, p = 0.0051, respectively) in the NB group. In patients with HFNEF, a history of OHS remained an independent predictor of BNP level (< 100 pg/ml) after adjustment for hypertension, age, LAd, and interventricular septal thickness (odds ratio 3.6, p = 0.0252).

Conclusion

We found associations between acute HFNEF with less elevated BNP and a history of OHS. In a patient suspected of HFNEF, a history of OHS is considered diagnostic evidence of presence of diastolic heart failure when plasma levels of BNP are less elevated.     

清胰汤对大鼠急性坏死性胰腺炎IL-6,IL-10及肠道通透性影响

目的：探讨清胰汤改善大鼠急性坏死性胰腺炎（acute necrotizing pancreatitis）ANP炎症反应及肠道通透性功能的治疗效果及机制。方法：将72只雄性SD大鼠随机分为3组,其中2组大鼠采用从胰腺被膜下多点缓慢均匀注入3.8%牛黄胆酸钠（0.5ml/100g）建立大鼠急性坏死性胰腺炎模型,再分为急性坏死性胰腺炎常规治疗组（A组）、清胰汤干预治疗组（B组）,其他24只大鼠为假手术组（S组）,每组再随机分为24h、48h、72h组。各组于12h后给于肠内营养,B组肠内营养后给于2次清胰汤2.5ml/100g,A组、S组给于同等剂量生理盐水。各组于建模后24h、48h、72h处死,腹腔动脉取血检测血清淀粉酶浓度、IL-6、IL-10、D-乳酸水平。结果：48h时点B组IL-10水平较A组高（P〈0.05）;72时点B组血清淀粉酶水平较A组低（P〈0.01）,IL-6水平较A组低（P〈0.01）,IL-10水平较A组高（P〈0.01）,D-乳酸水平较A组低（P〈0.01）。结论：清胰汤可以上调IL-10改善大鼠急性胰腺炎炎症反应从而降低肠道通透性。     

Pancreatic exocrine secretion in the pig following test meals of different composition and intra-duodenal loads of glucose and maltose.

Eleven pigs were fitted with pancreatic and duodenal fistulae, and pancreatic juice collected permanently. Amylase, chymotrypsin, lipase and total proteins were determined in juice collected within 2 and 6 hours after different test-meals or intraduodenal loads of glucose and maltose. In the pancreatic juice of pigs adapted to a high-lipid diet and submitted to a high-carbohydrate test-meal the activity of amylase was increased by 50%. When the consumption of the high-lipid meal was associated with an intraduodenal load of 100 g of glucose all the enzyme activities were stimulated when compared to the effect of meal alone, but only the activity of amylase was significantly increased (+ 82%). In the juice of pigs adapted to a balanced diet and submitted to intraduodenal loads of 150 ml of water, 50 g of glucose, 50 g of maltose and 150 g of maltose, the enzyme activities remained almost constant with the load of water and 50 g of maltose but with 50 g of glucose and 150 g of maltose loads, amylase activity was increased by 20% and 30% respectively. It is suggested, that the exocrine pancreas of the pig adapts itself rapidly to the changes in the size of the intestinal pool of starch hydrolysis products.     

Midgut amylase,lysozyme, aminopeptidase,and trehalase from larvae and adults of Musca domestica

Based on polyacrylamide gel electrophoresis, density-gradient ultracentrifugation and thermal inactivation, there is only one major molecular species of each of the following larval enzymes (soluble in water or solubilized in Triton X-100): membrane-bound aminopeptidase (pH optimum 8.5; K_m 0.21 mM L-leucine p-nitroanilide; M_r 322,000), amylase (pH optimum 6.5; K_m 0.14% starch; M_r 66,000), lysozyme (pH optimum 3.5; K_m 0.3 mg/ml; Mr 24,000); and membrane-bound trehalase (pH optimum 5.0; K_m 1.09 mM trehalose; M_r 94,000). Except for lysozyme, the properties of adult digestive enzymes are different from those described for larval enzymes. Larval aminopeptidase and trehalase were purified by electrophoresis and larval lysozyme (contaminated with amylase) by density-gradient ultracentrifugation, and were used to raise antibodies in a rabbit. Antibodies raised against larval aminopeptidase, trehalase, and amylase did not recognize the imaginal enzymes, whereas those against larval lysozyme recognize imaginal lysozyme. The data suggest that the genes coding for digestive enzymes (except for lysozyme) are different in larvae and imagoes.