Publicación a texto completo no autorizada por el autor / El documento digital no refiere asesor / Valora los scores de Ranson y APACHE II, como predictivos de severidad en pacientes con diagnóstico de ingreso al Servicio de Medicina de pancreatitis aguda en el Hospital de Nacional Dos de Mayo. Agosto 2011 a julio de 2012. Se realizó un estudio observacional, descriptivo, retrospectivo y transversal. Se revisaron 81 historias de pacientes con diagnóstico de pancreatitis aguda a quienes se les aplicó los Scores Ranson y APACHE II como scores predictores de severidad en el servicio de Medicina del Hospital de Nacional Dos de Mayo en el periodo que comprendió el estudio. Para el análisis descriptivo de variables cuantitativas se empleó medidas de tendencia central y de dispersión, para el análisis cualitativo se utilizó frecuencias absolutas y relativas. La valoración de los indicadores predictivos se realizó a través de la sensibilidad, especificidad, Valor Predictivo Positivo (VPP) y Valor Predictivo Negativo (VPN). El 55.6% de pacientes con pancreatitis aguda fueron varones y el 44.4%, mujeres. La edad promedio fue 50,5 años donde el rango de edad estuvo comprendido entre 24 años a 76 años. La etiología de la pancreatitis aguda más frecuente fue de tipo biliar (65.4 %). El score APACHE II permitió clasificar a los pacientes como grado severo de pancreatitis aguda al 18.5 % de ellos mientras que el score Ranson clasificó como grado severo al 14.8 % de los pacientes con pancreatitis aguda. Los Scores de Ranson y APACHE II permitieron identificar una predominancia de casos leves de pancreatitis aguda. Los resultados de TAC evidenciaron que el 48,1% tuvieron resultado normal, en los pacientes con hallazgos anormales se encontró edema de páncreas en el 7,4% y necrosis (mayor al 50%) en el 7,4%. La evaluación de los valores predictivos del score Ranson fue: Sensibilidad 57.1%, Especificidad 100%, Valor Predictivo Negativo (VPN) 86.9% y Valor Predictivo Positivo de 100%. La Sensibilidad de APACHE II fue 71.4%, Especificidad 100%, VPN 90.9% y VPP de 100%. Se observó que los scores APACHE II y Ranson poseen un buen valor predictivo positivo como negativo, lo que permite descartar severidad dentro de las 24 horas de ingreso de los pacientes con pancreatitis aguda evaluados. Los scores APACHE II y Ranson tienen la capacidad de predecir severidad de la pancreatitis aguda en todos los pacientes que son evaluados dentro de las 24 horas al ingreso, no se observó diferencias en el valor predictivo entre ambas pruebas. / Trabajo de investigación

No description available.

Magister Scientiae - MSc (Environ & Water Science) / The upper Olifants River catchment, situated in Mpumalanga Province, South Africa, is one of the main sources of water for this region. This region face challenges to guarantee future water security due to intensive land use activities e.g. mining, energy production, and agriculture activities. South Africa is the sixth largest producers of coal in the world and the Witbank (eMalahleni) coal fields, situated in the catchment, represents the largest conterminous area of active coal mining in South Africa. The second largest irrigation scheme (Loskop dam Irrigation Board) is also found below the Loskop Dam in the upper Olifants River catchment. The irrigation scheme of + - 480 km of irrigation channels provides water for a R1 Billion export industry of citric fruits to the European Union. Furthermore, the Olifants River in Mpumalanga is also a trans-boundary river that initially flows northwards before curving in an easterly direction through the Kruger National Park and into Mozambique where it joins the Limpopo River before discharging into the Indian Ocean. Although the Olifants River is one of the main river systems in South Africa, it has been described as one of the most polluted rivers in southern Africa, with Loskop Dam acting as a repository for pollutants from the upper catchment of the Olifants River system. Because Loskop Dam is of strategic important for the whole region the aim of the study was to show the implications of poor water quality on the local communities down stream of Loskop Dam that depend on water usage for their livelihood. (1) Developing a modified pollution index for the Loskop Dam, Mpumalanga Province using bioindicator algae species in relationship with water column physico-chemical parameters and national water guidelines as indication of pollution. (2) Analysing the threat of cyanobacteria, microsystin contaminations to crops irrigating by water from the Loskop Dam irrigation canals. (3) Discussing the social economic implication of water pollution on the Loskop Irrigation scheme and its stakeholders.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21632号 / 医博第4438号 / 新制||医||1034(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 生田 宏一, 教授 上本 伸二, 教授 竹内 理 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: The opioid epidemic in the United States has been on the rise. Acute exacerbations of chronic pancreatitis (AECP) patients are at higher risk for Opioid Use Disorder (OUD). Evidence on OUD's impact on healthcare utilization, especially hospital re-admissions is scarce. We measured the impact of OUD on 30-day readmissions, in patients admitted with AECP from 2010 to 2014. Methods: This is a retrospective cohort study which included patients with concurrently documented CP and acute pancreatitis as first two diagnoses, from the National Readmissions Database (NRD). Pancreatic cancer patients and those who left against medical advice were excluded. We compared the 30-day readmission risk between OUD-vs.-non-OUD, while adjusting for other confounders, using multivariable exact-matched [(EM); 18 confounders; n = 28,389] and non-EM regression/time-to-event analyses. Results: 189,585 patients were identified. 6589 (3.5%) had OUD. Mean age was 48.7 years and 57.5% were men. Length-of-stay (4.4 vs 3.9 days) and mean index hospitalization costs ($10,251 vs. $9174) were significantly higher in OUD-compared to non-OUD-patients (p < 0.001). The overall mean 30-day readmission rate was 27.3% (n = 51,806; 35.3% in OUD vs. 27.0% in non-OUD; p < 0.001). OUD patients were 25% more likely to be re-admitted during a 30-day period (EM-HR: 1.25; 95%CI: 1.16–1.36; p < 0.001), Majority of readmissions were pancreas-related (60%), especially AP. OUD cases’ aggregate readmissions costs were $23.3 ± 1.5 million USD (n = 2289). Conclusion: OUD contributes significantly to increased readmission risk in patients with AECP, with significant downstream healthcare costs. Measures against OUD in these patients, such as alternative pain-control therapies, may potentially alleviate such increase in health-care resource utilization.

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP) resulting in significant morbidity and occasional mortality. Post-ERCP pancreatitis (PEP) has been recognized since ERCP was first performed, and many studies have shown a consistent risk that must be balanced against the many benefits of this procedure. This review will discuss the pathogenesis, epidemiology, potential risk factors, and clinical presentation of PEP. Moreover, it will discuss in detail the most recent updates of PEP prevention and management.

Pancreatic ductal adenocarcinoma (PDAC) is the 3rd deadliest cancer in the United States with a projected 12% 5-year survival rate. Acinar cells have been proposed as a potential cell-of-origin for PDAC after undergoing acinar to ductal metaplasia (ADM). In the absence of oncogenic mutations (e.g. Kras), ADM lesions form as an adaptive response and eventually resolve to regenerate the acinar compartment, which we term as adaptive ADM. However, in the presence of oncogenic Kras mutations, the ADM lesions can transform to a pre-invasive state called pancreatic intraepithelial neoplasia (PanIN). Thus, a normally adaptive metaplastic response becomes maladaptive, which we term as oncogenic ADM. The mechanisms that drive PanIN formation in the context of injury and oncogenic mutations are poorly understood, resulting in an absence of targets to combat persistent ADM. This thesis investigates the role of FRA1 (gene name Fosl1) in acinar cell de-differentiation, PanIN transformation, and eventual PDAC tumorigenesis. Through CUT&RUN sequencing of mice undergoing recovery from caerulein-induced acute pancreatitis, we identify FRA1 as the most active transcription factor during KrasG12D mediated acute pancreatitis- mediated injury. We have elucidated a functional role of FRA1 by generating an acinar-specific Fosl1 knockout mouse expressing KrasG12D. Using a gene regulatory network and pseudotime trajectory inferred from single nuclei ATAC-seq and bulk-RNA seq, we hypothesize a regulatory model of the acinar-ADM-PanIN continuum and experimentally validate that Fosl1 knockout mice are delayed in the onset of ADM and PanIN. Furthermore, deletion of Fosl1 in an autochthonous PDAC mouse model revealed that this ADM-initiated delay eventually culminates in a significant survival advantage and a less aggressive tumor phenotype. Through investigation of upstream regulators of FRA1, we identified G-CSF as an ADM-promoting cytokine. Fosl1 depletion prevented the pro-inflammatory effects of G-CSF, indicating that the G-CSF/FRA1 signaling axis can modulate ADM. Using ex vivo acinar cultures, we also showed that G-CSF can induce FRA1 through MEK/ERK signaling. Our findings reveal that FRA1 is a mediator of acinar cell plasticity and contributes to acinar cell de-differentiation and malignant transformation. Although the majority of this thesis focuses on oncogenic ADM, we also include a chapter on the role of Prrx1 in adaptive ADM. Our comprehensive and unbiased approach identified previously the Paired-Related homebox1 (Prrx1) as the most upregulated transcription factor in the intersection of pancreatic ductal development, regeneration, and evolution of PanIN. We have demonstrated previously that Prrx1 can promote a ductal phenotype by binding the Sox9 promotor and inducing its expression during pancreatitis. In this body of work, we present a novel mechanism by which Prrx1 regulates maintenance of adaptive ADM. Using novel mouse models and ex vivo acinar culture systems, we demonstrate that Prrx1 can induce TGFβ signaling and reduce E-Cadherin expression to promote ADM. We do not know if there is any potential epistatic interaction between FRA1 and PRXX1. Overall, we reveal the rippling effects of FRA1 can have during the early stages of pre-neoplasia, and we unveil an alternative function of PRRX1 for stimulating an adaptive response to stress. This thesis presents a new understanding of how acinar cell de-differentiation occurs in the pancreas by revealing novel roles of two transcription factors, FRA1 and PRRX1, and furthers our understanding of tissue regeneration in an injured pancreas.

No description available.

Diss. (sammanfattning) Linköping : Univ., 2004. / I publikationen felaktig serie: Linköping studies in health sciences. Härtill 4 uppsatser.

Acute pancreatitis is a disease which can present in a mild or severe form. In the last few years, the incidence of acute pancreatitis has been steadily rising. The treatment of severe cases is complex and nutrition is one of the key treatment factors. Enteral and parenteral nutrition are documented parts of acute phase treatment included in many guidelines. However, there is a controversy about the timing of initiation of peroral nutrition after the acute phase of severe pancreatitis has resolved. This dissertation shows the results of monocentric prospective randomized trial which compares the safety and effectivity of peroral nutrition compared to enteral nutrition in patients with severe acute pancreatitis during hospitalization as well as in long term after hospital discharge. Patients with severe acute pancreatitis were randomized into two groups - enteral nutrition versus peroral nutrition. The randomized nutrition strategy was initiated within the first 14 days of hospitalization. We monitored the length of hospital stay, tolerance of nutrition, complications, body weight and nutrition parameters. The two groups did not differ significantly in the length of hospital stay. The number of complications was similar between the groups, there was no significant difference in the rate of acute...