Assessment of Usefulness of CRP, PMN Elastase, PCT and Il- 6 as Prognostic Factors in Patients with Acute Pancreatitis

Background: Acute pancreatitis is an inflammatory disease of the exocrine pancreas with rapid onset. The present study was conducted to assess the usefulness of CRP, PMN elastase, PCT and IL- 6 as prognostic factors in patients with acute pancreatitis. Subjects and Methods: The present study comprised 53 patients who presented with a diagnosis of Acute Pancreatitis. CRP was estimated by turbidimetric immunoassay using CRP/U2A-000 kit. PMN-Elastase was estimated by solid-phase enzyme immunoassay. Procalcitonin was estimated by the immuno- chromatographic test. IL-6 was estimated by Immuno-enzymatic assay. Results: There were 47 males and 6 females in the present study. The mean SD CRP in patients with mild pancreatitis was 44.35 53.04 and in severe pancreatitis was 174.80 14.55, PCT was seen in 4 in mild pancreatitis patients and 12 in severe pancreatitis patients, PMN- elastase level was 3.89 1087 in mild pancreatitis and 3.99 2.75 inn severe pancreatitis patients, IL-6 level was 129.63 319.08 in mild pancreatitis and 1166.76 818.06 in severe pancreatitis patients. The difference was significant (P< 0.05). CRP had higher (100) specificity as compared to PCT (81), PMN- E (10) and IL- 6 (90), Specificity found to be 88, 81, 97 and 94 respectively, PPV was 84, 74, 67 and 90 respectively, NPV was 100, 87, 62 and 94 respectively, accuracy was 92, 81, 62 and 92 respectively, AUC was 0.97, 0.81, 0.43 and 0.95 respectively. Conclusion: Authors found that CRP is the single best predictor of the severity of acute pancreatitis. IL-6 and PCT also are reliable predictors. PMN-Elastase needs to be assessed in patients with acute pancreatitis presenting early in the course of the illness.

Hemocompatibility of new magnetically-levitated centrifugal pump technology compared to the CentriMag adult pump

The specific hemocompatibility properties of mechanical-circulatory-support (MCS)-pump technologies have not previously been described in a comparable manner. We thus investigated the hemocompatibility-indicating marker of a new magnetically-levitated (MagLev) centrifugal pump (MT-Mag) in a human, whole-blood mock-loop for 360 min using the MCS devices as a driving component. We compared those results with the CentriMag adult (C-Mag) device under the same conditions according to ISO10993-4. Blood samples were analyzed via enzyme-linked-immunosorbent-assay (ELISA) for markers of coagulation, complement system, and the inflammatory response. The time-dependent activation of the coagulation system was measured by detecting thrombin-anti-thrombin complexes (TAT). The activation of the complement system was determined by increased SC5b-9 levels in both groups. A significant activation of neutrophils (PMN-elastase) was detected within the C-Mag group, but not in the MT-Mag group. However, the amount of PMN-elastase at 360 min did not differ significantly between groups. The activation of the complement and coagulation system was found to be significantly time-dependent in both devices. However, coagulation activation as determined by the TAT level was lower in the MT-Mag group than in the C-Mag group. This slight disparity could have been achieved by the optimized secondary flow paths and surface coating, which reduces the interaction of the surface with blood.

Comparison of Multifactor Vs Independent Marker in Predicting Severity of Acute Pancreatitis

Background: Acute pancreatitis (AP) is an inflammatory process with a highly variable clinical course. This study was conducted to compare the multifactor vs independent marker in predicting the severity of acute pancreatitis. Subjects and Methods: The present study comprised of 50 patients of acute pancreatitis. In all patients, reactive protein (CRP), Interleukin-6 (IL-6), PMN-Elastase (PMN-E), Procalcitonin (PCT), RANSON”s score, GLASGOW score, APACHE-II score, APACHE-O score and Balthazar’s CTSI score was recorded. Results: There were 45 males and 5 females in the study. There were 12 (22.64%) obese patients in this study. The age of the patients was a significant indicator to discriminate or predict patients with mild or severe pancreatitis. With an AUROC of 0.6004, it was found that age was a poor predictor of the severity of acute pancreatitis. Obesity of the patients was a significant indicator to discriminate or predict patients with mild or severe pancreatitis. With an AUROC of 0.6004, it was found that age is a poor predictor of the severity of acute pancreatitis. Organ failure at admission is more likely to reflect severe cases, it is found to be a poor predictor of severity in acute pancreatitis. The mean CTSI score in the study was 3.57 (SD 2.64), with a median of 2 and ranged from 1 to 10. It was higher in severe pancreatitis and a CTSI score of >=3 was significantly associated with patients with acute pancreatitis by bivariate analysis. Conclusion: The authors found that overall, CRP was the best predictor, followed by IL-6, CTSI score, PCT, Glasgow, Ranson’s and APACHE-II. PMN-Elastase, Age, obesity and organ failure at admission are poor predictors of severity of acute pancreatitis.

DIAGNOSTIC FEATURES OF PSEUDOCYST WALL FORMATION AND INFLAMMATORY ACTIVITY IN CHRONIC PANCREATITIS

Summary. Objective. To increase the efficiency of diagnostics in determining the wall formation of the pancreatic pseudocyst and the activity of the inflammatory process. Materials and methods. A total of 99 patients were examined who underwent digestive tract surgery from 2006 to 2019 with pseudocyst that developed on the background of acute and chronic pancreatitis. There were 73 males (73.74 %), 26 females (26.26 %), 21 to 74 years of age (47.55–2.4 years). Based on the morphological data of the biopsy material, pancreatic pseudocyst (PC) wall formation and inflammatory activity in chronic pancreatitis, patients were divided into two representative groups: Group I (n = 41) — patients with formed wall of PC, group II (n=58) — patients with unformed PC wall. Morphology data were compared with the data of immunological parameters and radiation diagnostic methods. Results. The TNF-α/IL-10 ratio was higher (p <0.05) in patients in group II than in group I. To differentiate the activity of inflammation, a threshold value of 1.4 was set (sensitivity — 86.7 %, specificity — 59.1 %). The IL-6/IL-10 ratio was higher (p <0.05) in group II patients, which also indicated an imbalance of pro- and anti-inflammatory mediators and was characteristic of active inflammation. The threshold value of the ratio of IL-6/IL-10, above which patients were diagnosed with active inflammation in the PC wall — less than or equal to 1.1 (sensitivity — 91.7 %, specificity — 84.6 %). In group II patients, the level of PMN-elastase was higher (p<0.05) than in group I, which indicated the activity of inflammation. Threshold of fecal PMN-elastase, above which patients were diagnosed with active inflammation of PC wall less than or equal to 84 ng/ml (sensitivity — 90.9 %, specificity - 66.7 %). 3. According to ultrasound/MSCT, the wall thickness of PC in group I was (4.41±0.49)/(4.27±2.02) mm, in group II (2.50±0.52)/(2.75±1.44) mm, which is probably less than 1.7 times and 1.6 times (p <0.05) with the unformed PC wall. According to SWE, the threshold value of the average stiffness values ​​of the PC wall, above which it was diagnosed, was> 7.6 kPa (sensitivity — 80.0 %, specificity 78.9 %). Conclusions. Indices of TNF-α/IL-10, IL-6/IL-10, PMN-elastase, ultrasound, MSCT, SWE have been determined, which allow to evaluate the formation of PC wall and the activity of the inflammatory process.

Regulation of Salivary Peptidoglycan Recognition Protein 1 in Adolescents

Introduction: Peptidoglycan recognition protein 1 (PGLYRP1), a member of peptidoglycan recognition proteins, is known to be involved in the proinflammatory response toward bacterial infections. Recently, PGLYRP1 was identified as a ligand for triggering receptor expressed on myeloid cells 1 (TREM-1). Although PGLYRP1 is involved in immune and inflammatory responses, its levels in initial stages of periodontal disease in adolescents are currently unknown. Objectives: We aimed to investigate salivary levels of PGLYRP1 and its correlation with TREM-1, polymorphonuclear leukocyte elastase (PMN elastase), and an active matrix metalloproteinase 8 (aMMP-8) in adolescents. Methods: Whole saliva samples (n = 537) were collected from 15- to 16-y-old adolescents at Kotka Health Center, Finland, prior to periodontal examination, including measurement of periodontal pocket depth (PPD), visible plaque index (VPI), and bleeding on probing (BOP). Adolescents, clustered as periodontally healthy, gingivitis, or subclinical periodontitis, were tested for salivary levels of TREM-1, PGLYRP1, and PMN elastase by enzyme-linked immunosorbent assay and aMMP-8 by a time-resolved immunofluorometric assay (IFMA). Results: Salivary levels of PGLYRP1 and aMMP-8 were significantly higher in adolescents with subclinical periodontitis and gingivitis compared to individuals with healthy periodontium. TREM-1 and PMN elastase levels were higher in adolescents with subclinical periodontitis compared to healthy individuals but did not reach significance. PGLYRP1 correlated positively with BOP, PPD, VPI, aMMP-8, and TREM-1. Conclusions: Elevated PGLYRP1 levels in adolescents with gingivitis and subclinical periodontitis and its positive correlation with TREM-1 and aMMP-8 may indicate an association of PGLYRP1 with initial stages of periodontal disease. Sex and poor oral hygiene but not smoking are also associated with higher levels of PGLYRP1. However, PGLYRP1 has a lower discriminating capacity and is therefore a less reliable marker alone in the diagnosis of initial stages of periodontal disease in adolescents. Knowledge Transfer Statement: PGLYRP1, a member of peptidoglycan recognition proteins, is a ligand for TREM-1. Elevated PGLYRP1 levels in adolescents with gingivitis and subclinical periodontitis and its positive correlation with TREM-1 and aMMP-8 may indicate an association of PGLYRP1 with initial stages of periodontal disease. However, it has a lower discriminating capacity and is therefore a less reliable marker alone in the diagnosis of periodontal disease in adolescents.

Correlation of PMN elastase and PMN elastase-to-neutrophil ratio with disease activity in patients with myositis

Background Polymorphonuclear (PMN) elastase plays an important role in a variety of inflammatory disorders. Our aim was to analyse PMN elastase in idiopathic inflammatory myopathies (IIMs) and its association with disease activity. Methods PMN elastase levels were measured using enzyme-linked immunosorbent assay in serum samples obtained from 74 patients with myositis (58 with dermatomyositis [DM] and 16 with polymyositis [PM]) and 22 healthy controls. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminant capacity of PMN elastase level and PMN elastase-to-neutrophil ratio (ENR) in patients with active and remission myositis. The association of serum PMN elastase level and ENR with disease variables was evaluated in patients with IIMs. The disease specificity of PMN elastase level and ENR was further examined in 60 patients with other systemic autoimmune diseases. Results PMN elastase level and ENR were significantly higher in patients with active IIMs, DM, and PM than in patients with remission. ROC curve analysis revealed that PMN elastase level and ENR both outperformed creatine kinase (CK), the currently used laboratory marker, and strongly discriminated patients with active disease and those with remission of IIMs, DM, and PM (area under the ROC curve [AUC] 0.9, 0.9, and 0.88 for PMN elastase; AUC 0.96, 0.96, and 1.0 for ENR; AUC 0.72, 0.70, and 0.80 for CK, respectively). PMN elastase level and ENR were positively correlated with myositis disease activity assessment, CK, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, and erythrocyte sedimentation rate. PMN elastase level and ENR were higher in the anti-PM-Scl positive myositis group than those in the anti-PM-Scl negative myositis group. Nevertheless, PMN elastase was not a specific disease marker for IIMs when compared with other autoimmune diseases. Conclusions PMN elastase, particularly ENR, were significantly correlated with disease activity and could serve as useful biochemical markers for evaluating the disease activity of patients with IIMs. Thus, they are potentially helpful in monitoring disease progression and guiding treatment.