A stable and reliable infected necrotizing pancreatitis (INP) model in rats was established in order to study the pathophysiological mechanism and pathological development rule of INP and explore the new therapeutic methods for the diseases. Forty-six SD rats were randomly divided into 5 groups. The animals in group A received the injection of 5% sodium taurocholate into the pancreatic duct and those in group B underwent that of E. coli into the pancreatic duct. The rats in groups C, D and E were subjected to the injection of 5% sodium taurocholate in combination with different concentrations of E. coli (10(3), 10(4), 10(5)/mL, respectively) into the pancreatic duct. The dose of injection was 0.1 mL/100 g and the velocity of injection was 0.2 mL/min in all the 5 groups. Eight h after the injection, the survival rate of animals was recorded and the surviving rats were killed to determine the serum content of amylase and perform pathological examination and germ cultivation of the pancreatic tissue. The results showed that acute necrotizing pancreatitis model was induced by injection of 5% sodium taurocholate into the pancreatic duct. The positive rate of germ cultivation in group A was 12.5%. The acute necrotizing pancreatitis model was not induced by injection of E. coli into the pancreatic duct and the positive rate of germ cultivation in group B was 0. The INP model was established in groups C to E. The positive rate of germ cultivation was 60%, 100% and 100% and 8-h survival rate 100%, 100% and 70% in groups C, D and E, respectively. It was concluded that a stable and reliable model of INP was established by injection of 5% sodium taurocholate in combination with 10(4)/mL E. coli into the pancreatic duct with a dose of 0.1 mL/100 g and a velocity of 0.2 mL/min. The pathogenesis of INP might be that the hemorrhage and necrosis of pancreatic tissue induced by sodium taurocholate results in weakness of pancreatic tissue in fighting against the germs. Meanwhile, the necrotic pancreatic tissue provides a good proliferative environment for the germs.
Cholagogues and Choleretics/*pharmacology ; Disease Models, Animal ; Escherichia coli/*metabolism ; Injections, Intraperitoneal ; Pancreas/enzymology ; Pancreas/microbiology ; Pancreatic Ducts/enzymology ; Pancreatic Ducts/microbiology ; Pancreatitis, Acute Necrotizing/*chemically induced ; Pancreatitis, Acute Necrotizing/*microbiology ; Rats, Sprague-Dawley ; Taurocholic Acid/*pharmacology ; Time Factors

OBJECTIVETo explore risk factors and infection characteristics of secondary pancreatic infection in severe acute pancreatitis (SAP).

METHODSA clinical data of 49 patients with secondary pancreatic infection in severe acute pancreatitis (SPI group)were matched with 49 patients without infection in severe acute pancreatitis (NSPI group) between January 2003 and December 2005. The two groups were analyzed by a case-control study. Conditional Logistic regression model univariate and multivariate were used to screen out risk factors. The types of infection, the peak infection and the bacteria spectrum were analyzed in SPI group.

RESULTS(1) In univariate Logistic regression analysis, 7 factors including continuous hypoalbuminemia, prolonged time of central venous catheter, usage of hormone, high APACHE II scores, multi-antibiotics, intestine dysfunction and continuous hyperglycemia were selected out. Moreover, the first three were statistically significant in multivariate Logistic regression analysis. (2) Pancreatic abscess ranked first in SPI group. Of all the pancreatic infection, 22.5% occurred within two weeks and 71.4% occurred in the 4th week or later. (3) In SPI group, 81 strains of microorganisms were cultured, including 45 strains of gram-negative bacteria (55.6%), 22 strains of gram-positive bacteria (27.2%), and 14 strains of fungi (17.3%). The common gram-negative bacteria were Escherichia coli, and the common gram-positive bacteria were Staphylococci and Enterococci. The fungi included Monilia and Yeastoid fungus. Further study revealed that 35 strains of all the microorganisms were intestinal bacteria (43.2%).

CONCLUSIONSContinuous hypoalbuminemia, prolonged time of central venous catheter and usage of hormone were independent risk factors of SPI. The main type of infection was pancreatic abscess. Gram-negative bacteria, were the common bacteria causing secondary pancreatic infection.

Adult ; Aged ; Bacterial Infections ; etiology ; microbiology ; Case-Control Studies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Pancreatitis ; etiology ; microbiology ; Pancreatitis, Acute Necrotizing ; complications ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the method and effect of percutaneous nephroscopic necrosectomy (PNN) for post-operatively resident infection of severe acute pancreatitis (SAP).

METHODSData of the 15 SAP patients with post-operatively resident infection treated by PNN from June 2008 to December 2014 in Chinese People's Liberation Army General Hospital were reviewed. Twelve of the patients underwent the laparotomy within 1 week, 1 in 3(rd) week, 1 in 4(th) week and the other one on the 127(th) day. All of the referrals firstly received (multi-)percutaneous catheter drainage (PCD), and then PNN operation according to the disease, followed by continuous irrigation-drainage.

RESULTSEleven patients were healed after received only one PNN operation, 2 patients for twice, 1 for three times and 1 for four times. The average post-operative time of hospital stay was 66.2 days (10-223 days). The complications after operation contained colon fistula (n = 1), abdominal hemorrhage (n = 1), pancreatic pseudocyst (n = 1), severe pulmonary infection (n = 1). Three patients eventually died.

CONCLUSIONSPercutaneous nephroscopic necrosectomy is a minimally invasive approach which could prevent the complicated re-laparotomy operation, result in less complication. It is an ideal method for treating SAP patients with post-operatively resident infection.

Drainage ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Operative Time ; Pancreatitis, Acute Necrotizing ; complications ; surgery ; Postoperative Complications ; microbiology ; Reoperation

OBJECTIVETo observe the effects and mechanism of Qingyi II Granules (QYG) on the bacterial translocation in rats with acute necrotizing pancreatitis (ANP).

METHODSEighteen Sprague-Dawley rats were randomized equally into 3 groups, the sham-operated group (A), the ANP model group (B) and the treated group (C). Rats in Group B and C were established into ANP model by retrograde injection of 30 g/L sodium taurocholate into pancreatobiliary duct. QYG was administered, beginning from 1 h after modeling, for three times (every 6 h) per day via intragastric infusion to Group C in dose of 10 mL/kg (250 g/L), while to the other two groups, equal volume of saline was infused instead. All animals were sacrificed 24 h after modeling. The contents in mesenteric lymph nodes and distant sites (liver, spleen, pancreas) were taken for bacterial culture and strain identification, the expression of high mobility group box 1 (Hmgb1) mRNA in ileal tissue was assayed by real-time PCR; the levels of nitric oxide (NO) and endothelin-1 (ET-1) were determined by ELISA; the wet/ dry ratio of ileum was measured; and the pathologic features of pancreas and ileum were examined respectively.

RESULTSIn Group B, evident pathological injury in pancreas and ileum was shown, expression of Hmgb1 mRNA up-regulated, levels of NO and ET-1 in ileum tissues increased to 1.67 +/- 0.21 micromol/L and 102.18 +/- 9.19 ng/L respectively, and the bacterial counts in the mesenteric lymph nodes and distant sites increased significantly. Compared with Group B, the level of NO and ET-1 reduced to 1.39 +/- 0.23 micromol/L and 83.15 +/- 5.39 ng/L, respectively in Group C, with all the above-mentioned abnormal changes alleviated significantly.

CONCLUSIONLevels of Hmgb1, NO and ET-1 might play important roles in the ANP model rats with intestinal bacterial translocation. QYG shows effects on preventing the intestinal bacterial translocation by way of down-regulate the Hmgb1 mRNA expression, lowering the concentration of NO and ET, and ameliorating the injury of pancreatic and ileum tissues.

Animals ; Bacterial Translocation ; Disease Models, Animal ; Drugs, Chinese Herbal ; therapeutic use ; Endothelin-1 ; analysis ; HMGB1 Protein ; metabolism ; Intestinal Mucosa ; microbiology ; Intestines ; microbiology ; Nitric Oxide ; analysis ; Pancreatitis, Acute Necrotizing ; drug therapy ; microbiology ; Phytotherapy ; Rats ; Rats, Sprague-Dawley