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- Appelros, Stefan, et al.
(författare)
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Activation peptide of carboxypeptidase B and anionic trypsinogen as early predictors of the severity of acute pancreatitis.
- 2001
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 88:2, s. 216-221
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Tidskriftsartikel (refereegranskat)abstract
- Summary Background Early prediction of severity is important in the management of patients with acute pancreatitis. The presence of activation peptides and certain pancreatic proenzymes in plasma and urine has been shown to correlate with severity. This study was designed to assess the value of measuring levels of the activation peptide of carboxypeptidase B (CAPAP) and of anionic trypsinogen. Methods Concentrations of CAPAP and anionic trypsinogen were measured in the urine and serum in 60 patients with acute pancreatitis. Preset cut-off levels were used to analyse the accuracy of the tests. Severity was classified retrospectively according to the Atlanta classification. Results Concentrations of CAPAP in urine and serum and of anionic trypsinogen in urine correlated with the severity of the pancreatitis. CAPAP in urine showed the highest accuracy. The overall accuracy was 90 per cent, with a positive predictive value of 69 per cent and a negative predictive value of 98 per cent. Conclusion In this study, measurement of CAPAP in urine was an accurate way to predict the severity of acute pancreatitis, and was superior to assay of anionic trypsinogen in urine and serum. Measurement of CAPAP in urine may be of value in the management of individual patients with pancreatitis and in the selection of patients for therapeutic trials.
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| 4. |
- Hultqvist, Kenneth, et al.
(författare)
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Staten, subjektet och pedagogisk teknologi. : En nutidshistorisk studie av politiska epistemologier och styrningsmentaliteter i det tidiga 2000-talet.
- 2002
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- In the early 2000, increasingly more institutions regard their activities as pedagogical or educationaL The libraries, the museum, correction care and public health, to mention a few of these institutions, all of them tend to rely on the "pedagogical paradigm" when reasoning about their activities. Thus we seem to live in a society where increasingly more phenomena become codified as educational. This trend towards a society as school creates a broad surjdcefor the inscriptions of pedagogy and pedagogical technology. The purpose of this study is making a history of ihe present analysis of the emergence of to use a loose term the pedagogical paradigm. To highlight this change we have chosen four institutioal fields: The teacher's education, the people´s library, people´s health and correction care. The empirical sources are historical texts from the period I8OOs -2OOOs.
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| 6. |
- Petersson, Ulf, et al.
(författare)
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Enzyme leakage, trypsinogen activation, and inflammatory response in endoscopic retrograde cholangiopancreatography-induced pancreatitis.
- 2002
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Ingår i: Pancreas. - 0885-3177. ; 24:4, s. 321-328
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis (EIP) provides an opportunity to study different pathophysiologic events early in the course of acute pancreatitis. AIMS: To investigate whether the leakage of pancreatic proenzymes (anionic trypsinogen), pancreatic protease activation (carboxypeptidase B activation peptide), cytokine response (interleukin [IL]-1 receptor antagonist, IL-6, and soluble tumor necrosis factor receptor-I) and neutrophil activation (neutrophil gelatinase-associated lipocalin and polymorphonuclear elastase) differ between patients with and without EIP. A second aim was to clarify the temporal relation between these different events. METHODOLOGY: Ninety-nine nonconsecutive patients undergoing ERCP were investigated in the study. RESULTS: Fourteen of 99 patients undergoing ERCP developed mild EIP. Six hours after the investigation the concentration of anionic trypsinogen was significantly higher in patients with EIP than in patients without EIP. The day after ERCP, higher concentrations of anionic trypsinogen, carboxypeptidase B activation peptide, IL-6, and polymorphonuclear elastase were recorded in the EIP group. No significant differences in IL-1 receptor antagonist, soluble tumor necrosis factor receptor-I or neutrophil gelatinase-associated lipocalin were found between the groups in this study. CONCLUSION: Mild EIP was accompanied by early leakage of proenzymes and later activation of trypsinogen/proteases. A significant cytokine response and neutrophil activation were recorded the day after ERCP, but further studies are needed to determine the temporal relation between these different pathophysiologic events.
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| 7. |
- Petersson, Ulf
(författare)
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Trypsinogen and Its Activation in Acute Pancreatitis
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pancreatic enzymes, neutrophils, free radicals and cytokines are involved in the pathophysiology of AP. Clarification of their interaction and time-course will improve our understanding of AP and provide a better basis for treatment. 20% will develop severe AP and benefit from improved treatment why an accurate test for prediction of severity is needed. Aims: To investigate the interactions between those factors and the accuracy of markers of proenzyme leakage (anionic and cationic trypsinogen=ATg and CTg) and free trypsin activity (carboxypeptidase B activation peptide =CAPAP) as predictors of severity. Free radical action may lead to intracellular enzyme activation. Diminished activation of Tg was found one-three days after pancreas transplantation in pigs, when allopurinol treatment was given. Thus, early intracellular events are of importance for later extracellular activation of Tg which, may be due to autoactivation or be secondary to inflammation. We found no proof of inflammation or neutrophil activation preceding the activation of Tg in ERCP- induced AP, indicating primary Tg-activation in AP. ATg but not CTg levels in urine correlated to severity in human AP but the specificity was too low for clinical use as a severity predictor. We developed a TAP-assay (Tg activation peptide) and could show an instable immunoreactivity in serum, and that the immunoreactivity in urine consists of a degradation product of TAP. CAPAP is not degraded after sampling. CAPAP is superior to ATg as a severity predictor, according to our study where pre-set cut-off levels were used. In conclusion: 1) Tg activation is a central event in the pathophysiology of AP, 2) free radicals is of importance for this, probably extracellular activation, 3) inflammation could not be shown to precede Tg activation, 4) TAP is degraded in the circulation and is recovered as a pentapeptide in urine in AP, and 5) CAPAP is an accurate predictor of severity in human AP.
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