Diagnostic Value of Serum Amylase Levels Indicating Computed Tomography-Defined Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Prospective Multicenter Observational Study.

Objective:Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis involves persistent serum amylase levels of 3 times or more the standard upper limit. However, these criteria were mostly based on retrospective studies and not necessarily supported by diagnostic imaging. Our prospective study aimed to investigate cutoff serum amylase levels suggesting post-ERCP pancreatitis using computed tomography as the criterion standard.Methods:We prospectively followed 2078 cases. Computed tomography was performed in patients whose serum amylase levels exceeded the institutional upper limit 12 to 24 hours after ERCP. Two expert radiologists blindly assessed the images and judged the presence or absence of pancreatitis. Correlations between serum amylase levels with pancreatitis were investigated using receiver operating characteristic analysis.Results:Amylase levels increased in 416 (23.2%) of 1789 cases included, and 350 cases were analyzed using computed tomography. Post-endoscopic retrograde cholangiopancreatography pancreatitis was diagnosed in 12.0% (214/1789). The cutoff amylase levels for judging pancreatitis after 12 to 24 hours was 2.75 times higher than the institutional upper limit, with an area under the curve of 0.77.Conclusions:The appropriate cutoff serum amylase level for judging post-ERCP pancreatitis at 12 to 24 hours after ERCP was 2.75 times higher than the institutional upper limit. These results may clarify the definition of post-ERCP pancreatitis

Fish oil accelerates diet-induced entrainment of the mouse peripheral clock via GPR120

The circadian peripheral clock is entrained by restricted feeding (RF) at a fixed time of day, and insulin secretion regulates RF-induced entrainment of the peripheral clock in mice. Thus, carbohydrate-rich food may be ideal for facilitating RF-induced entrainment, although the role of dietary oils in insulin secretion and RF-induced entrainment has not been described. The soybean oil component of standard mouse chow was substituted with fish or soybean oil containing docosahexaenoic acid (DHA) and/or eicosapentaenoic acid (EPA). Tuna oil (high DHA/EPA), menhaden oil (standard), and DHA/EPA dissolved in soybean oil increased insulin secretion and facilitated RF-induced phase shifts of the liver clock as represented by the bioluminescence rhythms of PER2::LUCIFERASE knock-in mice. In this model, insulin depletion blocked the effect of tuna oil and fish oil had no effect on mice deficient for GPR120, a polyunsaturated fatty acid receptor. These results suggest food containing fish oil or DHA/EPA is ideal for adjusting the peripheral clock

AIN-93M diet chow containing various fish oils or DHA/EPA dissolved in soybean oil and RF-induced phase shifts of the liver and SCN circadian clock.

<p>(A, C) mice were fed an AIN-93M diet tablet containing various substituted oils at ZT0 for 2 days or 7 days, and bioluminescence rhythm was recorded after sacrifice on Day 3 or Day 8. The horizontal axis indicates projected Zeitgeber time (pZT) at the peak of the bioluminescence rhythm. ZT0 is lights-on time and ZT12 is lights-off time in the housing room prior to sacrifice. (A) experimental protocol. RF was applied for 2 days at ZT0. (B) de-trended expression rhythms of the liver PER2::LUCIFERASE bioluminescence in mice under RF of an AIN-93M diet containing tuna oil (arrows) or soybean oil (arrow heads) for 2 days at ZT0. The horizontal line indicates time lapse. (C) magnitude of phase delay by fish oil-containing AIN-93M diet chow for 2 days at ZT0. A control experiment was prepared under free feeding conditions (closed triangle, FF). SB (7 days) shows the magnitude of the phase shifts by 7-day RF of soybean oil-containing AIM-93M at ZT0–ZT4 (Values are expressed as mean ± SEM. **<i>P</i> < 0.01, ***<i>P</i> < 0.001 (vs. SB, control chow, Dunn test). #<i>P</i> < 0.05, ###<i>P</i> < 0.001 [vs. SB, (FF), Dunn test]. (D) magnitude of phase-delay or phase-advance by DHA/EPA-containing AIN-93M diet chow. SB, soybean; FF, free-feeding. Numbers in parentheses indicate the number of tested mice. Values are expressed as mean ± SEM. *<i>P</i> < 0.05, **<i>P</i> < 0.01, ***<i>P</i> < 0.001 (vs. SB, control chow, Tukey-Kramer test).</p

AIN-93M diet chow containing tuna oil and DHA/EPA and RF-induced insulin secretion.

<p>(A, B) on Day 2 under RF conditions, mice were fed an AIN-93M diet containing tuna, menhaden, soybean, DHA/EPA-containing soybean oil or without oil at ZT0; mice were sacrificed at 60 min, 120 min, or 240 min after feeding of fish oil (A) and 120 min after feeding of DHA/EPA (B). Serum insulin levels were measured. SB, soybean; w/o oil, without oil. Numbers in parentheses indicate the number of tested mice. Values are expressed as mean ± SEM. *<i>P</i> < 0.05 (vs. SB control chow, Tukey-Kramer test).</p

Effect of oral administration of fish oil or soybean oil containing DHA and/or EPA alone at daytime under free-feeding conditions on phase shifts and insulin level.

<p>(A) magnitude of phase shifts induced by tuna oil or soybean oil containing DHA and/or EPA administration at ZT0 for 2 days under free-feeding conditions. Tuna oil, soybean oil, DHA- or EPA-containing oil was administered at 0.034 ml/10 g BW for 2 days, and mice were sacrificed to examine the phase of bioluminescence of liver on Day 3. (B) tuna oil, menhaden oil, or DHA-containing oil was administered at 0.034 ml/10 g BW at ZT0 under free-feeding conditions, and mice were sacrificed 2 h after injection to examine serum insulin level. *<i>P</i> < 0.05 (vs. SB group, Tukey-Kramer test). Numbers in parentheses indicate the number of tested mice.</p