title: Effect of necrosectomy and vacuum-assisted closure (VAC) on mitochondrial function and oxidative stress markers in severe acute pancreatitis.
abstract: BACKGROUND
  Severe acute pancreatitis (SAP) is associated with high morbidity and mortality.
  
  
  OBJECTIVE
  To evaluate whether necrosectomy, alone or combined with vacuum-assisted closure (VAC), has any additional beneficial effects on mitochondrial function and/or oxidative stress markers in SAP.
  
  
  METHODS
  Patients with SAP, APACHE II score > 8, and inadequate response to management in an intensive care unit were included in a prospective observational study. Sixteen underwent necrosectomy and 24 underwent necrosectomy plus VAC every 48 h. Patients were then categorized as survivors or deceased. Submitochondrial membrane fluidity of platelets and F0F1-ATPase hydrolysis were measured to represent mitochondrial function. Oxidative/nitrosative stress was measured using lipoperoxides (LPOs), nitric oxide (NO), erythrocyte membrane fluidity, and total antioxidant capacity (TAC).
  
  
  RESULTS
  Membrane fluidity in submitochondrial particles of platelets remained significantly increased throughout the study, and then eventually rised in deceased patients managed with necrosectomy + VAC vs. survivors (p < 0.041). Hydrolysis was significantly increased from baseline to endpoint in all patients, predominating in those who died after management with necrosectomy (p < 0.03). LPO increased in all patients, and necrosectomy was more efficient for the eventual decrease in survivors (p < 0.039). NO was found to be increased for the baseline-endpoint result among both survivors and deceased patients with both management options. Erythrocyte membrane fluidity was increased in survivors managed with necrosectomy + VAC, and eventually returned to normal (p < 0.045). TAC was found to be consumed in all patients for the duration of the study.
  
  
  CONCLUSIONS
  Mitochondrial dysfunction and oxidative/ nitrosative stress with significant systemic antioxidant consumption were found. Necrosectomy was more efficient and better cleared LPOs. Necrosectomy + VAC improved erythrocyte membrane fluidity and increased survival.
authors.forename: Alejandra Guillermina
authors.initials: AG
authors.lastname: Miranda-Díaz
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Hermosillo-Sandoval
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Gutiérrez-Martínez
authors.forename: Adolfo Daniel
authors.initials: AD
authors.lastname: Rodríguez-Carrizalez
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Román-Pintos
authors.forename: Ernesto Germán
authors.initials: EG
authors.lastname: Cardona-Muñoz
authors.forename: Fermín Paul
authors.initials: FP
authors.lastname: Pacheco-Moisés
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Arias-Carvajal
mesh_terms: D000328:Adult; D000975:Antioxidants; D005260:Female; D006801:Humans; D008297:Male; D008560:Membrane Fluidity; D008875:Middle Aged; D008928:Mitochondria / Q000378:metabolism*; D018384:Oxidative Stress; D010180:Pancreatectomy / Q000379:methods*; D010195:Pancreatitis / Q000378:metabolism* / Q000601:surgery*; D011446:Prospective Studies; D014618:Vacuum; D058106:Wound Closure Techniques
chemical_list: D000975:Antioxidants