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Kenichi Takahashi

Publications and source records attributed to Kenichi Takahashi.

At least 19 recordsLinked to original sources

The reactions of heme- and verdoheme-heme oxygenase-1 complexes with FMN-depleted NADPH-cytochrome P450 reductase. Electrons required for verdoheme oxidation can be transferred through a pathway not involving FMN.

Electrons utilized in the heme oxygenase (HO) reaction are provided by NADPH-cytochrome P450 reductase (CPR). To investigate the electron transfer pathway from CPR to HO, we examined the reactions of heme and verdoheme, the second intermediate in the heme degradation, complexed with rat HO-1 (rHO-1) using a rat FMN-depleted CPR; the FMN-depleted CPR was prepared by dialyzing the CPR mutant, Y140A/Y178A, against 2 m KBr. Degradation of heme in complex with rHO-1 did not occur with FMN-depleted CPR, notwithstanding that the FMN-depleted CPR was able to associate with the heme-rHO-1 complex with a binding affinity comparable with that of the wild-type CPR. Thus, the first electron to reduce the ferric iron of heme complexed with rHO-1 must be transferred from FMN. In contrast, verdoheme was converted to the ferric biliverdin-iron chelate with FMN-depleted CPR, and this conversion was inhibited by ferricyanide, indicating that electrons are certainly required for conversion of verdoheme to a ferric biliverdin-iron chelate and that they can be supplied from the FMN-depleted CPR through a pathway not involving FMN, probably via FAD. This conclusion was supported by the observation that verdoheme dimethyl esters were accumulated in the reaction of the ferriprotoporphyrin IX dimethyl ester-rHO-1 complex with the wild-type CPR. Ferric biliverdin-iron chelate, generated with the FMN-depleted CPR, was converted to biliverdin by the addition of the wild-type CPR or desferrioxamine. Thus, the final electron for reducing ferric biliverdin-iron chelate to release ferrous iron and biliverdin is apparently provided by the FMN of CPR.

Animals↗

Relationship of stopped flow to steady state parameters in the dimeric copper amine oxidase from Hansenula polymorpha and the role of zinc in inhibiting activity at alternate copper-containing subunits.

The expression of a copper amine oxidase (CAO) from Hansenula polymorpha in Saccharomyces cerevisiae under differing culture conditions leads to the incorporation of varied levels of CAO-bound zinc. The presence of substantial amount of zinc results in two distinctive enzyme species, designated as the fast and slow enzymes. Both forms are rapidly reduced by substrate methylamine with a rate constant of 199 s(-1) but behave remarkably differently in their oxidation rates; the fast enzyme is oxidized by dioxygen at a rate of 22.1 s(-1), whereas the slow enzyme reacts at a rate of 1.8 x 10(-4) s(-1). The apparent kcat of the enzyme preparation is linearly proportional to the fraction of the fast enzyme, with an extrapolated value of 6.17 s(-1) when the enzyme is 100% in its "fast" form. A comparison of rate constants for cofactor reduction and reoxidation steps, measured in stopped flow experiments, to the extrapolated kcat implicates additional steps in the steady state reaction. Measurement of the proportion of oxidized (ETPQ(ox)) and reduced cofactor (ETPQ(red)) under steady state conditions indicates approximately 50% of each cofactor form at 0.8 or 2 mM methylamine. Kinetic isotope effect measurements using deuterated amine substrate lead to the following steady state values: (D)(k(red)) = 8.5 (0.5), (D)(kcat) = 1.7 (0.1), and (D)(kcat/K(m)) = 4.3 (0.2). The collective data allow the calculation of partially rate-determining constants during the reductive half-reaction (ca. 200 s(-1) for binding of substrate to ETPQ(ox) and 27.9 s(-1) for release of aldehyde product or a protein isomerization from ETPQ(red)); an additional step with a rate constant of 13.2 s(-1) is assigned to the oxidative half-reaction, most likely for the release of product hydrogen peroxide. These results, together with the sole detection of oxidized and reduced cofactor during rapid scanning stopped flow experiments, indicate that four steps contribute to kcat, with the first electron transfer from cofactor to O2 contributing ca. 29%. An investigation of the relationship between the copper content and the extent of the fast enzyme shows that only the copper-containing homodimer is capable of rapid reoxidation and that zinc-copper heterodimers are incapable of rapid turnover at either subunit. This implies communication between the metal sites of the two subunits per dimer that impacts O2 binding and/or electron transfer from reduced cofactor to bound O2.

Amine Oxidase (Copper-Containing)↗

[Jaw evolution and function of mastication].

Gnathostomata improved the brachial cartilages of Agnahta into jaws. At the same time, such a jaw formation resulted not only in the development of eye, nose, and ear for searching foods but also in the development of brain which regulates the functions of these sense organs and mastication muscles. In this paper, we described about the muscles, mouth, tongue, and jaw which participate in mastication from a view point of morphology and molecular biology.

Animals↗

[A case of large cell carcinoma of the lung with rhabdoid phenotype].

A 37-year-old man was admitted to our hospital because of suspicion of the lung cancer in November 2003. Transbronchial tumor biopsy revealed a small number of tumor cells with rhabdoid features, which had eosinophilic cytoplasmic globules. However, a definitive histological diagnosis was not obtained. We considered that a diagnosis of lung malignant tumor was likely according to the findings of chest CT scan and pathology. Although radiotherapy reduced the tumor size, he started to have abdominal pain and tarry stool one month after radio therapy. Multiple small intestine metastases were detected by gastroenterological endoscopy. The patient died due to bleeding from these metastatic lesions in May 2004. Immunohistologic staining of the cervical lymph node showed that rhabdoid cells were positive for epithelial membrane antigen (EMA), vimentin, and anticytokeratin antibody (CAM5.2), but not for thyroid transcription factor-1 (TTF-1). From the autopsy findings and clinical course, he was finally diagnosed with large cell carcinoma of the lung with rhabdoid phenotype. Because of its aggressive clinical course, early diagnosis and decision on therapy would be very important for this disease.

Adult↗

A kinetic study of the mechanism of conversion of alpha-hydroxyheme to verdoheme while bound to heme oxygenase.

O2-dependent reactions of the ferric and ferrous forms of alpha-hydroxyheme complexed with water-soluble rat heme oxygenase-1 were examined by rapid-scan stopped-flow measurements. Ferric alpha-hydroxyheme reacted with O2 to form ferric verdoheme with an O2-dependent rate constant of 4x10(5) M(-1) s(-1) at pH 7.4 and 9.0. A decrease of the rate constant to 2.8x10(5) M(-1) s(-1) at pH 6.5 indicates that the reaction proceeds by direct attack of O2 on the pi-neutral radical form of alpha-hydroxyheme, which is generated by deprotonation of the alpha-hydroxy group. The reaction of ferrous alpha-hydroxyheme with O2 yielded ferrous verdoheme in a biphasic fashion involving a new intermediate having absorption maxima at 415 and 815 nm. The rate constants for this two-step reaction were 68 and 145 s(-1). These results show that conversion of alpha-hydroxyheme to verdoheme is much faster than the reduction of coordinated iron (<1 s(-1)) under physiological conditions [Y. Liu, P.R. Ortiz de Montellano, Reaction intermediates and single turnover rate constants for the oxidation of heme by human heme oxygenase-1, J. Biol. Chem. 275 (2000) 5297-5307], suggesting that, in vivo, the conversion of ferric alpha-hydroxyheme to ferric verdoheme precedes the reduction of ferric alpha-hydroxyheme.

Animals↗

Aldosterone enhances 11beta-hydroxysteroid dehydrogenase type 2 expression in colonic epithelial cells in vivo.

OBJECTIVE: [corrected] 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) metabolizes glucocorticoids, thus enabling aldosterone to bind to the mineralocorticoid receptor. However, little is known about the regulatory mechanism of epithelial 11beta-HSD2 expression in the gut. MATERIALS AND METHODS: Sprague-Dawley rats were maintained on a sodium-depleted diet or subjected to continuous aldosterone infusion for 4 weeks. Plasma aldosterone and arginine-vasopressin (AVP) levels were measured by radioimmunoassay. Expression of 11beta-HSD2 in colonic epithelia was evaluated by Northern blotting and immunohistochemistry. T84 and Caco2 cells were stimulated with aldosterone, dexamethasone and AVP alone or in combination, and 11beta-HSD2 mRNA was measured by quantitative reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Sodium-depleted and aldosterone-infused rats showed an increase of plasma aldosterone and AVP. Both treatments resulted in induction of 11beta-HSD2 in the colonic epithelia at mRNA and protein levels. Positive immunoreactivity was detected in the cytoplasm of the surface epithelia in control rats. In contrast, epithelial cells in the crypt also showed immunoreactivity for 11beta-HSD2 in the proximal colon of dietary sodium-depleted and aldosterone-infused rats. Induction of 11beta-HSD2 mRNA was observed when T84 cells were stimulated with corticosteroids plus AVP. CONCLUSIONS: Aldosterone has a pivotal role by increasing expression of 11beta-HSD2 in epithelial cells of the colon. AVP may act as a synergistic hormone in aldosterone-mediated 11beta-HSD2 induction.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗

[Ontogeny of the jaw].

Four pairs of branchial arch appear apparently in the neck region of human embryo about 32 days after fertilization. Maxillary prominence of the first branchial arch gives rise to the maxilla and zygomatic bone etc., and mandibular prominence forms the mandible and so on. Muscles for mastication are also derived from 1st branchial arch, into which fifth cranial nerves grow from the brain. Thus, human embryo improves the 1st branchial arches into the upper and lower jaws, and forms digestive organs needed for intake, mastication, and swallowing of foods. Finally they develop the brain for integral treatment of sensory information from eyes, tongue, nose, and ears.

Brain↗

Response shift in perception of sleepiness in obstructive sleep apnea-hypopnea syndrome before and after treatment with nasal CPAP.

STUDY OBJECTIVES: After nasal continuous positive airway pressure (nCPAP) treatment, several symptoms such as hypersomnolence, daytime fatigue, and impaired concentration improve in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). A variability of perception of pretreatment sleepiness (response-shift phenomenon) experienced in OSAHS patients before and after nCPAP treatment may reflect informative shifts in an individual's internal standards, in values and priorities, or in the conceptualization of perceived sleepiness. The objective of this study is to determine whether there is a response shift in perceptions of pretreatment sleepiness before and after nCPAP treatment in patients with OSAHS. We investigated the response shift in Epworth Sleepiness Scale scores before and after nCPAP. DESIGN: Thirty-one consecutive OSAHS patients filled out the subjective ESS before nCPAP treatment (Pre-ESS). After a mean of about 10 months of nCPAP treatment, the patients filled out the ESS again, which was designated as the Post-ESS. Then they were asked to complete the scale again, recalling sleepiness before nCPAP treatment (Response Shift-Pre-ESS). The control group consisted of 11 patients with OSAHS who had not yet received nCPAP treatments and were matched for age, body mass index, and respiratory disturbance index. SETTING: University Hospital in, Japan. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: There was a significant response shift in ESS scores before and after nCPAP treatment (Pre-ESS: 8.5 [95% Confidence interval [CI], 7.1-9.9] vs Response Shift-Pre-ESS: 11.1 [95% CI, 9.5-12.8], P < .002). A significant number of patients (P < .02) had not recognized the degree of sleepiness experienced before treatment until after they had received nCPAP treatment. Eight had pretreatment ESS scores > or = 11 and 18 had posttreatment ESS scores > or = 11 on the Response Shift-Pre-ESS. In the control group, ESS did not change significantly from the first to the second testing performed before nCPAP treatment (first ESS, 8.8 [95% CI, 5.3-12.3]; second ESS, 8.3 [95% CI, 4.7-11.8]: P = .95). CONCLUSIONS: Response shifts should be taken into consideration when explaining factors underlying individual differences in susceptibility to daytime sleepiness.

Arousal↗

Corrected QT dispersion and cardiac sympathetic function in patients with obstructive sleep apnea-hypopnea syndrome.

STUDY OBJECTIVES: Hypoxemia increases corrected QT dispersion (QTcD), which is the difference between the maximum and minimum QT intervals and is a strong risk factor for cardiovascular mortality. The aim of this study was to investigate the QTcD in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and the relationship between the QTcD and (123)I-metaiodobenzylguanidine (MIBG) cardiac imaging, which reflects cardiac sympathetic activity. SETTING: A university hospital. PATIENTS: Forty-eight OSAHS patients without cardiac diseases (mean [+/- SD] age, 45.9 +/- 10.8 years; apnea-hypopnea index [AHI] 51.9 +/- 18.5 events per hour) who underwent polysomnography before treatment and on the first night of nasal continuous positive airway pressure (nCPAP) treatment. METHODS: Before and after nCPAP treatment was started, we measured the QTcD with computer software, before, during, and after sleep, as well as the washout rate of the MIBG administered for cardiac imaging. As a control, QTcD was also measured in the morning from 26 healthy subjects. RESULTS: Before treatment, the mean QTcD during sleep (65.0 +/- 14.6 ms) was greater than that before sleep (57.0 +/- 13.5 ms; p < 0.0001). Meanwhile, after 1 night of nCPAP therapy, the QTcD during sleep (50.6 +/- 11.4 ms) decreased from that before treatment (p < 0.0001) and was smaller than the QTcD before sleep (56.2 +/- 13.3 ms; p = 0.003). Before treatment, the QTcD during sleep correlated with the AHI (r = 0.38; p = 0.009) and the percentage of time that SaO(2) was < 90% (SaO(2) < 90% time) [r = 0.34; p = 0.018]. The QTcD did not correlate with the body mass index or the washout rate of MIBG. However, the washout rate of MIBG correlated with the AHI and the SaO(2) < 90% time. CONCLUSIONS: Nocturnal QTcD is increased in OSAHS patients but is decreased by nCPAP therapy independently of cardiac sympathetic function.

3-Iodobenzylguanidine↗

[Phylogeny of the jaw].

Since primary life appeared in the sea about 3.8 billion years ago, the Agnatha improved a part of the respiratory organ, or brachial arch into the jaw during the evolutionary process. The resulting Gnathostomata could catch bigger fish by using the strong jaw. In addition, they developed specific sensory organs in the head, including nose, eyes and ears for detecting position of diets, brain for treating the sensory information, and muscles for masticating foods. Such development of jaw from the brachial arch had an important meaning in the evolutional history of organisms.

Animals↗

Total sleep deprivation elevates blood pressure through arterial baroreflex resetting: a study with microneurographic technique.

STUDY OBJECTIVES: Sleep deprivation has a profound effect on cardiovascular regulation through the autonomic nervous system. This study examined the effect of 24-hour total sleep deprivation on muscle sympathetic nerve activity (MSNA), which is a direct measurement of the postganglionic sympathetic efferent innervating the vascular bed in the skeletal muscle and other circulatory structures. DESIGN: The study was performed on 6 young healthy men. The factors exerting influence on MSNA, such as aging, obesity, body posture, activity, intensity of illumination, and food and beverage consumption were strictly controlled. Burst rate and burst incidence were used as parameters of MSNA. The burst rate, burst incidence, heart rate, and systolic and diastolic blood pressure were measured after total sleep deprivation and control sleep. To perform a linear regression analysis of arterial baroreflex (ABR), the incidence of MSNA bursts corresponding to a given diastolic blood pressure (%MSNA) was examined. MEASUREMENT AND RESULTS: The diastolic blood pressure was significantly higher after total sleep deprivation than after control sleep (66.5 +/- 1.7 vs 57.4 +/- 3.3 mm Hg). The burst rate (9.6 +/- 1.8 vs 13.3 +/- 2.7 bursts/min) and burst incidence (21.6 +/- 4.5 vs 30.3 +/- 8.9 bursts/100 heart beats) of MSNA were significantly lower after total sleep deprivation than after control sleep (P < .05). Analysis of the ABR disclosed a significant linear regressive relation between %MSNA and diastolic blood pressure in every subject after both total sleep deprivation and control sleep. This result implies that the ABR regulates the occurrence of MSNA bursts under different diastolic blood pressure conditions. The threshold (X-axis intercept) of the blood pressure regression line (ie, an indicator of the ABR set point) shifted by 12 +/- 4.3 mm Hg toward a higher blood pressure level after total sleep deprivation (P < .05). The ABR sensitivity, or the slope of the regression line, tended to be less steep after total sleep deprivation than after control sleep, although it was not statistically significant (P = .09). CONCLUSIONS: The diastolic blood pressure increased and both burst rate and burst incidence of MSNA decreased after total sleep deprivation. The results show that resetting of the ABR toward a higher blood pressure level occurred after total sleep deprivation. This ABR resetting probably brings about an increase in arterial blood pressure after total sleep deprivation.

Adult↗

Effects of obstructive sleep apnea syndrome on serum aminotransferase levels in obese patients.

PURPOSE: Obesity has been associated with obstructive sleep apnea and hepatic steatosis. We investigated the effects of obstructive sleep apnea and treatment with nasal continuous positive airway pressure (CPAP) on serum aminotransferase levels in obese patients. METHODS: We studied 40 obese men with obstructive sleep apnea syndrome. None had hepatitis B antigen or C antibody, autoimmune disease, or an excessive intake of alcohol. Serum levels of aspartate aminotransferase, alanine aminotransferase, triglyceride, glucose, insulin, and leptin were determined in the afternoon and in the morning immediately after sleep, before and after nasal CPAP treatment. RESULTS: Aminotransferase levels were abnormal in 35% (n = 14) of patients. Before treatment, mean (+/- SD) aspartate aminotransferase levels were higher in the morning than in the previous afternoon (presleep, 34 +/- 20 IU/L; postsleep, 39 +/- 28 IU/L; P = 0.006). The overnight mean increases in aminotransferase levels were less marked after the first night of nasal CPAP treatment (aspartate aminotransferase: from 6 +/- 11 IU/L to 2 +/- 6 IU/L, P = 0.0003; alanine aminotransferase: from 5 +/- 9 IU/L to 2 +/- 6 IU/L, P = 0.006). Leptin levels (n = 23) decreased significantly after treatment (P = 0.0002), whereas insulin resistance (calculated by the homeostasis model assessment method) and triglyceride levels were unchanged. Improvements in aspartate and alanine aminotransferase levels were maintained after 1 and 6 months of nasal CPAP treatment. CONCLUSION: Nasal CPAP therapy may have beneficial effects on serum aminotransferase abnormalities in obese patients who have obstructive sleep apnea.

Alanine Transaminase↗

Expression and characterization of frog peptidylglycine alpha-hydroxylating monooxygenase.

We report here a recombinant Chinese hamster ovary cell system,which is able to stably express frog peptidylglycine alpha-hydroxylating monooxygenase (PHM, EC 1.14.17.3), the first enzyme responsible for the formation of peptide C-terminal amide. This system excreted PHM mostly into the medium and almost no PHM activity was detected in the cell lysate. Three differentiation inducers were examined to determine whether or not they would enhance the PHM expression. Addition of 4mM sodium butyrate into the medium increased the expression of PHM activity about 4-fold at 48 h after addition. Increases of about 2-fold were observed in the cases of sodium propionate or N,N(')-hexamethylene-bis-acetamide. Through a three-step purification procedure, we obtained 5mg purified PHM, which showed a single band at 40 kDa on SDS-PAGE, from 2-L of conventional monolayer culture medium. The reactions with three synthetic substrates, D-Tyr-Val-Gly, N-trinitrophenyl-D-Tyr-Val-Gly (TNPYVG), and hippuric acid (HA), were characterized. Of these, TNPYVG was the most active substrate. The pH optima for TNPYVG and HA were pH 5-6, while that for D-Tyr-Val-Gly was pH 7.5. There is a possibility that the substrate N-terminal structure may affect the interaction between the substrate and the enzyme catalytic site.

Animals↗

Expression and characterization of human bifunctional peptidylglycine alpha-amidating monooxygenase.

We report the purification and characterization of human bifunctional peptidylglycine alpha-amidating monooxygenase (the bifunctional PAM) expressed in Chinese hamster ovary cells. PAM is in charge of the formation of the C-terminal amides of biologically active peptides. The bifunctional PAM possesses two catalytic domains in a single polypeptide, peptidylglycine alpha-hydroxylating monooxygenase (PHM, EC 1.14.17.3) and peptidylamidoglycolate lyase (PAL, EC 4.3.2.5). By introducing a stop codon at 835 Glu, we were able to eliminate the membrane-spanning domain in the C-terminal region and succeeded in purifying a soluble form of bifunctional PAM that was secreted into the medium. Through a three-step purification procedure, we obtained 0.3mg of the purified PAM, which showed a single band at 91 kDa on SDS-PAGE, from 1L of monolayer culture medium. Metals contained in the purified PAM were analyzed and chemical modifications were performed to gain insight into the mechanism of the PAL reaction. Inductively coupled plasma detected 0.62 mol of Zn(2+) and 1.25 mol of Cu(2+) per mol of bifunctional PAM. Further, the addition of 1mM EDTA reduced the PAL activity by about 50%, but the decreased activity was recovered by the addition of an excess amount of Zn(2+). In a series of chemical modifications, phenylglyoxal almost completely eliminated the PAL activity and diethyl pyrocarbonate suppressed activity by more than 70%. These findings implied that Arg and His residues might play crucial roles during catalysis.

Amidine-Lyases↗

Development of hepatocytes from ES cells after transfection with the HNF-3beta gene.

We have attempted to generate embryonic stem (ES) cell-derived hepatocytes expressing liver-specific functional properties by use of ES cell technology. It was found that ES cells are allowed to differentiate into hepatocytes possessing high metabolic activities when hepatocyte nuclear factor (HNF)-3beta-transfected ES cells are cultured in alpha-MEM medium supplemented with 10% fetal bovine serum (FBS) and fibroblast growth factor (FGF)-2 in the three-dimensional cell culture system at 5% CO2. The differentiated cells induced albumin, triacylglycerol, urea, and glycogen synthesis as well as further expression of metabolic proteins and serum factors as markers of hepatocytic differentiation for at least 4 months. The cells differentiated from HNF-3beta-transfected ES cells also had hepatocyte-like ultrastructural characteristics, including several endoplasmic reticula, mitochondrion, and glycogen. Our findings indicate that generation of hepatocytes maintaining high metabolic functions developed from mouse ES cells will facilitate the study of the basic mechanism for hepatogenesis and will certainly provide new opportunities for tissue transplantation.

Albumins↗

Role of each Asn-linked glycan in the anticoagulant activity of human protein C inhibitor.

The N-glycosylation site mutants of human protein C inhibitor (PCI; N230S, N243Q, N319Q, N230S/N243Q, and N230S/N319Q) were prepared by amino acid replacement of the asparagine residue with a serine or glutamine residue using site-directed mutagenesis and expressed in the baculovirus/insect cell expression system. To examine the importance of each Asn-linked glycan in the activity of PCI, we compared wtPCI with the mutants of N-glycosylation site(s) in terms of the procoagulant protease-inhibitory and anticoagulant activities. The inhibitory activities of N230S, N319Q, and N230S/N319Q toward human thrombin and plasma kallikrein were significantly increased compared with wtPCI, but those of N243Q and N230S/N243Q were reduced. The inhibitory activity of N230S toward human plasma coagulation was significantly increased compared with wtPCI, and that of N230S/N319Q was also significantly increased compared with N319Q. Furthermore, the procoagulant protease-inhibitory and anticoagulant activities of N230S/N319Q (glycosylated on Asn243 only) compared favorably with those of N230S, and both of the mutants possessed highest activities in the purified mutants. These results suggest that the Asn243-linked glycan in PCI molecule possesses critical roles for its anticoagulant activity in the circulation, and the Asn230-linked glycan down-regulates the activity of PCI.

Amino Acid Substitution↗

Plasma exchange for hypertriglyceridemic acute necrotizing pancreatitis: report of two cases.

We report two cases of hypertriglyceridemic necrotizing pancreatitis treated by plasma exchange (PE). The outcome of each case was quite different according to the timing of PE. A 36 year old man presented with abdominal pain, and a diagnosis of severe acute pancreatitis was made. His serum triglyceride (TG) level was 6,460 mg/dl. He did not undergo PE at first, however, his condition never improved and PE was performed 20 days after the onset of his illness. Finally, he died of multiple organ failure and sepsis. In contrast, a 52 year old man with acute necrotizing pancreatitis was referred to our department. He received PE quickly after hospital admission. His serum TG level, which was 3,540 mg/dl at hospital admission, dramatically returned to normal limits, and he was discharged from the hospital 62 days after admission. The prognosis of severe necrotizing pancreatitis due to hypertriglyceridemia is extremely poor. PE should be applied for the treatment of hypertriglyceridemic necrotizing pancreatitis immediately after its onset.

Adult↗