ObjectiveThe gut microbiota are the main source of infections in necrotising pancreatitis. We investigated the effect of disruption of the intestinal microbiota by a Western-type diet on mortality and bacterial dissemination in necrotising pancreatitis and its reversal by butyrate supplementation.DesignC57BL/6 mice were fed either standard chow or a Western-type diet for 4 weeks and were then subjected to taurocholate-induced necrotising pancreatitis. Blood and pancreas were collected for bacteriology and immune analysis. The cecum microbiota composition of mice was analysed using 16S rRNA gene amplicon sequencing and cecal content metabolites were analysed by targeted (ie, butyrate) and untargeted metabolomics. Prevention of necrotising pancreatitis in this model was compared between faecal microbiota transplantation (FMT) from healthy mice, antibiotic decontamination against Gram-negative bacteria and oral or systemic butyrate administration. Additionally, the faecal microbiota of patients with pancreatitis and healthy subjects were analysed.ResultsMortality, systemic inflammation and bacterial dissemination were increased in mice fed Western diet and their gut microbiota were characterised by a loss of diversity, a bloom of Escherichia coli and an altered metabolic profile with butyrate depletion. While antibiotic decontamination decreased mortality, Gram-positive dissemination was increased. Both oral and systemic butyrate supplementation decreased mortality, bacterial dissemination, and reversed the microbiota alterations. Paradoxically, mortality and bacterial dissemination were increased with FMT administration. Finally, patients with acute pancreatitis demonstrated an increase in Proteobacteria and a decrease of butyrate producers compared with healthy subjects.ConclusionButyrate depletion and its repletion appear to play a central role in disease progression towards necrotising pancreatitis.

Background: Both obesity and the presence of collagenolytic bacterial strains (Enterococcus faecalis) can increase the risk of anastomotic leak. The aim of this study was to determine whether mice chronically fed a high-fat Western-type diet (WD) develop anastomotic leak in association with altered microbiota, and whether this can be mitigated by a short course of standard chow diet (SD; low fat/high fibre) before surgery.Methods: Male C57BL/6 mice were assigned to either SD or an obesogenic WD for 6 weeks followed by preoperative antibiotics and colonic anastomosis. Microbiota were analysed longitudinally after operation and correlated with healing using an established anastomotic healing score. In reiterative experiments, mice fed a WD for 6 weeks were exposed to a SD for 2, 4 and 6 days before colonic surgery, and anastomotic healing and colonic microbiota analysed.Results: Compared with SD-fed mice, WD-fed mice demonstrated an increased risk of anastomotic leak, with a bloom in the abundance of Enterococcus in lumen and expelled stool (65-90 per cent for WD versus 4-15 per cent for SD; P = 0⋅010 for lumen, P = 0⋅013 for stool). Microbiota of SD-fed mice, but not those fed WD, were restored to their preoperative composition after surgery. Anastomotic healing was significantly improved when WD-fed mice were exposed to a SD diet for 2 days before antibiotics and surgery (P < 0⋅001).

BackgroundFor several purposes, skin parameters like thickness and elasticity can be measured. However, little is known about the accuracy of those measurements.AimThe aim of this study was to determine the intrarater and test‐retest reliability of skin thickness and elasticity measurements performed with the DermaLab Combo®.MethodsA total of 49 participants were included in this study. Skin thickness and elasticity were measured at six defined locations on the dominant arm. Measurements were repeated two times by the same observer to determine the test‐retest reliability. To determine the inter‐rater reliability, a second observer repeated the measurements once.ResultsInter‐rater and test‐retest reliability for elasticity measurements fluctuates per location and per parameter: Inter‐rater intraclass correlation coefficient (ICC) ranged from 0.23 to 0.80, and test‐retest ICC ranged from 0.25 to 0.84. Skin thickness was measured reliable by every observer on every location, with a test‐retest ICC ranging from 0.71 to 0.83 and an inter‐rater ICC ranging from 0.69 to 0.80.ConclusionThe DermaLab Combo® showed a good inter‐rater reliability when measuring skin thickness and elasticity. Not all locations are suitable for reliable inter‐rater or test‐retest measurements. The device is difficult to use by inexperienced users, as the echo probe is sensitive to small movements.