Diabetes is a widespread disease affecting millions of people,making it one of the leading causes of death in the world.It is a leading cause of cardiovascular disease and end-stage renal disease.Despite advancements ...Diabetes is a widespread disease affecting millions of people,making it one of the leading causes of death in the world.It is a leading cause of cardiovascular disease and end-stage renal disease.Despite advancements in treatment,including insulin therapy and glucose monitoring devices,diabetes continues to significantly impact quality of life and current modalities do not reverse the end-organ damage associated with its progression.While traditionally indicated for type 1 diabetes,recent clinical practice refinements have made pancreas transplants available to select type 2 diabetics meeting specific criteria.These transplants are usually a part of a simultaneous kidney-pancreas transplant.However,although less frequently performed,transplants of pancreas alone or pancreas after kidney transplant are still available.For selected diabetic patients,pancreas transplants offer significant survival benefits and the improvement of cardiovascular and metabolic complications;however,they are not without risks.Complications such as bleeding,vascular thrombosis,infection,organ leak,and rejection are possible.Another challenge to pancreas transplantation is the decreasing number of procedures being performed due to decline in the volume of available highquality allografts and resource constraints of transplant centers.Advancements in monitoring and treatment of diabetes are contributing to the decline in pancreas transplants nowadays.展开更多
Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological me...Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.展开更多
Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in le...Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.展开更多
Obesity is a major contributor to metabolic dysfunction,and its impact on pancreatic health has garnered increasing attention.Macrophages,as key regulators of inflammation and metabolism,play a central role in mediati...Obesity is a major contributor to metabolic dysfunction,and its impact on pancreatic health has garnered increasing attention.Macrophages,as key regulators of inflammation and metabolism,play a central role in mediating obesity-induced pancreatic damage.In obese individuals,excessive lipid accumulation and chronic low-grade inflammation drive the infiltration and polarization of macrophages within the pancreas.These macrophages,particularly the pro-inflammatory Macrophage,pro-inflammatory phenotype(M1)phenotype,secrete cytokines such as C-C motif ligand 2(CCL2)and transforming growth factor beta(TGF-β),which disrupt pancreaticβ-cell function and impair insulin secretion.Conversely,anti-inflammatory Macrophage,anti-inflammatory phenotype(M2)macrophages contribute to tissue repair but may also promote fibrotic changes under prolonged metabolic stress.Pancreatic macrophages are activated under high-fat diet conditions,promoting inflammation and impairingβ-cell function through the SUCLA2-HIF-1αaxis and mechanistic Target of Rapamycin Complex 1(mTORC1)/PD-1 pathway,thereby establishing a self-perpetuating"metabolicimmunosuppressive"vicious cycle.Targeted intervention strategies against macrophages—such as SUCLA2 inhibitors can ameliorate metabolic dysregulation.Meanwhile,exosome-mediated interorgan communication[e.g.,via microRNA-155(miR-155)and miR-30a]offers novel insights for multi-system synergistic therapies.Understanding the mechanisms by which macrophages mediate metabolic dysregulation in the pancreas under obese conditions provides critical insights into the pathogenesis of obesity-related pancreatic disorders.展开更多
Basic medical education is the cornerstone of healthcare development,directly impacting the well-being of a nation’s population.The advancement of modern medicine has raised increasing demands on the research capabil...Basic medical education is the cornerstone of healthcare development,directly impacting the well-being of a nation’s population.The advancement of modern medicine has raised increasing demands on the research capabilities of medical students.Therefore,it is crucial to foster their research interests and cultivate their research skills early in their education.As core components of basic medical science and introductory courses to immerse medical students in the intricate microscopic world of the human body,histology and embryology are indispensable in medical education,igniting their curiosity.Incorporating cutting-edge research into education courses can effectively stimulate medical students’research interests.This article primarily focuses on histology and embryology to explore how the latest scientific advancements and emerging technologies can be incorporated into basic medical curricula,offering insights and suggestions for future developments in medical education.展开更多
Automatic pancreas segmentation plays a pivotal role in assisting physicians with diagnosing pancreatic diseases,facilitating treatment evaluations,and designing surgical plans.Due to the pancreas’s tiny size,signifi...Automatic pancreas segmentation plays a pivotal role in assisting physicians with diagnosing pancreatic diseases,facilitating treatment evaluations,and designing surgical plans.Due to the pancreas’s tiny size,significant variability in shape and location,and low contrast with surrounding tissues,achieving high segmentation accuracy remains challenging.To improve segmentation precision,we propose a novel network utilizing EfficientNetV2 and multi-branch structures for automatically segmenting the pancreas fromCT images.Firstly,an EfficientNetV2 encoder is employed to extract complex and multi-level features,enhancing the model’s ability to capture the pancreas’s intricate morphology.Then,a residual multi-branch dilated attention(RMDA)module is designed to suppress irrelevant background noise and highlight useful pancreatic features.And re-parameterization Visual Geometry Group(RepVGG)blocks with amulti-branch structure are introduced in the decoder to effectively integrate deep features and low-level details,improving segmentation accuracy.Furthermore,we apply re-parameterization to the model,reducing computations and parameters while accelerating inference and reducing memory usage.Our approach achieves average dice similarity coefficient(DSC)of 85.59%,intersection over union(IoU)of 75.03%,precision of 85.09%,and recall of 86.57%on the NIH pancreas dataset.Compared with other methods,our model has fewer parameters and faster inference speed,demonstrating its enormous potential in practical applications of pancreatic segmentation.展开更多
Diffusion-weighted magnetic resonance imaging(DWI)has become an essential tool in the field of pancreatic magnetic resonance imaging,enabling the detection,characterization,prediction,and evaluation of pancreatic dise...Diffusion-weighted magnetic resonance imaging(DWI)has become an essential tool in the field of pancreatic magnetic resonance imaging,enabling the detection,characterization,prediction,and evaluation of pancreatic diseases.In this article,we review the acquisition parameters,postprocessing techniques,and quantitative methods utilized in pancreatic DWI.Various postprocessing models,including monoexponential,biexponential,stretched exponential and non-Gaussian kurtosis models,as well as deep learning networks,have been used to assess the clinical utility of these models in diagnosing pancreatic diseases.The single-shot echo-planar imaging sequence is the most commonly used sequence for DWI data acquisition in clinical settings,and the apparent diffusion coefficient(ADC)calculated using the monoexponential model is the most widely used quantitative parameter in clinical practice.The repeatability threshold for the ADC of a normal pancreas is 37%for test-retest scans,but the repeatability threshold for pancreatic tumors needs to be further investigated.Complex postprocessing models exploring novel DWI-based biomarkers beyond ADC to assess histological features,and artificial intelligence in DWI postprocessing and data analyses hold promise in the diagnosis of pancreatic diseases.Future work should focus on standardizing protocols,conducting multicentre studies,and exploring variety of methods to improve the accuracy of quantitative DWI results to increase the clinical effectiveness of DWI in patients with pancreatic diseases.展开更多
BACKGROUND Intraductal oncocytic papillary neoplasm(IOPN)of the pancreas is an extremely rare pancreatic tumor,with only sporadic cases reported in the literature.IOPN is difficult to diagnose and highly prone to misd...BACKGROUND Intraductal oncocytic papillary neoplasm(IOPN)of the pancreas is an extremely rare pancreatic tumor,with only sporadic cases reported in the literature.IOPN is difficult to diagnose and highly prone to misdiagnosis.IOPN carries a certain risk of progressing to invasive cancer.Surgical resection is the primary treatment for IOPN.According to the existing literature reports,the vast majority of patients with IOPN of the pancreas undergo open surgery,while only one case of laparoscopic surgery have been reported.CASE SUMMARY This report presents two cases of IOPN in elderly female patients,aged 60 and 61.Both patients were asymptomatic,and their pancreatic masses were discovered incidentally.Preoperative diagnosis of IOPN is challenging and prone to misdiagnosis.In the first case,the patient underwent a laparoscopic distal pancreatectomy and splenectomy.The surgical procedure spanned 342 minutes,with an estimated intraoperative blood loss of around 100 mL.The patient experienced an uneventful postoperative recovery and was discharged on the 8th postoperative day.For the second case,a laparoscopic pancreaticoduodenectomy was performed.The operation lasted for 431 minutes with an intraoperative blood loss of approximately 50 mL.The patient also demonstrated a favorable postoperative course and was discharged on the 24^(th)postoperative day.Postoperative pathology and immunohistochemistry confirmed the diagnosis of IOPN.No recurrence was observed in either patient after follow-up periods of 8 and 10 months,respectively.CONCLUSION These cases demonstrate that laparoscopic surgery can be considered as one of the treatment options for IOPN of the pancreas.展开更多
BACKGROUND Solid pseudopapillary neoplasm(SPN)of the pancreas is a rare epithelial tumor that primarily affects young women.Since the condition is often asymptomatic or presents with non-specific symptoms,its diagnosi...BACKGROUND Solid pseudopapillary neoplasm(SPN)of the pancreas is a rare epithelial tumor that primarily affects young women.Since the condition is often asymptomatic or presents with non-specific symptoms,its diagnosis can be difficult.CASE SUMMARY This report details the case of a 15-year-old girl who presented with a 2-year history of abdominal pain,with no significant findings during physical examination.Abdominal ultrasound revealed a well-defined heterogeneous solidcystic mass in the epigastric region,likely originating from the tail of the pancreas.A subsequent contrast-enhanced computed tomography scan indicated a welldefined cystic lesion with an enhancing solid component and capsule in the tail of the pancreas,suggestive of a cystic neoplasm.The patient underwent an open distal pancreatectomy with splenectomy,and histopathological analysis confirmed the diagnosis of SPN of the pancreas.CONCLUSION This case highlights the risk of SPN in adolescent girls and the necessity of early diagnosis and intervention for better outcomes.展开更多
BACKGROUND Malignant transformation of an ectopic pancreas is exceptionally rare,posing significant diagnostic challenges.As such,there are currently no established management guidelines.We present a rare case of gast...BACKGROUND Malignant transformation of an ectopic pancreas is exceptionally rare,posing significant diagnostic challenges.As such,there are currently no established management guidelines.We present a rare case of gastric adenocarcinoma arising from ectopic pancreatic tissue and provide a systematic review of previous case reports of adenocarcinomas derived from ectopic pancreas in the stomach,duodenum,and jejunum in the past 20 years.We provide an overview of the clinicopathological characteristics and discuss critical diagnostic and therapeutic considerations.CASE SUMMARY A 58-year-old female was admitted to our hospital in August 2024 due to elevated carbohydrate antigen 19-9.Relevant examinations found a huge abdominal tumor that was radiologically adherent to both the pancreatic head and the greater curvature of the gastric antrum.A preoperative endoscopic biopsy-confirmed adenocarcinoma,prompting a pancreaticoduodenectomy.Histopathological examination subsequently identified the tumor as an adenocarcinoma originating from a gastric ectopic pancreas.Adjuvant chemotherapy(gemcitabine+cap ecitabine)commenced on November 13,2024.After five cycles,surveillance imaging(April 3,2025)revealed metastatic progression,prompting a transition to second-line therapy(nab-paclitaxel+gemcitabine).The patient is currently undergoing regular chemotherapy and has been followed up regularly,and the condition has not changed significantly compared with before.CONCLUSION We hope that our findings will facilitate the clinical recognition of this entity and help to increase knowledge regarding its management.展开更多
Automatic pancreas segmentation in CT scans is crucial for various medical applications including early disease detection,treatment planning and therapeutic evaluation.However,the pancreas’s small size,irregular morp...Automatic pancreas segmentation in CT scans is crucial for various medical applications including early disease detection,treatment planning and therapeutic evaluation.However,the pancreas’s small size,irregular morphology,and low contrast with surrounding tissues make accurate pancreas segmentation still a challenging task.To address these challenges,we propose a novel RPMS-DSAUnet for accurate automatic pancreas segmentation in abdominal CT images.First,a Residual Pyramid Squeeze Attention module enabling hierarchical multi-resolution feature extraction with dynamic feature weighting and selective feature reinforcement capabilities is integrated into the backbone network,enhancing pancreatic feature extraction and improving localization accuracy.Second,a Multi-Scale Feature Extraction module is embedded into the network to expand the receptive field while preserving feature map resolution,mitigate feature degradation caused by network depth,and maintain awareness of pancreatic anatomical structures.Third,a Dimensional Squeeze Attention module is designed to reduce interference from adjacent organs and highlight useful pancreatic features through spatial-channel interaction,thereby enhancing sensitivity to small targets.Finally,a hybrid loss function combining Dice loss and Focal loss is employed to alleviate class imbalance issues.Extensive evaluation on two public datasets(NIH and MSD)shows that the proposed RPMS-DSAUnet achieves Dice Similarity Coefficients of 85.51%and 80.91%,with corresponding Intersection over Union(IoU)scores of 74.93%and 67.94%on each dataset,respectively.Experimental results demonstrate superior performance of the proposed model over baseline methods and state-of-the-art approaches,validating its effectiveness for CT-based pancreas segmentation.展开更多
BACKGROUND Acinar cystic transformation(ACT)of the pancreas is a rare non-neoplastic transformation of the pancreas.Adult women are the majority of patients with ACT,but few cases have been reported in pediatric patie...BACKGROUND Acinar cystic transformation(ACT)of the pancreas is a rare non-neoplastic transformation of the pancreas.Adult women are the majority of patients with ACT,but few cases have been reported in pediatric patients.Given that there are currently no guidelines for the treatment of ACT,current treatment is based primarily on expert opinions and clinical experiences.Here,we report the case of the youngest child with ACT to date.Additionally,a literature review on pediatric ACT cases was performed to summarize previous clinical experience and treatment methods.CASE SUMMARY A 1-year-old Chinese girl presented with progressive abdominal distension for 6 months.A detailed consultation revealed an uneventful history.The patient showed no signs of fever or abdominal pain and had a good appetite and normal feces.A mass of about 20 cm×10 cm×10 cm in size was detected in the abdomen.Both abdominal ultrasound and computed tomography examination revealed a multilocular cystic mass about 21.7 cm×16.8 cm×8.9 cm in size.At first,due to the large size and the possible retroperitoneal origin of the cyst,a total resection of the lesion was not possible.A single-port laparoscopic lymphangioma puncture and Pingyangmycin injection were performed in March 2023.One month after surgery,the abdominal cyst rapidly enlarged to its pre-operative size.After consulting with the experts in the angiology department and interventional department,sclerotherapy combined with oral sirolimus was performed in May 2023.After confirming that the tumor was not sensitive to sclerotherapy combined with oral sirolimus,our surgical team performed tumor reduction in August 2023.This surgery confirmed that the polycystic mass originated from the head of the pancreas,and pathological and immunohistochemical findings diagnosed pancreatic ACT.The patient showed no signs of cyst lesions after 6 months of follow-up and remains in good health up to the time of this report.CONCLUSION ACT is a rare non-neoplastic transformation of the pancreas,more rarely seen in children.Manifestation and examinations show no specificity for diagnosis,and final diagnosis is mainly based on histological findings.To reach a specific diagnosis and rule out malignancy is a priority in clinical practice,and repeated biopsy or radical surgery should be considered before malignancy is ruled out.However,once a diagnosis of ACT is made,a conser-vative treatment with consecutive follow-up is recommended until symptoms present or obvious enlargement occurs because ACT is considered a slow-growing and benign tumor.展开更多
The development of plant embryology in China can be roughly divided into three stages: (1) the initial stage, (2) the stage of establishing plant embryology as a branch of plant sciences, and (3) the stage when plant...The development of plant embryology in China can be roughly divided into three stages: (1) the initial stage, (2) the stage of establishing plant embryology as a branch of plant sciences, and (3) the stage when plant embryology evolves into plant reproductive biology with its vigorous development. It is in the third stage that research work in this field in China has developed rapidly and many of the significant achievements obtained are described in more details in this review. Researches of experimental embryology are not included in this paper.展开更多
Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pan...Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pancreatic cancer (LAPC) were collected and randomized into two groups: Arm A 125 I (18 patients) and Arm B 125 I+GEM (20 patients). Eligibility criteria were: cytologically and pathologically proven pancreatic carcinoma, Karnofsky performance status (kps) 60 80, age 18 75 years, adequate hematological, renal and liver function, and controllable pain. Arm A patients were treated with 125 I implants. Arm B patients started chemotherapy within 10 14 d post operatively following the implant procedure. Chemotherapy doses were as follows: GEM 1 000 mg/m 2 weekly × 3 followed by 1 week of rest for 3 cycles. In addition, all patients underwent laparotomy and surgical staging. The surgical procedures performed were biopsy, gastric bypass and biliary bypass. The total activity and number of seeds used were as recommended by Anderson. The mean activity, minimal peripheral dose (MPD), and volume of implants were 20 mCi, 14 000 cGy, and 53 cm 3, respectively. Results: Overall response rate (CR+PR) in Arm A was 37.6% and in Arm B it was 44.5% ( P >0.05). PR median duration in Arm A was 6.7 months and in Arm B it was 4.8 months ( P <0.05). Clinical benefit response was experienced by 11.7 % of Arm A compared with 42.1% of Arm B ( P <0.05). The incidences of hematological toxicity (such as neutropenia) between Arm A and Arm B were 5.8% and 21.1%, respectively ( P >0.05). The survival rates of 12 and 24 month were 32.5%, 16.3% for Arm A and 61%, 38.7% for Arm B ( P =0.04). The rate of complication of Arm A was lower than that of Arm B without statistical significance. Conclusion: To some extent, 125 I or 125 I plus GEM is able to lead to a moderate objective response for LAPC with obstructive jaundice on the base of biliary bypass or/and gastric bypass, but 125 I plus GEM is more effective than 125 I in improvement of the quality of life and survival rate in patients with LAPC.展开更多
AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional revi...AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional review board approval was obtained.Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions(SEL)with a final diagnosis of EP between January 2009and December 2013 were identified.Patients in this group were selected for the study if they underwent endoscopic ultrasound(EUS)with fine-needle aspiration(FNA)or deep biopsy.A review of the medical record was performed specifically to review the following information:presenting symptoms,endoscopic and EUS findings,computed tomography or magnetic resonance imaging findings,pathology results,procedure-related adverse events,and subsequent treatments after EUSFNA.EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians(Attwell A,Fukami N).Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses.RESULTS:Between July 2009 and December 2013,10patients[3 males,7 females,median age 52(26-64)years]underwent EUS for a gastroduodenal SEL and were diagnosed with EP.One patient was symptomatic.Six(60%)lesions were in the antrum,3(30%)in the body,and 1(10%)in the duodenum.A mucosal dimple was noted in 6(60%).Mean lesion size was 17(8-25)mm.Gastrointestinal wall involvement:muscularis mucosae,10%;submucosa,70%;muscularis propria,60%;and serosa,10%.Nine(90%)lesions were hypoechoic and 5(50%)were homogenous.A duct was seen in 5(50%).FNA was attempted in 9(90%)and successful in 8(80%)patients after 4(2-6)passes.Cytology showed acini or ducts in 7 of 8(88%).Superficial biopsies in 7 patients(70%)showed normal gastric mucosa.Deep endoscopic biopsies were taken in 2 patients and diagnostic in one.One patient(10%)developed pancreatitis after EUS-FNA.Two patients(20%)underwent surgery to relieve symptoms or confirm the diagnosis.The main limitation of the study was the fact that it was retrospective and performed at a single medical center.CONCLUSION:EUS features of EP include antral location,mucosal dimple,location in layers 3-4,and lesional duct,and FNA or biopsy is accurate and effective.展开更多
AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endos...AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.展开更多
A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duoden...A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature.展开更多
文摘Diabetes is a widespread disease affecting millions of people,making it one of the leading causes of death in the world.It is a leading cause of cardiovascular disease and end-stage renal disease.Despite advancements in treatment,including insulin therapy and glucose monitoring devices,diabetes continues to significantly impact quality of life and current modalities do not reverse the end-organ damage associated with its progression.While traditionally indicated for type 1 diabetes,recent clinical practice refinements have made pancreas transplants available to select type 2 diabetics meeting specific criteria.These transplants are usually a part of a simultaneous kidney-pancreas transplant.However,although less frequently performed,transplants of pancreas alone or pancreas after kidney transplant are still available.For selected diabetic patients,pancreas transplants offer significant survival benefits and the improvement of cardiovascular and metabolic complications;however,they are not without risks.Complications such as bleeding,vascular thrombosis,infection,organ leak,and rejection are possible.Another challenge to pancreas transplantation is the decreasing number of procedures being performed due to decline in the volume of available highquality allografts and resource constraints of transplant centers.Advancements in monitoring and treatment of diabetes are contributing to the decline in pancreas transplants nowadays.
基金Supported by National Natural Science Foundation of China,No.82170651and the Research Support Fund of Hubei Microcirculation Society,No.HBWXH2024(1)-1.
文摘Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.
基金supported by the National Cancer Institute(T32,CA 236621-5).
文摘Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.
基金Supported by National Natural Science Foundation of China Youth Science Fund Project,No.82305376the Young Talent Support Program of the China Association for Acupuncture-Moxibustion,No.2024-2026ZGZJXH-QNRC005+1 种基金the 2024 Jiangsu Provincial Young Scientific and Technological Talent Support Program,No.JSTJ-2024-380the 2025 Jiangsu Science and Technology Think Tank Program Project,No.JSKX0125035。
文摘Obesity is a major contributor to metabolic dysfunction,and its impact on pancreatic health has garnered increasing attention.Macrophages,as key regulators of inflammation and metabolism,play a central role in mediating obesity-induced pancreatic damage.In obese individuals,excessive lipid accumulation and chronic low-grade inflammation drive the infiltration and polarization of macrophages within the pancreas.These macrophages,particularly the pro-inflammatory Macrophage,pro-inflammatory phenotype(M1)phenotype,secrete cytokines such as C-C motif ligand 2(CCL2)and transforming growth factor beta(TGF-β),which disrupt pancreaticβ-cell function and impair insulin secretion.Conversely,anti-inflammatory Macrophage,anti-inflammatory phenotype(M2)macrophages contribute to tissue repair but may also promote fibrotic changes under prolonged metabolic stress.Pancreatic macrophages are activated under high-fat diet conditions,promoting inflammation and impairingβ-cell function through the SUCLA2-HIF-1αaxis and mechanistic Target of Rapamycin Complex 1(mTORC1)/PD-1 pathway,thereby establishing a self-perpetuating"metabolicimmunosuppressive"vicious cycle.Targeted intervention strategies against macrophages—such as SUCLA2 inhibitors can ameliorate metabolic dysregulation.Meanwhile,exosome-mediated interorgan communication[e.g.,via microRNA-155(miR-155)and miR-30a]offers novel insights for multi-system synergistic therapies.Understanding the mechanisms by which macrophages mediate metabolic dysregulation in the pancreas under obese conditions provides critical insights into the pathogenesis of obesity-related pancreatic disorders.
基金supported by Shanghai Rising-Star Program(22QA1411500)Naval Medical University(2023MS0001).
文摘Basic medical education is the cornerstone of healthcare development,directly impacting the well-being of a nation’s population.The advancement of modern medicine has raised increasing demands on the research capabilities of medical students.Therefore,it is crucial to foster their research interests and cultivate their research skills early in their education.As core components of basic medical science and introductory courses to immerse medical students in the intricate microscopic world of the human body,histology and embryology are indispensable in medical education,igniting their curiosity.Incorporating cutting-edge research into education courses can effectively stimulate medical students’research interests.This article primarily focuses on histology and embryology to explore how the latest scientific advancements and emerging technologies can be incorporated into basic medical curricula,offering insights and suggestions for future developments in medical education.
基金supported by the Science and Technology Innovation Programof Hunan Province(Grant No.2022RC1021)the Hunan Provincial Natural Science Foundation Project(Grant No.2023JJ60124)+1 种基金the Changsha Natural Science Foundation Project(Grant No.kq2202265)the key project of the Hunan Provincial of Education(Grant No.22A0255).
文摘Automatic pancreas segmentation plays a pivotal role in assisting physicians with diagnosing pancreatic diseases,facilitating treatment evaluations,and designing surgical plans.Due to the pancreas’s tiny size,significant variability in shape and location,and low contrast with surrounding tissues,achieving high segmentation accuracy remains challenging.To improve segmentation precision,we propose a novel network utilizing EfficientNetV2 and multi-branch structures for automatically segmenting the pancreas fromCT images.Firstly,an EfficientNetV2 encoder is employed to extract complex and multi-level features,enhancing the model’s ability to capture the pancreas’s intricate morphology.Then,a residual multi-branch dilated attention(RMDA)module is designed to suppress irrelevant background noise and highlight useful pancreatic features.And re-parameterization Visual Geometry Group(RepVGG)blocks with amulti-branch structure are introduced in the decoder to effectively integrate deep features and low-level details,improving segmentation accuracy.Furthermore,we apply re-parameterization to the model,reducing computations and parameters while accelerating inference and reducing memory usage.Our approach achieves average dice similarity coefficient(DSC)of 85.59%,intersection over union(IoU)of 75.03%,precision of 85.09%,and recall of 86.57%on the NIH pancreas dataset.Compared with other methods,our model has fewer parameters and faster inference speed,demonstrating its enormous potential in practical applications of pancreatic segmentation.
基金Supported by National Natural Science Foundation of China,No.62472315Shanghai Science and Technology Innovation Action Plan Medical Innovation Research Project,No.20Y11912500.
文摘Diffusion-weighted magnetic resonance imaging(DWI)has become an essential tool in the field of pancreatic magnetic resonance imaging,enabling the detection,characterization,prediction,and evaluation of pancreatic diseases.In this article,we review the acquisition parameters,postprocessing techniques,and quantitative methods utilized in pancreatic DWI.Various postprocessing models,including monoexponential,biexponential,stretched exponential and non-Gaussian kurtosis models,as well as deep learning networks,have been used to assess the clinical utility of these models in diagnosing pancreatic diseases.The single-shot echo-planar imaging sequence is the most commonly used sequence for DWI data acquisition in clinical settings,and the apparent diffusion coefficient(ADC)calculated using the monoexponential model is the most widely used quantitative parameter in clinical practice.The repeatability threshold for the ADC of a normal pancreas is 37%for test-retest scans,but the repeatability threshold for pancreatic tumors needs to be further investigated.Complex postprocessing models exploring novel DWI-based biomarkers beyond ADC to assess histological features,and artificial intelligence in DWI postprocessing and data analyses hold promise in the diagnosis of pancreatic diseases.Future work should focus on standardizing protocols,conducting multicentre studies,and exploring variety of methods to improve the accuracy of quantitative DWI results to increase the clinical effectiveness of DWI in patients with pancreatic diseases.
基金Supported by the Zhejiang Medical Science and Technology Project,No.2022KY1325 and No.2023KY381.
文摘BACKGROUND Intraductal oncocytic papillary neoplasm(IOPN)of the pancreas is an extremely rare pancreatic tumor,with only sporadic cases reported in the literature.IOPN is difficult to diagnose and highly prone to misdiagnosis.IOPN carries a certain risk of progressing to invasive cancer.Surgical resection is the primary treatment for IOPN.According to the existing literature reports,the vast majority of patients with IOPN of the pancreas undergo open surgery,while only one case of laparoscopic surgery have been reported.CASE SUMMARY This report presents two cases of IOPN in elderly female patients,aged 60 and 61.Both patients were asymptomatic,and their pancreatic masses were discovered incidentally.Preoperative diagnosis of IOPN is challenging and prone to misdiagnosis.In the first case,the patient underwent a laparoscopic distal pancreatectomy and splenectomy.The surgical procedure spanned 342 minutes,with an estimated intraoperative blood loss of around 100 mL.The patient experienced an uneventful postoperative recovery and was discharged on the 8th postoperative day.For the second case,a laparoscopic pancreaticoduodenectomy was performed.The operation lasted for 431 minutes with an intraoperative blood loss of approximately 50 mL.The patient also demonstrated a favorable postoperative course and was discharged on the 24^(th)postoperative day.Postoperative pathology and immunohistochemistry confirmed the diagnosis of IOPN.No recurrence was observed in either patient after follow-up periods of 8 and 10 months,respectively.CONCLUSION These cases demonstrate that laparoscopic surgery can be considered as one of the treatment options for IOPN of the pancreas.
文摘BACKGROUND Solid pseudopapillary neoplasm(SPN)of the pancreas is a rare epithelial tumor that primarily affects young women.Since the condition is often asymptomatic or presents with non-specific symptoms,its diagnosis can be difficult.CASE SUMMARY This report details the case of a 15-year-old girl who presented with a 2-year history of abdominal pain,with no significant findings during physical examination.Abdominal ultrasound revealed a well-defined heterogeneous solidcystic mass in the epigastric region,likely originating from the tail of the pancreas.A subsequent contrast-enhanced computed tomography scan indicated a welldefined cystic lesion with an enhancing solid component and capsule in the tail of the pancreas,suggestive of a cystic neoplasm.The patient underwent an open distal pancreatectomy with splenectomy,and histopathological analysis confirmed the diagnosis of SPN of the pancreas.CONCLUSION This case highlights the risk of SPN in adolescent girls and the necessity of early diagnosis and intervention for better outcomes.
基金Supported by Hygiene and Health Development Scientific Research Fostering Plan of Haidian District Beijing,No.HP2024-19-503002National Key R&D Program of China,No.2023YFC2413802Beijing Municipal Administration of Hospitals Incubating Program,No.PX2024041.
文摘BACKGROUND Malignant transformation of an ectopic pancreas is exceptionally rare,posing significant diagnostic challenges.As such,there are currently no established management guidelines.We present a rare case of gastric adenocarcinoma arising from ectopic pancreatic tissue and provide a systematic review of previous case reports of adenocarcinomas derived from ectopic pancreas in the stomach,duodenum,and jejunum in the past 20 years.We provide an overview of the clinicopathological characteristics and discuss critical diagnostic and therapeutic considerations.CASE SUMMARY A 58-year-old female was admitted to our hospital in August 2024 due to elevated carbohydrate antigen 19-9.Relevant examinations found a huge abdominal tumor that was radiologically adherent to both the pancreatic head and the greater curvature of the gastric antrum.A preoperative endoscopic biopsy-confirmed adenocarcinoma,prompting a pancreaticoduodenectomy.Histopathological examination subsequently identified the tumor as an adenocarcinoma originating from a gastric ectopic pancreas.Adjuvant chemotherapy(gemcitabine+cap ecitabine)commenced on November 13,2024.After five cycles,surveillance imaging(April 3,2025)revealed metastatic progression,prompting a transition to second-line therapy(nab-paclitaxel+gemcitabine).The patient is currently undergoing regular chemotherapy and has been followed up regularly,and the condition has not changed significantly compared with before.CONCLUSION We hope that our findings will facilitate the clinical recognition of this entity and help to increase knowledge regarding its management.
基金supported by the National Natural and Science Foundation of China under Grant No.12301662Zhejiang Provincial Natural Science Foundation of China under Grant No.LQ21F030019.
文摘Automatic pancreas segmentation in CT scans is crucial for various medical applications including early disease detection,treatment planning and therapeutic evaluation.However,the pancreas’s small size,irregular morphology,and low contrast with surrounding tissues make accurate pancreas segmentation still a challenging task.To address these challenges,we propose a novel RPMS-DSAUnet for accurate automatic pancreas segmentation in abdominal CT images.First,a Residual Pyramid Squeeze Attention module enabling hierarchical multi-resolution feature extraction with dynamic feature weighting and selective feature reinforcement capabilities is integrated into the backbone network,enhancing pancreatic feature extraction and improving localization accuracy.Second,a Multi-Scale Feature Extraction module is embedded into the network to expand the receptive field while preserving feature map resolution,mitigate feature degradation caused by network depth,and maintain awareness of pancreatic anatomical structures.Third,a Dimensional Squeeze Attention module is designed to reduce interference from adjacent organs and highlight useful pancreatic features through spatial-channel interaction,thereby enhancing sensitivity to small targets.Finally,a hybrid loss function combining Dice loss and Focal loss is employed to alleviate class imbalance issues.Extensive evaluation on two public datasets(NIH and MSD)shows that the proposed RPMS-DSAUnet achieves Dice Similarity Coefficients of 85.51%and 80.91%,with corresponding Intersection over Union(IoU)scores of 74.93%and 67.94%on each dataset,respectively.Experimental results demonstrate superior performance of the proposed model over baseline methods and state-of-the-art approaches,validating its effectiveness for CT-based pancreas segmentation.
文摘BACKGROUND Acinar cystic transformation(ACT)of the pancreas is a rare non-neoplastic transformation of the pancreas.Adult women are the majority of patients with ACT,but few cases have been reported in pediatric patients.Given that there are currently no guidelines for the treatment of ACT,current treatment is based primarily on expert opinions and clinical experiences.Here,we report the case of the youngest child with ACT to date.Additionally,a literature review on pediatric ACT cases was performed to summarize previous clinical experience and treatment methods.CASE SUMMARY A 1-year-old Chinese girl presented with progressive abdominal distension for 6 months.A detailed consultation revealed an uneventful history.The patient showed no signs of fever or abdominal pain and had a good appetite and normal feces.A mass of about 20 cm×10 cm×10 cm in size was detected in the abdomen.Both abdominal ultrasound and computed tomography examination revealed a multilocular cystic mass about 21.7 cm×16.8 cm×8.9 cm in size.At first,due to the large size and the possible retroperitoneal origin of the cyst,a total resection of the lesion was not possible.A single-port laparoscopic lymphangioma puncture and Pingyangmycin injection were performed in March 2023.One month after surgery,the abdominal cyst rapidly enlarged to its pre-operative size.After consulting with the experts in the angiology department and interventional department,sclerotherapy combined with oral sirolimus was performed in May 2023.After confirming that the tumor was not sensitive to sclerotherapy combined with oral sirolimus,our surgical team performed tumor reduction in August 2023.This surgery confirmed that the polycystic mass originated from the head of the pancreas,and pathological and immunohistochemical findings diagnosed pancreatic ACT.The patient showed no signs of cyst lesions after 6 months of follow-up and remains in good health up to the time of this report.CONCLUSION ACT is a rare non-neoplastic transformation of the pancreas,more rarely seen in children.Manifestation and examinations show no specificity for diagnosis,and final diagnosis is mainly based on histological findings.To reach a specific diagnosis and rule out malignancy is a priority in clinical practice,and repeated biopsy or radical surgery should be considered before malignancy is ruled out.However,once a diagnosis of ACT is made,a conser-vative treatment with consecutive follow-up is recommended until symptoms present or obvious enlargement occurs because ACT is considered a slow-growing and benign tumor.
文摘The development of plant embryology in China can be roughly divided into three stages: (1) the initial stage, (2) the stage of establishing plant embryology as a branch of plant sciences, and (3) the stage when plant embryology evolves into plant reproductive biology with its vigorous development. It is in the third stage that research work in this field in China has developed rapidly and many of the significant achievements obtained are described in more details in this review. Researches of experimental embryology are not included in this paper.
文摘Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pancreatic cancer (LAPC) were collected and randomized into two groups: Arm A 125 I (18 patients) and Arm B 125 I+GEM (20 patients). Eligibility criteria were: cytologically and pathologically proven pancreatic carcinoma, Karnofsky performance status (kps) 60 80, age 18 75 years, adequate hematological, renal and liver function, and controllable pain. Arm A patients were treated with 125 I implants. Arm B patients started chemotherapy within 10 14 d post operatively following the implant procedure. Chemotherapy doses were as follows: GEM 1 000 mg/m 2 weekly × 3 followed by 1 week of rest for 3 cycles. In addition, all patients underwent laparotomy and surgical staging. The surgical procedures performed were biopsy, gastric bypass and biliary bypass. The total activity and number of seeds used were as recommended by Anderson. The mean activity, minimal peripheral dose (MPD), and volume of implants were 20 mCi, 14 000 cGy, and 53 cm 3, respectively. Results: Overall response rate (CR+PR) in Arm A was 37.6% and in Arm B it was 44.5% ( P >0.05). PR median duration in Arm A was 6.7 months and in Arm B it was 4.8 months ( P <0.05). Clinical benefit response was experienced by 11.7 % of Arm A compared with 42.1% of Arm B ( P <0.05). The incidences of hematological toxicity (such as neutropenia) between Arm A and Arm B were 5.8% and 21.1%, respectively ( P >0.05). The survival rates of 12 and 24 month were 32.5%, 16.3% for Arm A and 61%, 38.7% for Arm B ( P =0.04). The rate of complication of Arm A was lower than that of Arm B without statistical significance. Conclusion: To some extent, 125 I or 125 I plus GEM is able to lead to a moderate objective response for LAPC with obstructive jaundice on the base of biliary bypass or/and gastric bypass, but 125 I plus GEM is more effective than 125 I in improvement of the quality of life and survival rate in patients with LAPC.
文摘AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional review board approval was obtained.Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions(SEL)with a final diagnosis of EP between January 2009and December 2013 were identified.Patients in this group were selected for the study if they underwent endoscopic ultrasound(EUS)with fine-needle aspiration(FNA)or deep biopsy.A review of the medical record was performed specifically to review the following information:presenting symptoms,endoscopic and EUS findings,computed tomography or magnetic resonance imaging findings,pathology results,procedure-related adverse events,and subsequent treatments after EUSFNA.EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians(Attwell A,Fukami N).Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses.RESULTS:Between July 2009 and December 2013,10patients[3 males,7 females,median age 52(26-64)years]underwent EUS for a gastroduodenal SEL and were diagnosed with EP.One patient was symptomatic.Six(60%)lesions were in the antrum,3(30%)in the body,and 1(10%)in the duodenum.A mucosal dimple was noted in 6(60%).Mean lesion size was 17(8-25)mm.Gastrointestinal wall involvement:muscularis mucosae,10%;submucosa,70%;muscularis propria,60%;and serosa,10%.Nine(90%)lesions were hypoechoic and 5(50%)were homogenous.A duct was seen in 5(50%).FNA was attempted in 9(90%)and successful in 8(80%)patients after 4(2-6)passes.Cytology showed acini or ducts in 7 of 8(88%).Superficial biopsies in 7 patients(70%)showed normal gastric mucosa.Deep endoscopic biopsies were taken in 2 patients and diagnostic in one.One patient(10%)developed pancreatitis after EUS-FNA.Two patients(20%)underwent surgery to relieve symptoms or confirm the diagnosis.The main limitation of the study was the fact that it was retrospective and performed at a single medical center.CONCLUSION:EUS features of EP include antral location,mucosal dimple,location in layers 3-4,and lesional duct,and FNA or biopsy is accurate and effective.
基金Supported by Pusan National University Research Grant for two years
文摘AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.
文摘A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature.
