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
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
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
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
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
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
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
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
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
BACKGROUND Heterotopic pancreas(HP)is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract.While the majority of heterotopic pancreatic lesions are asymptomatic,many manifest...BACKGROUND Heterotopic pancreas(HP)is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract.While the majority of heterotopic pancreatic lesions are asymptomatic,many manifest severe clinical symptoms which require surgical or endoscopic intervention.Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature.The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease.AIM To classify the common clinical manifestations of heterotopic pancreas.METHODS A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018.Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location.Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated.These were compared to a systematic review of the literature utilizing Pub Med and Embase searches for papers pertaining to heterotopic pancreas.Publications describing symptomatic presentation of HP were selected for review.Information including demographics,symptoms,presentation and treatment were compiled and analyzed.RESULTS Twenty-nine patient were identified with HP at a single center,with six of these identified has having clinical symptoms.Clinical manifestations included,gastrointestinal bleeding,gastric ulceration with/without perforation,pancreatitis,and gastric outlet obstruction.Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients.Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients.The majority of patients presented with abdominal pain(67%)combined with one of the following clinical categories:(1)Dyspepsia,(n=445,48%);(2)Pancreatitis(n=260,28%);(3)Gastrointestinal bleeding(n=80,9%);and(4)Gastric outlet obstruction(n=80,9%).The majority of cases(n=832,90%)underwent surgical or endoscopic resection with 85%reporting resolution or improvement in their symptoms.CONCLUSION Heterotopic pancreas can cause significant clinical symptoms in the upper gastrointestinal tract.Better understanding and classification of this disease may result in more accurate identification and treatment of this malformation.展开更多
Solid pseudopapillary neoplasms are rare.This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas,including the epidemiology,cytology,molecular pathology,differential...Solid pseudopapillary neoplasms are rare.This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas,including the epidemiology,cytology,molecular pathology,differential diagnosis,treatment,and prognosis.Solid pseudopapillary neoplasms are low-grade malignant tumours of the pancreas characterized by poorly cohesive epithelial cells with solid and pseudopapillary patterns.Solid pseudopapillary neoplasms occur predominantly in young women.Although solid pseudopapillary neoplasms can occur throughout the pancreas,they arise slightly more frequently in the tail of the pancreas.The aetiology is unknown.Extremely rare cases have been reported in the setting of familial adenomatous polyposis.There are no symptoms unique to solid pseudopapillary neoplasms,however,the most common symptom is abdominal pain or discomfort.The features of solid pseudopapillary neoplasms on computed tomography imaging are indicative of the pathologic changes within the tumour.Typically,well-demarcated masses with variably solid and cystic appearances.Microscopically,these tumours are composed of epithelial cells forming solid and pseudopapillary structures,frequently undergoing haemorrhagic cystic degeneration.Typically,these tumours express nuclear and/or cytoplasmicβ-catenin.Almost all solid pseudopapillary neoplasms harbour mutations in exon 3 of CTNNB1,the gene encodingβ-catenin.The overall prognosis is excellent,and most patients are cured by complete surgical resection.展开更多
To summarize the long-term complications after pancreas transplantation that affect graft function,a literature search was carried out on the long-term complications of pancreatic transplantation,namely,complications ...To summarize the long-term complications after pancreas transplantation that affect graft function,a literature search was carried out on the long-term complications of pancreatic transplantation,namely,complications from postoperative 3rd mo onwards,in terms of loss of graft function,late infection and vascular complications as pseudoaneurysms.The most relevant reviews and studies were selected to obtain the current evidence on these topics.The definition of graft failure varies among different studies,so it is difficult to evaluate,a standardized definition is of utmost importance to know the magnitude of the problem in all worldwide series.Chronic rejection is the main cause of long-term graft failure,occurring in 10%of patients.From the 3rd mo of transplantation onwards,the main risk factor for late infections is immunosuppression,and patients have opportunistic infections like:Cytomegalovirus,hepatitis B and C viruses,Epstein-Barr virus and varicella-zoster virus;opportunistic bacteria,reactivation of latent infections as tuberculosis or fungal infections.Complete preoperative studies and serological tests should be made in all recipients to avoid these infections,adding perioperative prophylactic treatments when indicated.Pseudoaneurysm are uncommon,but one of the main causes of late bleeding,which can be fatal.The treatment should be performed with radiological endovascular approaches or open surgery in case of failure.Despite all therapeutic options for the complications mentioned above,transplantectomy is a necessary option in approximately 50%of relaparotomies,especially in lifethreatening complications.Late complications in pancreatic transplantation threatens long-term graft function.An exhaustive follow-up as well as a correct immunosuppression protocol are necessary for prevention.展开更多
The aim of the work was to analyze and expose the donor and recipient riskfactors in pancreas transplantation.In the following paper,we exposed the 2018Spanish Consensus Document on Donor and Recipient Selection Crite...The aim of the work was to analyze and expose the donor and recipient riskfactors in pancreas transplantation.In the following paper,we exposed the 2018Spanish Consensus Document on Donor and Recipient Selection Criteria forPancreas Transplantation.An assessment of the previous Selection Criteria forDonors and Recipients of Pancreas Transplantation,published in 2005 by theSpanish Pancreas Transplant Group(GETP)and the National TransplantOrganization(ONT)was performed.A literature review was performed usingCochrane Library,PubMed and Google Scholar databases.Some of the followingterms were used for the literature search:“Diabetes Mellitus,”“PancreasTransplantation,”“Insulin-Secreting Cells,”“Pancreas Allograft Thrombosis,”“Allograft Pancreatitis,”“Donors’Risk Factors,”“Recipients’Risk Factors,”“Pancreas Allograft Rejection”and“Pancreas Allograft Survival.”After anextended search,different inclusion criteria were established.Articles anddocuments with abstracts of full text and in English or Spanish language wereselected.Subsequently,different scientific meetings took place during 2015 and2016 by the GETP.Finally,the updated criteria were published by the GETP andONT in 2018.Several risk factors have been described in pancreas transplantationthat can be divided into donor risk factors:Advanced age(>50 years);high bodymass index(BMI)(>30 kg/m2);cause of death(e.g.,stroke);previoushyperglycemia;hyperamylasemia;cold ischemia time(greater than 8 or 12 h,depending on the type of donation);the use of vasopressors in the intensive careunit or cardiac arrest;and the macroscopic aspect of the pancreas allograft.Thefollowing are recipient risk factors:Advanced age(>50 years);active smoking;high BMI(>30 kg/m2);and peripheral artery disease or sensorimotorpolyneuropathy.Based on the aforementioned parameters,different selectioncriteria have been established for the recipients depending on the type of pancreastransplantation.Knowledge of the risk factors for pancreas transplantation allowsthe establishment of reliable selection criteria for choosing donors and recipients.展开更多
BACKGROUND Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes.However,since 2005,no comprehensive analysis has compared survival outcomes of:(1)Simult...BACKGROUND Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes.However,since 2005,no comprehensive analysis has compared survival outcomes of:(1)Simultaneous pancreas-kidney(SPK)transplant;(2)Pancreas after kidney(PAK)transplant;and(3)Pancreas transplant alone(PTA)to waitlist survival.AIM To explore the outcomes of pancreas transplants in the United States during the decade 2008-2018.METHODS Our study utilized the United Network for Organ Sharing Standard Transplant Analysis and Research file.Pre-and post-transplant recipient and waitlist characteristics and the most recent recipient transplant and mortality status were used.We included all patients with type I diabetes listed for pancreas or kidneypancreas transplant between May 31,2008 and May 31,2018.Patients were grouped into one of three transplant types:SPK,PAK,or PTA.RESULTS The adjusted Cox proportional hazards models comparing survival between transplanted and non-transplanted patients in each transplant type group showed that patients who underwent an SPK transplant exhibited a significantly reduced hazard of mortality[hazard ratio(HR)=0.21,95%confidence intervals(CI):0.19-0.25]compared to those not transplanted.Neither PAK transplanted patients(HR=1.68,95%CI:0.99-2.87)nor PTA patients(HR=1.01,95%CI:0.53-1.95)experienced significantly different hazards of mortality compared to patients who did not receive a transplant.CONCLUSION When assessing each of the three transplant types,only SPK transplant offered a survival advantage compared to patients on the waiting list.PKA and PTA transplanted patients demonstrated no significant differences compared to patients who did not receive a transplant.展开更多
AIM: To investigate the Wake Forest experience with pancreas transplantation in the new millennium with attention to surgical techniques and immunosuppression. METHODS: A monocentric, retrospective review of outcomes ...AIM: To investigate the Wake Forest experience with pancreas transplantation in the new millennium with attention to surgical techniques and immunosuppression. METHODS: A monocentric, retrospective review of outcomes in simultaneous kidney-pancreas transplant(SKPT) and solitary pancreas transplant(SPT) recipients was performed. All patients underwent pancreas transplantation as intent-to-treat with portal venous and enteric exocrine drainage and received depleting antibody induction; maintenance therapy included tapered steroids or early steroid elimination with my-cophenolate and tacrolimus. Recipient selection was based on clinical judgment whether or not the patient exhibited measureable levels of C-peptide. RESULTS: Over an 11.25 year period, 202 pancreas transplants were performed in 192 patients including 162 SKPTs and 40 SPTs. A total of 186(92%) were primary and 16(8%) pancreas retransplants; portalenteric drainage was performed in 179 cases. A total of 39 pancreas transplants were performed in African American(AA) patients; of the 162 SKPTs, 30 were performed in patients with pretransplant C-peptide levels 】 2.0 ng/m L. In addition, from 2005-2008, 46 SKPT patients were enrolled in a prospective study of single dose alemtuzumab vs 3-5 doses of rabbit antithymocyte globulin induction therapy. With a mean follow-up of 5.7 in SKPT vs 7.7 years in SPT recipients, overall patient(86% SKPT vs 87% SPT) and kidney(74% SKPT vs 80% SPT) graft survival rates as well as insulin-free rates(both 65%) were similar(P = NS). Although mortality rates were nearly identical in SKPT compared to SPT recipients, patterns and timing of death were different as no early mortality occurred in SPT recipients whereas the rates of mortality following SKPT were 4%, 9% and 12%, at 1-, 3- and 5-years follow-up, respectively(P 【 0.05). The primary cause of graft loss in SKPT recipients was death with a functioning graft whereas the major cause of graft loss following SPT was acute and chronic rejection. The overall incidence of acute rejection was 29% in SKPT and 27.5% in SPT recipients(P = NS). Lower rates of acute rejection and major infection were evidenced in SKPT patients receiving alemtuzumab induction therapy. Comparable kidney and pancreas graft survival rates were observed in AA and non-AA recipients despite a higher prevalence of a “type 2 diabetes” phenotype in AA. Results comparable to those achieved in insulinopenic diabetics were found in the transplantation of type 2 diabetics with detectable C-peptide levels.CONCLUSION: In the new millennium, acceptablemedium-term outcomes can be achieved in SKPT and SPTs as nearly 2/3rds of patients are insulin independent following pancreas transplantation.展开更多
To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique.Back-table surgery for pancreatic graft is a complex,meticulous and laborious technique on which the ...To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique.Back-table surgery for pancreatic graft is a complex,meticulous and laborious technique on which the success of implant surgery and perioperative results depends.The technique can be described in the following steps:Preparation of the sterile table,ex-situ inspection of the pancreasspleen block,management of the duodenum,identification of the bile duct,preparation of the portal vein,preparation of the own graft arteries and anastomosis to the arterial graft,spleen management and graft preservation prior to implantation in the recipient.A careful inspection of the pancreas-spleen block should be performed.It is important to identify the stump of the main bile duct,the portal vein cuff,and the arrangement of the superior mesenteric artery and splenic artery.The redundant duodenum must be removed.The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft,two key points to prevent thrombosis.The section line of the arteries must be clean,without atherosclerosis,to prevent arterial thrombosis.The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue.The artery can be reconstructed by interposing a"Y"graft from the donor iliac artery;or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery.An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation:Thrombosis and graft pancreatitis.展开更多
In pancreas transplantation, complications can arise at each step of the process,from the initial selection of donors and recipients through the surgical techniqueitself and the post-operative period, when lifelong im...In pancreas transplantation, complications can arise at each step of the process,from the initial selection of donors and recipients through the surgical techniqueitself and the post-operative period, when lifelong immunosuppression isrequired. In the early steps, careful retrieval and preservation of the pancreas arecrucial for the viability of the organ and ultimate success of the transplant. Thepancreas is a low-flow gland, making it highly sensitive to transplantationconditions and presenting risk of pancreatitis due to periods of ischemia. The twogroups of donors - after brain death (DBD) or after cardiac arrest (DCD) - requiredifferent strategies of retrieval and preservation to avoid or reduce the risk ofcomplications developing during and after the transplantation. For DBD donortransplantation, multiorgan retrieval and cold preservation is the conventionaltechnique. Asystole donor (DCD) transplantation, in contrast, can benefit from thenewest technologies, such as hypothermic and especially normothermicpreservation machines (referred to as NECMO), to optimize organ preservation.The latter has led to an increase in the pool of donors by facilitating recuperationof organs for transplantation that would have been discarded otherwise.展开更多
The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980 s to 1995, most pancreas transplants were wh...The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980 s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder(systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin(systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990 s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion(portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine theliterature on exocrine drainage in the new millennium(the purported "enteric drainage" era) with special attention to technical variations and nuances in vascularized pancreas transplantation that have been proposed and studied in this time period.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.
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 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 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 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.
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.
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.
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.
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.
文摘BACKGROUND Heterotopic pancreas(HP)is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract.While the majority of heterotopic pancreatic lesions are asymptomatic,many manifest severe clinical symptoms which require surgical or endoscopic intervention.Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature.The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease.AIM To classify the common clinical manifestations of heterotopic pancreas.METHODS A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018.Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location.Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated.These were compared to a systematic review of the literature utilizing Pub Med and Embase searches for papers pertaining to heterotopic pancreas.Publications describing symptomatic presentation of HP were selected for review.Information including demographics,symptoms,presentation and treatment were compiled and analyzed.RESULTS Twenty-nine patient were identified with HP at a single center,with six of these identified has having clinical symptoms.Clinical manifestations included,gastrointestinal bleeding,gastric ulceration with/without perforation,pancreatitis,and gastric outlet obstruction.Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients.Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients.The majority of patients presented with abdominal pain(67%)combined with one of the following clinical categories:(1)Dyspepsia,(n=445,48%);(2)Pancreatitis(n=260,28%);(3)Gastrointestinal bleeding(n=80,9%);and(4)Gastric outlet obstruction(n=80,9%).The majority of cases(n=832,90%)underwent surgical or endoscopic resection with 85%reporting resolution or improvement in their symptoms.CONCLUSION Heterotopic pancreas can cause significant clinical symptoms in the upper gastrointestinal tract.Better understanding and classification of this disease may result in more accurate identification and treatment of this malformation.
文摘Solid pseudopapillary neoplasms are rare.This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas,including the epidemiology,cytology,molecular pathology,differential diagnosis,treatment,and prognosis.Solid pseudopapillary neoplasms are low-grade malignant tumours of the pancreas characterized by poorly cohesive epithelial cells with solid and pseudopapillary patterns.Solid pseudopapillary neoplasms occur predominantly in young women.Although solid pseudopapillary neoplasms can occur throughout the pancreas,they arise slightly more frequently in the tail of the pancreas.The aetiology is unknown.Extremely rare cases have been reported in the setting of familial adenomatous polyposis.There are no symptoms unique to solid pseudopapillary neoplasms,however,the most common symptom is abdominal pain or discomfort.The features of solid pseudopapillary neoplasms on computed tomography imaging are indicative of the pathologic changes within the tumour.Typically,well-demarcated masses with variably solid and cystic appearances.Microscopically,these tumours are composed of epithelial cells forming solid and pseudopapillary structures,frequently undergoing haemorrhagic cystic degeneration.Typically,these tumours express nuclear and/or cytoplasmicβ-catenin.Almost all solid pseudopapillary neoplasms harbour mutations in exon 3 of CTNNB1,the gene encodingβ-catenin.The overall prognosis is excellent,and most patients are cured by complete surgical resection.
文摘To summarize the long-term complications after pancreas transplantation that affect graft function,a literature search was carried out on the long-term complications of pancreatic transplantation,namely,complications from postoperative 3rd mo onwards,in terms of loss of graft function,late infection and vascular complications as pseudoaneurysms.The most relevant reviews and studies were selected to obtain the current evidence on these topics.The definition of graft failure varies among different studies,so it is difficult to evaluate,a standardized definition is of utmost importance to know the magnitude of the problem in all worldwide series.Chronic rejection is the main cause of long-term graft failure,occurring in 10%of patients.From the 3rd mo of transplantation onwards,the main risk factor for late infections is immunosuppression,and patients have opportunistic infections like:Cytomegalovirus,hepatitis B and C viruses,Epstein-Barr virus and varicella-zoster virus;opportunistic bacteria,reactivation of latent infections as tuberculosis or fungal infections.Complete preoperative studies and serological tests should be made in all recipients to avoid these infections,adding perioperative prophylactic treatments when indicated.Pseudoaneurysm are uncommon,but one of the main causes of late bleeding,which can be fatal.The treatment should be performed with radiological endovascular approaches or open surgery in case of failure.Despite all therapeutic options for the complications mentioned above,transplantectomy is a necessary option in approximately 50%of relaparotomies,especially in lifethreatening complications.Late complications in pancreatic transplantation threatens long-term graft function.An exhaustive follow-up as well as a correct immunosuppression protocol are necessary for prevention.
文摘The aim of the work was to analyze and expose the donor and recipient riskfactors in pancreas transplantation.In the following paper,we exposed the 2018Spanish Consensus Document on Donor and Recipient Selection Criteria forPancreas Transplantation.An assessment of the previous Selection Criteria forDonors and Recipients of Pancreas Transplantation,published in 2005 by theSpanish Pancreas Transplant Group(GETP)and the National TransplantOrganization(ONT)was performed.A literature review was performed usingCochrane Library,PubMed and Google Scholar databases.Some of the followingterms were used for the literature search:“Diabetes Mellitus,”“PancreasTransplantation,”“Insulin-Secreting Cells,”“Pancreas Allograft Thrombosis,”“Allograft Pancreatitis,”“Donors’Risk Factors,”“Recipients’Risk Factors,”“Pancreas Allograft Rejection”and“Pancreas Allograft Survival.”After anextended search,different inclusion criteria were established.Articles anddocuments with abstracts of full text and in English or Spanish language wereselected.Subsequently,different scientific meetings took place during 2015 and2016 by the GETP.Finally,the updated criteria were published by the GETP andONT in 2018.Several risk factors have been described in pancreas transplantationthat can be divided into donor risk factors:Advanced age(>50 years);high bodymass index(BMI)(>30 kg/m2);cause of death(e.g.,stroke);previoushyperglycemia;hyperamylasemia;cold ischemia time(greater than 8 or 12 h,depending on the type of donation);the use of vasopressors in the intensive careunit or cardiac arrest;and the macroscopic aspect of the pancreas allograft.Thefollowing are recipient risk factors:Advanced age(>50 years);active smoking;high BMI(>30 kg/m2);and peripheral artery disease or sensorimotorpolyneuropathy.Based on the aforementioned parameters,different selectioncriteria have been established for the recipients depending on the type of pancreastransplantation.Knowledge of the risk factors for pancreas transplantation allowsthe establishment of reliable selection criteria for choosing donors and recipients.
基金This study was reviewed and approved by Mayo Clinic institutional review board(IRB application number 20-004621).
文摘BACKGROUND Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes.However,since 2005,no comprehensive analysis has compared survival outcomes of:(1)Simultaneous pancreas-kidney(SPK)transplant;(2)Pancreas after kidney(PAK)transplant;and(3)Pancreas transplant alone(PTA)to waitlist survival.AIM To explore the outcomes of pancreas transplants in the United States during the decade 2008-2018.METHODS Our study utilized the United Network for Organ Sharing Standard Transplant Analysis and Research file.Pre-and post-transplant recipient and waitlist characteristics and the most recent recipient transplant and mortality status were used.We included all patients with type I diabetes listed for pancreas or kidneypancreas transplant between May 31,2008 and May 31,2018.Patients were grouped into one of three transplant types:SPK,PAK,or PTA.RESULTS The adjusted Cox proportional hazards models comparing survival between transplanted and non-transplanted patients in each transplant type group showed that patients who underwent an SPK transplant exhibited a significantly reduced hazard of mortality[hazard ratio(HR)=0.21,95%confidence intervals(CI):0.19-0.25]compared to those not transplanted.Neither PAK transplanted patients(HR=1.68,95%CI:0.99-2.87)nor PTA patients(HR=1.01,95%CI:0.53-1.95)experienced significantly different hazards of mortality compared to patients who did not receive a transplant.CONCLUSION When assessing each of the three transplant types,only SPK transplant offered a survival advantage compared to patients on the waiting list.PKA and PTA transplanted patients demonstrated no significant differences compared to patients who did not receive a transplant.
文摘AIM: To investigate the Wake Forest experience with pancreas transplantation in the new millennium with attention to surgical techniques and immunosuppression. METHODS: A monocentric, retrospective review of outcomes in simultaneous kidney-pancreas transplant(SKPT) and solitary pancreas transplant(SPT) recipients was performed. All patients underwent pancreas transplantation as intent-to-treat with portal venous and enteric exocrine drainage and received depleting antibody induction; maintenance therapy included tapered steroids or early steroid elimination with my-cophenolate and tacrolimus. Recipient selection was based on clinical judgment whether or not the patient exhibited measureable levels of C-peptide. RESULTS: Over an 11.25 year period, 202 pancreas transplants were performed in 192 patients including 162 SKPTs and 40 SPTs. A total of 186(92%) were primary and 16(8%) pancreas retransplants; portalenteric drainage was performed in 179 cases. A total of 39 pancreas transplants were performed in African American(AA) patients; of the 162 SKPTs, 30 were performed in patients with pretransplant C-peptide levels 】 2.0 ng/m L. In addition, from 2005-2008, 46 SKPT patients were enrolled in a prospective study of single dose alemtuzumab vs 3-5 doses of rabbit antithymocyte globulin induction therapy. With a mean follow-up of 5.7 in SKPT vs 7.7 years in SPT recipients, overall patient(86% SKPT vs 87% SPT) and kidney(74% SKPT vs 80% SPT) graft survival rates as well as insulin-free rates(both 65%) were similar(P = NS). Although mortality rates were nearly identical in SKPT compared to SPT recipients, patterns and timing of death were different as no early mortality occurred in SPT recipients whereas the rates of mortality following SKPT were 4%, 9% and 12%, at 1-, 3- and 5-years follow-up, respectively(P 【 0.05). The primary cause of graft loss in SKPT recipients was death with a functioning graft whereas the major cause of graft loss following SPT was acute and chronic rejection. The overall incidence of acute rejection was 29% in SKPT and 27.5% in SPT recipients(P = NS). Lower rates of acute rejection and major infection were evidenced in SKPT patients receiving alemtuzumab induction therapy. Comparable kidney and pancreas graft survival rates were observed in AA and non-AA recipients despite a higher prevalence of a “type 2 diabetes” phenotype in AA. Results comparable to those achieved in insulinopenic diabetics were found in the transplantation of type 2 diabetics with detectable C-peptide levels.CONCLUSION: In the new millennium, acceptablemedium-term outcomes can be achieved in SKPT and SPTs as nearly 2/3rds of patients are insulin independent following pancreas transplantation.
文摘To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique.Back-table surgery for pancreatic graft is a complex,meticulous and laborious technique on which the success of implant surgery and perioperative results depends.The technique can be described in the following steps:Preparation of the sterile table,ex-situ inspection of the pancreasspleen block,management of the duodenum,identification of the bile duct,preparation of the portal vein,preparation of the own graft arteries and anastomosis to the arterial graft,spleen management and graft preservation prior to implantation in the recipient.A careful inspection of the pancreas-spleen block should be performed.It is important to identify the stump of the main bile duct,the portal vein cuff,and the arrangement of the superior mesenteric artery and splenic artery.The redundant duodenum must be removed.The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft,two key points to prevent thrombosis.The section line of the arteries must be clean,without atherosclerosis,to prevent arterial thrombosis.The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue.The artery can be reconstructed by interposing a"Y"graft from the donor iliac artery;or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery.An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation:Thrombosis and graft pancreatitis.
文摘In pancreas transplantation, complications can arise at each step of the process,from the initial selection of donors and recipients through the surgical techniqueitself and the post-operative period, when lifelong immunosuppression isrequired. In the early steps, careful retrieval and preservation of the pancreas arecrucial for the viability of the organ and ultimate success of the transplant. Thepancreas is a low-flow gland, making it highly sensitive to transplantationconditions and presenting risk of pancreatitis due to periods of ischemia. The twogroups of donors - after brain death (DBD) or after cardiac arrest (DCD) - requiredifferent strategies of retrieval and preservation to avoid or reduce the risk ofcomplications developing during and after the transplantation. For DBD donortransplantation, multiorgan retrieval and cold preservation is the conventionaltechnique. Asystole donor (DCD) transplantation, in contrast, can benefit from thenewest technologies, such as hypothermic and especially normothermicpreservation machines (referred to as NECMO), to optimize organ preservation.The latter has led to an increase in the pool of donors by facilitating recuperationof organs for transplantation that would have been discarded otherwise.
文摘The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980 s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder(systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin(systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990 s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion(portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine theliterature on exocrine drainage in the new millennium(the purported "enteric drainage" era) with special attention to technical variations and nuances in vascularized pancreas transplantation that have been proposed and studied in this time period.
