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
2008548 The effects of pioglitazone on the process of oxidative stress in acute pancreatitis induced by cerulein.WAN Hongyu(万红宇),et al. Dept Gastroenterol,Ruijin Hosp,Med Sch,Shanghai Jiaotong Univ,Shanghai 200025....2008548 The effects of pioglitazone on the process of oxidative stress in acute pancreatitis induced by cerulein.WAN Hongyu(万红宇),et al. Dept Gastroenterol,Ruijin Hosp,Med Sch,Shanghai Jiaotong Univ,Shanghai 200025. Chin J Dig 2008;28(8):531-534. Objective To investigate the effects of pioglitazone,a peroxisome proliferation activated receptor(PPAR)γ agonist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 Propolis and honey are known for their antioxidant,hypoglycemic,and antiproteinuric effects.AIM To explore the effect of propolis,and honey,against D-glucose-induced hyperglycemia,acute kidney injury(AKI),l...BACKGROUND Propolis and honey are known for their antioxidant,hypoglycemic,and antiproteinuric effects.AIM To explore the effect of propolis,and honey,against D-glucose-induced hyperglycemia,acute kidney injury(AKI),liver injury,dyslipidemia,and changes in the oxidants and antioxidants in renal,hepatic,and pancreatic tissues.METHODS The chemical analysis and antioxidant content of propolis and honey and their effect on alpha-amylase and alpha-glucosidase activity were studied.The study included five groups of male rats;four groups(2,3,4 and 5)were treated with Dglucose,and one group was untreated,group 1.In addition to D-glucose,groups 3,4,and 5 were treated with propolis,honey,and their combination,respectively.Blood glucose levels,liver and renal function tests,urine protein and electrolytes,oxidant and antioxidant parameters,and histopathological changes in hepatic,renal,and pancreatic tissues were examined.RESULTS Propolis contains a higher level of total protein and exhibits a higher antioxidant activity.Honey has a higher alpha-amylase and glucosidase inhibitory activity than propolis.D-glucose caused a significant elevation of blood glucose,insulin,homeostasis model assessment,blood urea,creatinine,lipid parameters,liver enzymes,and urine protein levels.It significantly increases malondialdehyde and decreases antioxidant parameters in pancreatic,hepatic,and renal tissues.D-glucose caused histopathological changes in hepatic,renal,and pancreatic tissues;these changes were significantly ameliorated by honey and propolis.CONCLUSION Propolis,honey,or their combination treated hyperglycemia,AKI,proteinuria,liver injury,and dyslipidemia induced by D-glucose,most likely,through their antioxidant activity and alpha-amylase and alpha-glucosidase inhibitory activity.This will pave the way for testing this natural combination in the prevention of diabetic complications,as a complement to basic therapies.展开更多
BACKGROUND Data on clinical characteristics,treatment outcomes,and prognosis of pancreatic primitive neuroectodermal tumors(PNETs)are limited.AIM To analyze the clinical data of 30 patients with pancreatic PNETs to id...BACKGROUND Data on clinical characteristics,treatment outcomes,and prognosis of pancreatic primitive neuroectodermal tumors(PNETs)are limited.AIM To analyze the clinical data of 30 patients with pancreatic PNETs to identify their clinical characteristics and factors associated with prognosis.METHODS We used the keywords"primary neuroectodermal tumor,""digestive tract,""pancreas,""pancreatic,"and"gastrointestinal,"individually or in combination,to collect data from a global database for all patients with pancreatic PNET to date.Univariate and Cox regression analyses were performed to identify prognostic factors for patient survival.RESULTS A total of 30 cases of pancreatic PNET were included in this study:15 males and 15 females with a mean age of 24 years.The main symptom was abdominal pain(73.3%),and the median tumor size was 7.85 cm.Twenty-four patients(80.0%)underwent surgery and nineteen patients received adjuvant therapy.Local metastasis was observed in 13 patients(43.3%),lymph node metastasis in 10 patients(33.3%),and distant metastasis in 6 patients(20.0%).Local recurrence was observed in 13 patients(43.3%).The median survival time of all patients was 29.4 months,and the overall estimated 1-year and 3-year survival rates were approximately 66.0%and 36.4%,respectively.Univariate analysis showed that chemotherapy(P=0.036),local metastasis(P=0.041),lymph node metastasis(P=0.003),distant metastasis(P=0.049),and surgical margins(P=0.048)were the prognostic factors affecting survival.Multivariate analysis revealed only lymph node metastasis(P=0.012)as a prognostic factor.CONCLUSION Pancreatic PNET is extremely rare,occurs in young adults,has no apparent sex predisposition,has a high rate of metastasis and early recurrence,and has a very poor prognosis.The diagnosis of pancreatic PNET requires a combination of clinical symptoms,pathologic features,immunohistochemistry,and cytogenetic analysis.Univariate analysis suggested that chemotherapy,metastasis,and surgical margins were prognostic factors affecting survival,and multivariate analysis suggested that lymph node metastasis is an important prognostic factor.Therefore,early diagnosis,early and extensive resection,and adjuvant chemoradiotherapy may help improve prognosis.展开更多
Pesticides are chemical substances used to eliminate various pests.Currently,more than two million tons of pesticides are used annually in developing and developed countries.One of the chronic diseases associated with...Pesticides are chemical substances used to eliminate various pests.Currently,more than two million tons of pesticides are used annually in developing and developed countries.One of the chronic diseases associated with pesticide poisoning is diabetes.This review aimed to elucidate the mechanisms of action involved in the development of diabetes after pesticide poisoning.Relevant information was collected between January and May 2024,using databases such as PubMed,Google Academic,and Elsevier.Pesticides reduce the secretion of glucagon-like peptide-1(GLP-1)in the intestine,thereby decreasing the release of insulin.Moreover,pesticides are metabolized to acetic acid by intestinal microbiota.This contributes to gluconeogenesis in the liver.In addition,the accumulation of pesticides in adipose tissue affects pancreatic beta-cells(β-cells)through increases in the levels of proinflammatory cytokines and the release of leptin,resulting in insulin resistance and impairments of appetite control and energy balance.These alterations caused by pesticides can contribute to the development of diabetes by affecting many organic systems.展开更多
BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-ye...BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.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
Drugs and pesticide residues in broiler feed can compromise the therapeutic and production benefits of antibiotic(ANT)application and affect gene expression.In this study,we analyzed the expression of 13 key pancreati...Drugs and pesticide residues in broiler feed can compromise the therapeutic and production benefits of antibiotic(ANT)application and affect gene expression.In this study,we analyzed the expression of 13 key pancreatic genes and blood physiology parameters after administering one maximum residue limit of herbicide glyphosate(GLY),two ANTs,and one anticoccidial drug(AD).A total of 260 Ross 308 broilers aged 1-40 d were divided into the following four groups of 65 birds each:control group,which was fed the main diet(MD),and three experimental groups,which were fed MD supplemented with GLY,GLY+ANTs(enrofloxacin and colistin methanesulfonate),and GLY+AD(ammonium maduramicin),respectively.The results showed that the addition of GLY,GLY+ANTs,and GLY+AD caused significant changes in the expression of several genes of physiological and economic importance.In particular,genes related to inflammation and apoptosis(interleukin 6(IL6),prostaglandin-endoperoxide synthase 2(PTGS2),and caspase 6(CASP6))were downregulated by up to 99.1%,and those related to antioxidant protection(catalase(CAT),superoxide dismutase 1(SOD1)and peroxiredoxin 6(PRDX6))by up to 98.6%,compared to controls.There was also a significant decline in the values of immunological characteristics in the blood serum observed in the experimental groups,and certain changes in gene expression were concordant with changes in the functioning of the pancreas and blood.The changes revealed in gene expression and blood indices in response to GLY,ANTs,and AD provide insights into the possible mechanisms of action of these agents at the molecular level.Specifically,these changes may be indicative of physiological mechanisms to overcome the negative effects of GLY,GLY+ANTs,and GLY+AD in broilers.展开更多
Neoadjuvant treatment is being extensively evaluated in pancreatic ductal adenocarcinoma(PDAC).This interest is appropriate given the dismal long-term prognosis for most patients who undergo upfront surgery.Despite pr...Neoadjuvant treatment is being extensively evaluated in pancreatic ductal adenocarcinoma(PDAC).This interest is appropriate given the dismal long-term prognosis for most patients who undergo upfront surgery.Despite prospective,retrospective and randomized trials supporting the role of neoadjuvant therapy in general for PDAC,the long-term benefit specifically for patients with resectable PDAC remains unclear.The phase III PREOPANC trial showed an improvement in overall survival in borderline resectable PDAC with neoadjuvant gemcitabinebased chemoradiation compared to upfront surgery alone,however,no such benefit was observed in the resectable cohort.Notably,three randomized trials(PANACHE01-PRODIGE 48,NORPACT-1,and PREOPANC-2)failed to show a clear improvement in overall survival with a neoadjuvant approach.The ongoing NeoFOL-R,PREOPANC-3,and the Alliance A021806 will help clarify the role of neoadjuvant therapy in resectable PDAC.In this minireview article we summarize the data surrounding neoadjuvant therapy in resectable pancreatic cancer and discuss future considerations of trials in this subgroup.展开更多
BACKGROUND Shear wave elastography(SWE)is a non-invasive ultrasound-based technique used to assess tissue stiffness,which reflects underlying pathological changes.While SWE has been widely applied for liver fibrosis e...BACKGROUND Shear wave elastography(SWE)is a non-invasive ultrasound-based technique used to assess tissue stiffness,which reflects underlying pathological changes.While SWE has been widely applied for liver fibrosis evaluation,its application to other abdominal organs,such as the spleen and pancreas,is gaining interest.However,normal stiffness values and inter-system agreement remain poorly defined.AIM To assess the feasibility and agreement of liver,spleen,and pancreas stiffness using three SWE methods.METHODS This single-center observational study enrolled 50 healthy adult volunteers.Liver,spleen,and pancreas stiffness were assessed using three SWE methods:Point-SWE(p-QElaXto)and 2-Dimensional-SWE(2D-QElaXto)with Esaote MyLab 9,and 2D-SWE with SuperSonic Imagine.Feasibility,inter-operator reproducibility,and concordance among systems were evaluated.Stiffness was expressed as median kPa values,and technical reliability was assessed using the interquartile range/median ratio and stability index thresholds.RESULTS Liver and spleen stiffness assessment was feasible in>98%of patients,while pancreas stiffness was measurable in 84%-88%depending on the SWE technique.Mean liver stiffness ranged between 3.9-4.7 kPa across techniques,spleen stiffness ranged from 19.4-23.0 kPa,and pancreas stiffness from 5.2-7.6 kPa.Inter-operator agreement was excellent for liver(intraclass correlation coefficient>0.90)and good to moderate for spleen and pancreas(intraclass correlation coefficient from 0.43 to 0.90).Bland-Altman analysis confirmed good correlation but also systematic differences among devices,especially in pancreas measurements.CONCLUSION This is the first study to establish normal liver,spleen,and pancreas stiffness using MyLab 9 SWE integrated methods as compared to SuperSonic Imagine,with acceptable inter-technique agreement.Liver and spleen values matched existing guidelines;pancreas SWE showed more variability and reduced reproducibility.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
Type 2 Diabetes(T2D)is a growing global health issue,often aggravated by excessive sugar intake.Chronic high-sucrose diets contribute to insulin resistance,oxidative stress,and pancreatic dysfunction,worsening metabol...Type 2 Diabetes(T2D)is a growing global health issue,often aggravated by excessive sugar intake.Chronic high-sucrose diets contribute to insulin resistance,oxidative stress,and pancreatic dysfunction,worsening metabolic health.Sodium-glucose co-transporter 2(SGLT2)inhibitors,like empagliflozin,show potential in improving glycemic control and metabolic parameters,but their effects on pancreatic efficiency in sugar-induced T2D are not well understood.This study aimed to explore the effects of empagliflozin on metabolic and pancreatic protection in a high-sucrose diet-induced T2D model.Male Wistar rats were divided into four groups:normal,normal-treated,diabetic,and diabetic-treated(n=8 per group).Diabetes was induced with a 35%sucrose solution for 8 weeks,followed by a low-dose streptozotocin(STZ)injection.Treated groups received empagliflozin(15 mg/kg/day)for the duration.Biochemical markers,including fasting blood sugar(FBS),lipid profile,insulin levels,and oxidative stress markers,were measured.Insulin resistance(HOMA-IR)and pancreatic function(HOMA-B)were assessed.Histological analysis of pancreatic tissues was performed.The high-sucrose diet increased FBS,insulin resistance,and oxidative stress,while decreasing pancreatic function and islet diameter.Empagliflozin treatment lowered FBS(p=0.001),improved insulin sensitivity(p=0.001),reduced triglycerides(p=0.001),and LDL(p=0.05).It also enhanced antioxidant enzymes,reduced lipid peroxidation(MDA,p=0.001),and preserved pancreatic islet structure(p=0.001).A high-sucrose diet negatively affects metabolic health and pancreatic function.Empagliflozin mitigates these effects by improving metabolism,reducing oxidative stress,and preserving pancreatic integrity,suggesting its potential as a therapeutic agent in diabetes related to excessive sugar consumption.展开更多
Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both...Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both diagnosis and treatment within a single procedure.In therapeutic applications,it facilitates interventions such as stone fragmentation,stone retrieval,and tumor-related obstruction management.In diagnostic applications,it improves the accuracy of biopsies for suspicious lesions,particularly in cases of cystic neoplasms,indeterminate strictures,and pancreatic fistula assessments.The most common complications include postprocedural pancreatitis and self-limited abdominal pain,with their incidence mitigated by prophylactic anti-inflammatory drugs and pancreatic stent placement.Despite being limited by the need for specialized equipment and trained personnel,technological advancements may position pancreatoscopy as a first-line tool in modern clinical practice.展开更多
BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic h...BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic histology,as well as the usefulness of ECVf in predicting POPF.METHODS In 71 patients who underwent pancreatic resection,we caluculated pancreatic ECVf by comparing absolute enhancements of the pancreas and aorta between pre-contrast and equilibrium phases.Areas of fibrosis,fat,acini,and islets were calculated based on resection specimens.RESULTS ECVf correlated with fibrosis(r=0.724;P<0.001)and negatively correlated with acini(r=-0.510;P<0.001).Among 48 patients who underwent pancreatoduoden ectomy,21 developed POPF.Main pancreatic duct diameter≤2 mm and ECVf<36%were selected as risk factors by multivariate analysis[respective odds ratios(OR)and P values,4.26 and P=0.048;OR=11.07 and P=0.036].Using these factors as a risk score(0-2 points),POPF occurred in 0%,50%,and 70%of patients with 0,1,and 2 points,respectively.CONCLUSION ECVf is useful in predicting acinar loss and pancreatic fibrosis,and ECVf<36%may be a risk factor for POPF.展开更多
BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess...BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess the long-term risk of pancreatitis in CD patients.METHODS We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network.Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects.The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis,and the secondary outcome was to assess the etiologies of pancreatitis.The incidence was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 160228 patients were identified to have CD,and the remaining 250725 individuals without CD were considered as controls.At 7-year follow-up,CD patients exhibited a significantly higher risk of acute pancreatitis(HR=2.05;95%CI:1.93-2.17)and chronic pancreatitis(HR=1.42;95%CI:1.31-1.54)compared to controls.Elevated risks for alcohol-induced(HR=1.35),biliary(HR=1.37),and idiopathic pancreatitis(HR=1.49)were also observed.Findings remained robust across all follow-up intervals and sensitivity analyses.CONCLUSION Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis,including alcoholrelated,biliary,and idiopathic subtypes.These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.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
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.
文摘2008548 The effects of pioglitazone on the process of oxidative stress in acute pancreatitis induced by cerulein.WAN Hongyu(万红宇),et al. Dept Gastroenterol,Ruijin Hosp,Med Sch,Shanghai Jiaotong Univ,Shanghai 200025. Chin J Dig 2008;28(8):531-534. Objective To investigate the effects of pioglitazone,a peroxisome proliferation activated receptor(PPAR)γ agonist
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 Propolis and honey are known for their antioxidant,hypoglycemic,and antiproteinuric effects.AIM To explore the effect of propolis,and honey,against D-glucose-induced hyperglycemia,acute kidney injury(AKI),liver injury,dyslipidemia,and changes in the oxidants and antioxidants in renal,hepatic,and pancreatic tissues.METHODS The chemical analysis and antioxidant content of propolis and honey and their effect on alpha-amylase and alpha-glucosidase activity were studied.The study included five groups of male rats;four groups(2,3,4 and 5)were treated with Dglucose,and one group was untreated,group 1.In addition to D-glucose,groups 3,4,and 5 were treated with propolis,honey,and their combination,respectively.Blood glucose levels,liver and renal function tests,urine protein and electrolytes,oxidant and antioxidant parameters,and histopathological changes in hepatic,renal,and pancreatic tissues were examined.RESULTS Propolis contains a higher level of total protein and exhibits a higher antioxidant activity.Honey has a higher alpha-amylase and glucosidase inhibitory activity than propolis.D-glucose caused a significant elevation of blood glucose,insulin,homeostasis model assessment,blood urea,creatinine,lipid parameters,liver enzymes,and urine protein levels.It significantly increases malondialdehyde and decreases antioxidant parameters in pancreatic,hepatic,and renal tissues.D-glucose caused histopathological changes in hepatic,renal,and pancreatic tissues;these changes were significantly ameliorated by honey and propolis.CONCLUSION Propolis,honey,or their combination treated hyperglycemia,AKI,proteinuria,liver injury,and dyslipidemia induced by D-glucose,most likely,through their antioxidant activity and alpha-amylase and alpha-glucosidase inhibitory activity.This will pave the way for testing this natural combination in the prevention of diabetic complications,as a complement to basic therapies.
文摘BACKGROUND Data on clinical characteristics,treatment outcomes,and prognosis of pancreatic primitive neuroectodermal tumors(PNETs)are limited.AIM To analyze the clinical data of 30 patients with pancreatic PNETs to identify their clinical characteristics and factors associated with prognosis.METHODS We used the keywords"primary neuroectodermal tumor,""digestive tract,""pancreas,""pancreatic,"and"gastrointestinal,"individually or in combination,to collect data from a global database for all patients with pancreatic PNET to date.Univariate and Cox regression analyses were performed to identify prognostic factors for patient survival.RESULTS A total of 30 cases of pancreatic PNET were included in this study:15 males and 15 females with a mean age of 24 years.The main symptom was abdominal pain(73.3%),and the median tumor size was 7.85 cm.Twenty-four patients(80.0%)underwent surgery and nineteen patients received adjuvant therapy.Local metastasis was observed in 13 patients(43.3%),lymph node metastasis in 10 patients(33.3%),and distant metastasis in 6 patients(20.0%).Local recurrence was observed in 13 patients(43.3%).The median survival time of all patients was 29.4 months,and the overall estimated 1-year and 3-year survival rates were approximately 66.0%and 36.4%,respectively.Univariate analysis showed that chemotherapy(P=0.036),local metastasis(P=0.041),lymph node metastasis(P=0.003),distant metastasis(P=0.049),and surgical margins(P=0.048)were the prognostic factors affecting survival.Multivariate analysis revealed only lymph node metastasis(P=0.012)as a prognostic factor.CONCLUSION Pancreatic PNET is extremely rare,occurs in young adults,has no apparent sex predisposition,has a high rate of metastasis and early recurrence,and has a very poor prognosis.The diagnosis of pancreatic PNET requires a combination of clinical symptoms,pathologic features,immunohistochemistry,and cytogenetic analysis.Univariate analysis suggested that chemotherapy,metastasis,and surgical margins were prognostic factors affecting survival,and multivariate analysis suggested that lymph node metastasis is an important prognostic factor.Therefore,early diagnosis,early and extensive resection,and adjuvant chemoradiotherapy may help improve prognosis.
文摘Pesticides are chemical substances used to eliminate various pests.Currently,more than two million tons of pesticides are used annually in developing and developed countries.One of the chronic diseases associated with pesticide poisoning is diabetes.This review aimed to elucidate the mechanisms of action involved in the development of diabetes after pesticide poisoning.Relevant information was collected between January and May 2024,using databases such as PubMed,Google Academic,and Elsevier.Pesticides reduce the secretion of glucagon-like peptide-1(GLP-1)in the intestine,thereby decreasing the release of insulin.Moreover,pesticides are metabolized to acetic acid by intestinal microbiota.This contributes to gluconeogenesis in the liver.In addition,the accumulation of pesticides in adipose tissue affects pancreatic beta-cells(β-cells)through increases in the levels of proinflammatory cytokines and the release of leptin,resulting in insulin resistance and impairments of appetite control and energy balance.These alterations caused by pesticides can contribute to the development of diabetes by affecting many organic systems.
文摘BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.
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 the Russian Science Foundation(No.22-16-00128),“Investigation of the Toxic Effect of Glyphosates on the Functional State of the Bird Intestinal Microbial Community,Their Growth and Development,and the Development of a Biological Product Based on the Glyphosate Degrading Strain”.
文摘Drugs and pesticide residues in broiler feed can compromise the therapeutic and production benefits of antibiotic(ANT)application and affect gene expression.In this study,we analyzed the expression of 13 key pancreatic genes and blood physiology parameters after administering one maximum residue limit of herbicide glyphosate(GLY),two ANTs,and one anticoccidial drug(AD).A total of 260 Ross 308 broilers aged 1-40 d were divided into the following four groups of 65 birds each:control group,which was fed the main diet(MD),and three experimental groups,which were fed MD supplemented with GLY,GLY+ANTs(enrofloxacin and colistin methanesulfonate),and GLY+AD(ammonium maduramicin),respectively.The results showed that the addition of GLY,GLY+ANTs,and GLY+AD caused significant changes in the expression of several genes of physiological and economic importance.In particular,genes related to inflammation and apoptosis(interleukin 6(IL6),prostaglandin-endoperoxide synthase 2(PTGS2),and caspase 6(CASP6))were downregulated by up to 99.1%,and those related to antioxidant protection(catalase(CAT),superoxide dismutase 1(SOD1)and peroxiredoxin 6(PRDX6))by up to 98.6%,compared to controls.There was also a significant decline in the values of immunological characteristics in the blood serum observed in the experimental groups,and certain changes in gene expression were concordant with changes in the functioning of the pancreas and blood.The changes revealed in gene expression and blood indices in response to GLY,ANTs,and AD provide insights into the possible mechanisms of action of these agents at the molecular level.Specifically,these changes may be indicative of physiological mechanisms to overcome the negative effects of GLY,GLY+ANTs,and GLY+AD in broilers.
文摘Neoadjuvant treatment is being extensively evaluated in pancreatic ductal adenocarcinoma(PDAC).This interest is appropriate given the dismal long-term prognosis for most patients who undergo upfront surgery.Despite prospective,retrospective and randomized trials supporting the role of neoadjuvant therapy in general for PDAC,the long-term benefit specifically for patients with resectable PDAC remains unclear.The phase III PREOPANC trial showed an improvement in overall survival in borderline resectable PDAC with neoadjuvant gemcitabinebased chemoradiation compared to upfront surgery alone,however,no such benefit was observed in the resectable cohort.Notably,three randomized trials(PANACHE01-PRODIGE 48,NORPACT-1,and PREOPANC-2)failed to show a clear improvement in overall survival with a neoadjuvant approach.The ongoing NeoFOL-R,PREOPANC-3,and the Alliance A021806 will help clarify the role of neoadjuvant therapy in resectable PDAC.In this minireview article we summarize the data surrounding neoadjuvant therapy in resectable pancreatic cancer and discuss future considerations of trials in this subgroup.
文摘BACKGROUND Shear wave elastography(SWE)is a non-invasive ultrasound-based technique used to assess tissue stiffness,which reflects underlying pathological changes.While SWE has been widely applied for liver fibrosis evaluation,its application to other abdominal organs,such as the spleen and pancreas,is gaining interest.However,normal stiffness values and inter-system agreement remain poorly defined.AIM To assess the feasibility and agreement of liver,spleen,and pancreas stiffness using three SWE methods.METHODS This single-center observational study enrolled 50 healthy adult volunteers.Liver,spleen,and pancreas stiffness were assessed using three SWE methods:Point-SWE(p-QElaXto)and 2-Dimensional-SWE(2D-QElaXto)with Esaote MyLab 9,and 2D-SWE with SuperSonic Imagine.Feasibility,inter-operator reproducibility,and concordance among systems were evaluated.Stiffness was expressed as median kPa values,and technical reliability was assessed using the interquartile range/median ratio and stability index thresholds.RESULTS Liver and spleen stiffness assessment was feasible in>98%of patients,while pancreas stiffness was measurable in 84%-88%depending on the SWE technique.Mean liver stiffness ranged between 3.9-4.7 kPa across techniques,spleen stiffness ranged from 19.4-23.0 kPa,and pancreas stiffness from 5.2-7.6 kPa.Inter-operator agreement was excellent for liver(intraclass correlation coefficient>0.90)and good to moderate for spleen and pancreas(intraclass correlation coefficient from 0.43 to 0.90).Bland-Altman analysis confirmed good correlation but also systematic differences among devices,especially in pancreas measurements.CONCLUSION This is the first study to establish normal liver,spleen,and pancreas stiffness using MyLab 9 SWE integrated methods as compared to SuperSonic Imagine,with acceptable inter-technique agreement.Liver and spleen values matched existing guidelines;pancreas SWE showed more variability and reduced reproducibility.
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.
文摘Type 2 Diabetes(T2D)is a growing global health issue,often aggravated by excessive sugar intake.Chronic high-sucrose diets contribute to insulin resistance,oxidative stress,and pancreatic dysfunction,worsening metabolic health.Sodium-glucose co-transporter 2(SGLT2)inhibitors,like empagliflozin,show potential in improving glycemic control and metabolic parameters,but their effects on pancreatic efficiency in sugar-induced T2D are not well understood.This study aimed to explore the effects of empagliflozin on metabolic and pancreatic protection in a high-sucrose diet-induced T2D model.Male Wistar rats were divided into four groups:normal,normal-treated,diabetic,and diabetic-treated(n=8 per group).Diabetes was induced with a 35%sucrose solution for 8 weeks,followed by a low-dose streptozotocin(STZ)injection.Treated groups received empagliflozin(15 mg/kg/day)for the duration.Biochemical markers,including fasting blood sugar(FBS),lipid profile,insulin levels,and oxidative stress markers,were measured.Insulin resistance(HOMA-IR)and pancreatic function(HOMA-B)were assessed.Histological analysis of pancreatic tissues was performed.The high-sucrose diet increased FBS,insulin resistance,and oxidative stress,while decreasing pancreatic function and islet diameter.Empagliflozin treatment lowered FBS(p=0.001),improved insulin sensitivity(p=0.001),reduced triglycerides(p=0.001),and LDL(p=0.05).It also enhanced antioxidant enzymes,reduced lipid peroxidation(MDA,p=0.001),and preserved pancreatic islet structure(p=0.001).A high-sucrose diet negatively affects metabolic health and pancreatic function.Empagliflozin mitigates these effects by improving metabolism,reducing oxidative stress,and preserving pancreatic integrity,suggesting its potential as a therapeutic agent in diabetes related to excessive sugar consumption.
文摘Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both diagnosis and treatment within a single procedure.In therapeutic applications,it facilitates interventions such as stone fragmentation,stone retrieval,and tumor-related obstruction management.In diagnostic applications,it improves the accuracy of biopsies for suspicious lesions,particularly in cases of cystic neoplasms,indeterminate strictures,and pancreatic fistula assessments.The most common complications include postprocedural pancreatitis and self-limited abdominal pain,with their incidence mitigated by prophylactic anti-inflammatory drugs and pancreatic stent placement.Despite being limited by the need for specialized equipment and trained personnel,technological advancements may position pancreatoscopy as a first-line tool in modern clinical practice.
文摘BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic histology,as well as the usefulness of ECVf in predicting POPF.METHODS In 71 patients who underwent pancreatic resection,we caluculated pancreatic ECVf by comparing absolute enhancements of the pancreas and aorta between pre-contrast and equilibrium phases.Areas of fibrosis,fat,acini,and islets were calculated based on resection specimens.RESULTS ECVf correlated with fibrosis(r=0.724;P<0.001)and negatively correlated with acini(r=-0.510;P<0.001).Among 48 patients who underwent pancreatoduoden ectomy,21 developed POPF.Main pancreatic duct diameter≤2 mm and ECVf<36%were selected as risk factors by multivariate analysis[respective odds ratios(OR)and P values,4.26 and P=0.048;OR=11.07 and P=0.036].Using these factors as a risk score(0-2 points),POPF occurred in 0%,50%,and 70%of patients with 0,1,and 2 points,respectively.CONCLUSION ECVf is useful in predicting acinar loss and pancreatic fibrosis,and ECVf<36%may be a risk factor for POPF.
文摘BACKGROUND Celiac disease(CD)is an autoimmune disorder associated with an increased risk of pancreatitis,yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.AIM To assess the long-term risk of pancreatitis in CD patients.METHODS We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network.Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects.The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis,and the secondary outcome was to assess the etiologies of pancreatitis.The incidence was estimated using a Cox proportional hazards model with a hazard ratio(HR)and 95%confidence interval(CI).RESULTS A total of 160228 patients were identified to have CD,and the remaining 250725 individuals without CD were considered as controls.At 7-year follow-up,CD patients exhibited a significantly higher risk of acute pancreatitis(HR=2.05;95%CI:1.93-2.17)and chronic pancreatitis(HR=1.42;95%CI:1.31-1.54)compared to controls.Elevated risks for alcohol-induced(HR=1.35),biliary(HR=1.37),and idiopathic pancreatitis(HR=1.49)were also observed.Findings remained robust across all follow-up intervals and sensitivity analyses.CONCLUSION Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis,including alcoholrelated,biliary,and idiopathic subtypes.These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.
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.
