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
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
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
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
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
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 Intraductal oncocytic papillary neoplasm(IOPN)of the pancreas is an extremely rare pancreatic tumor,with only sporadic cases reported in the literature.IOPN is difficult to diagnose and highly prone to misd...BACKGROUND Intraductal oncocytic papillary neoplasm(IOPN)of the pancreas is an extremely rare pancreatic tumor,with only sporadic cases reported in the literature.IOPN is difficult to diagnose and highly prone to misdiagnosis.IOPN carries a certain risk of progressing to invasive cancer.Surgical resection is the primary treatment for IOPN.According to the existing literature reports,the vast majority of patients with IOPN of the pancreas undergo open surgery,while only one case of laparoscopic surgery have been reported.CASE SUMMARY This report presents two cases of IOPN in elderly female patients,aged 60 and 61.Both patients were asymptomatic,and their pancreatic masses were discovered incidentally.Preoperative diagnosis of IOPN is challenging and prone to misdiagnosis.In the first case,the patient underwent a laparoscopic distal pancreatectomy and splenectomy.The surgical procedure spanned 342 minutes,with an estimated intraoperative blood loss of around 100 mL.The patient experienced an uneventful postoperative recovery and was discharged on the 8th postoperative day.For the second case,a laparoscopic pancreaticoduodenectomy was performed.The operation lasted for 431 minutes with an intraoperative blood loss of approximately 50 mL.The patient also demonstrated a favorable postoperative course and was discharged on the 24^(th)postoperative day.Postoperative pathology and immunohistochemistry confirmed the diagnosis of IOPN.No recurrence was observed in either patient after follow-up periods of 8 and 10 months,respectively.CONCLUSION These cases demonstrate that laparoscopic surgery can be considered as one of the treatment options for IOPN of the pancreas.展开更多
BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppressio...BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppression remains a concern,as it can adversely affect recipients’quality of life and survival.While the link be-tween immunosuppression and increased cancer risk is well-documented,the specific interactions between graft rejection and post-transplant malignancy(PTM)remain poorly understood.Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.AIM To investigate whether immunosuppression in PTM reduces rejection risk,while immune activation during rejection protects against malignancy.METHODS We analyzed data from the United Network for Organ Sharing’s Organ Procurewith no prior history of malignancy(in donors or recipients).Landmark analyses at 1,2,3,5,10,15,and 20 years post-transplant,Kaplan–Meier analyses,and time-dependent Cox proportional hazards regression models,each incorporating the temporal dimension of outcomes,assessed the association between rejection-induced graft failure(RGF)and PTM.Multivariate models were adjusted for clinical and immunological factors,including immunosuppression regimens.RESULTS The cohort included 579905 recipients(kidney:386878;liver:108390;heart:45046;lung:37643;pancreas:1948)with a mean follow-up of 7.3 years and a median age of 50.6±13.2 years.RGF was associated with a reduction in PTM risk across all time points[hazard ratio(HR)=0.07-0.20,P<0.001],even after excluding mortality cases.Kidney transplant recipients exhibited the most pronounced reduction(HR=0.22,P<0.001).Conversely,among recipients with PTM,RGF risk decreased across all time points up to 15 years after excluding mortality cases(HR=0.49–0.80,P<0.001).This risk reduction was observed in kidney,liver,heart,and lung transplants(HRs=0.90,0.21,0.21,and 0.18,respectively;P<0.001)but not in pancreas transplants.CONCLUSION RGF reduces PTM risk,particularly in kidney transplants,while PTM decreases RGF risk in kidney,liver,heart,and lung transplants.展开更多
BACKGROUND Pancreas transplantation(PT)has emerged as a critical therapeutic intervention for patients with type 1 diabetes mellitus(T1DM).This procedure restores neuroendocrine communication,which is essential for op...BACKGROUND Pancreas transplantation(PT)has emerged as a critical therapeutic intervention for patients with type 1 diabetes mellitus(T1DM).This procedure restores neuroendocrine communication,which is essential for optimal pancreatic function and insulin regulation.The recovery process involves multiple phases,including neural regeneration,revascularization,and the re-establishment of synaptic connections,all of which contribute to the restoration of both endocrine and neurological functions.AIM To systematically examine the mechanisms underlying neurological recovery following PT,to explore the role of endocrine factors in restoring neurofunctional integrity,and to evaluate the impact of immunosuppressive therapy on nerve regeneration and its clinical outcomes.METHODS A comprehensive literature search was conducted across international databases such as PubMed,Web of Science,and Cochrane Library to identify studies addressing PT,neurological recovery,and endocrine regulation.Inclusion criteria encompassed randomized controlled trials,cohort studies,and systematic reviews.The review focused on the neurogenic mechanisms activated post-transplantation,the effect of glycemic control on nerve repair,and the implications of immunosuppressive drugs on the process of neurological recovery.RESULTS A total of 211 articles were initially identified through the literature search across international databases such as PubMed,Web of Science,and Cochrane Library.Following a detailed evaluation and the application of inclusion and exclusion criteria,56 articles were further reviewed,and 8 were selected for the final analysis.Additionally,a comprehensive patent search yielded 168 patents,out of which 6 were selected for further examination.These sources,including both journal literature and patents,offer significant insights into the mechanisms of neurological recovery and endocrine function following PT,with an emphasis on nerve regeneration,glycemic control,and the impact of immunosuppressive therapy.CONCLUSION PT represents a promising intervention for restoring both endocrine and neurological functions in patients with T1DM.Glycemic control,neural regeneration,and the restoration of neuroendocrine signaling are key components of successful recovery.While the procedure yields substantial improvements in nerve function,challenges persist,particularly in patients with long-standing diabetes or severe neuropathy.The dual impact of immunosuppressive drugs on immune suppression and neurotoxicity necessitates careful management.Future research should focus on refining immunosuppressive protocols and exploring advanced therapeutic options,including stem cell-based interventions,to enhance neural regeneration and further improve clinical outcomes.展开更多
BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisu...BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisum with obstruction of the minor papilla,or an abnormal patulous orifice of the minor papilla during endoscopic retrograde cholangiopancreatography(ERCP).However,the relatively low pa-tency and small opening of the minor papillae pose technical challenges.AIM To evaluate the technical success,clinical success,stone clearance,and safety pro-file of EMPI for diagnosis and treatment of symptomatic pancreatic diseases.METHODS Patients diagnosed with symptomatic pancreatic diseases and EMPI between February 1996 and February 2023 were included.The primary outcomes were the initial technical success,defined as successful deep cannulation via the minor papilla(DCMP;access of the guidewire to the upstream pancreatic duct via the minor papilla)alone,overall technical success,defined as successful DCMP alone and successful DCMP with additional needle-knife precut minor papillotomy(NKPMP),and immediate clinical success,defined as>50%improvement in abdominal pain after therapeutic EMPI.Secondary outcomes included long-term clinical success at 1,3,and 7 years,pancreatic stone clearance,and procedure-related early and late adverse events(AEs).RESULTS Overall,43 patients,32 with obstructive chronic pancreatitis,8 with pancreatic divisum,and 3 with intraductal papillary mucinous neoplasm were included.The initial and overall technical success rates were 74.4%(32/43)and 88.4%(38/43),respectively.The immediate clinical success rate was 79.1%(34/43),and the long-term clinical success rates at 1,3,and 7 years were 74.7%,55.3%,and 41.5%,respectively,among the 22 patients with a follow-up period of 57.5(7-266)months.Complete and partial success of pancreatic stone clearance was achieved in 53.9%(7/13)and 15.4%(2/13),respectively.Early AEs included post-ERCP pancreatitis(PEP,n=5)and self-limiting bleeding(n=1);surgery therapy was required for 1 case with severe PEP and conservative management for the other 4 with mild PEP.Late AEs included minor papilla stricture(n=1)after endoscopic minor papillotomy and pancreatic duct stricture(n=1)after double pancreatic stent placement;no specific treatment was implemented for these events.CONCLUSION EMPI is feasible,effective,and safe for symptomatic pancreatic diseases,in terms of the technical and clinical success,stone clearance,and incidence and severity of AEs.NKPMP appears to enhance technical success.However,potential risks of developing PEP and late AEs should be kept in mind.展开更多
To the Editor:Pancreatic acinar cell carcinoma(PACC),with primary compo-nent similar to acinar cells,represents merely 1%-2%of pancreatic exocrine neoplasms[1].As a high-grade malignancy,PACC has the potential to mani...To the Editor:Pancreatic acinar cell carcinoma(PACC),with primary compo-nent similar to acinar cells,represents merely 1%-2%of pancreatic exocrine neoplasms[1].As a high-grade malignancy,PACC has the potential to manifest in any anatomical region of the pancreas,while mostly in the head of the pancreas[2].The initial symptoms of PACC may not be obvious.Upon diagnosis,the tumor typi-cally manifests as a substantial size,resulting in compression of adjacent organs and subsequent non-specific gastrointestinal mani-festations.These complications encompass abdominal pain,nausea,diarrhea,and weight loss[3].Nevertheless,the incidence of bile duct obstruction and jaundice is relatively modest.Despite being classified as an aggressive tumor,PACC exhibits a slightly slower disease progression compared to pancreatic ductal adenocarcinoma(PDAC).Currently,the median survival of PACC ranges from 18 to 47 months[4].Here,we presented a unique occurrence of PACC with liver metastases,aiming to enhance comprehension of the disease and diminish the probability of misdiagnosis.展开更多
Intraductal papillary mucinous neoplasm(IPMN)and intraductal papillary neoplasm of the bile duct(IPNB)are mucinous cystic tumors with intraductal papillary growth and malignant potential.Their concurrent occurrence is...Intraductal papillary mucinous neoplasm(IPMN)and intraductal papillary neoplasm of the bile duct(IPNB)are mucinous cystic tumors with intraductal papillary growth and malignant potential.Their concurrent occurrence is exceptionally rare.CASE SUMMARY A 58-year-old Chinese man presented with recurrent upper abdominal pain.Imaging and laboratory tests revealed lesions consistent with IPNB and IPMN.Postoperative pathological examination confirmed IPNB with high-grade dysplasia and main-duct type IPMN with low-grade dysplasia.The patient underwent extrahepatic bile duct resection with Roux-en-Y choledochoenterostomy and distal pancreatectomy.He had an excellent prognosis with no tumor recurrence during the 30-month follow-up.CONCLUSION This case emphasizes the importance of comprehensive preoperative assessment and individualized management for these complex tumors.Further research is needed to understand their pathogenesis and improve treatment strategies.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
A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incisio...A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).展开更多
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 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.
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 the National Cancer Institute(T32,CA 236621-5).
文摘Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.
基金Supported by the Zhejiang Medical Science and Technology Project,No.2022KY1325 and No.2023KY381.
文摘BACKGROUND Intraductal oncocytic papillary neoplasm(IOPN)of the pancreas is an extremely rare pancreatic tumor,with only sporadic cases reported in the literature.IOPN is difficult to diagnose and highly prone to misdiagnosis.IOPN carries a certain risk of progressing to invasive cancer.Surgical resection is the primary treatment for IOPN.According to the existing literature reports,the vast majority of patients with IOPN of the pancreas undergo open surgery,while only one case of laparoscopic surgery have been reported.CASE SUMMARY This report presents two cases of IOPN in elderly female patients,aged 60 and 61.Both patients were asymptomatic,and their pancreatic masses were discovered incidentally.Preoperative diagnosis of IOPN is challenging and prone to misdiagnosis.In the first case,the patient underwent a laparoscopic distal pancreatectomy and splenectomy.The surgical procedure spanned 342 minutes,with an estimated intraoperative blood loss of around 100 mL.The patient experienced an uneventful postoperative recovery and was discharged on the 8th postoperative day.For the second case,a laparoscopic pancreaticoduodenectomy was performed.The operation lasted for 431 minutes with an intraoperative blood loss of approximately 50 mL.The patient also demonstrated a favorable postoperative course and was discharged on the 24^(th)postoperative day.Postoperative pathology and immunohistochemistry confirmed the diagnosis of IOPN.No recurrence was observed in either patient after follow-up periods of 8 and 10 months,respectively.CONCLUSION These cases demonstrate that laparoscopic surgery can be considered as one of the treatment options for IOPN of the pancreas.
文摘BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppression remains a concern,as it can adversely affect recipients’quality of life and survival.While the link be-tween immunosuppression and increased cancer risk is well-documented,the specific interactions between graft rejection and post-transplant malignancy(PTM)remain poorly understood.Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.AIM To investigate whether immunosuppression in PTM reduces rejection risk,while immune activation during rejection protects against malignancy.METHODS We analyzed data from the United Network for Organ Sharing’s Organ Procurewith no prior history of malignancy(in donors or recipients).Landmark analyses at 1,2,3,5,10,15,and 20 years post-transplant,Kaplan–Meier analyses,and time-dependent Cox proportional hazards regression models,each incorporating the temporal dimension of outcomes,assessed the association between rejection-induced graft failure(RGF)and PTM.Multivariate models were adjusted for clinical and immunological factors,including immunosuppression regimens.RESULTS The cohort included 579905 recipients(kidney:386878;liver:108390;heart:45046;lung:37643;pancreas:1948)with a mean follow-up of 7.3 years and a median age of 50.6±13.2 years.RGF was associated with a reduction in PTM risk across all time points[hazard ratio(HR)=0.07-0.20,P<0.001],even after excluding mortality cases.Kidney transplant recipients exhibited the most pronounced reduction(HR=0.22,P<0.001).Conversely,among recipients with PTM,RGF risk decreased across all time points up to 15 years after excluding mortality cases(HR=0.49–0.80,P<0.001).This risk reduction was observed in kidney,liver,heart,and lung transplants(HRs=0.90,0.21,0.21,and 0.18,respectively;P<0.001)but not in pancreas transplants.CONCLUSION RGF reduces PTM risk,particularly in kidney transplants,while PTM decreases RGF risk in kidney,liver,heart,and lung transplants.
基金Supported by National Natural Science Foundation of China,No.82305376The Project of Supporting Young Scientific and Technological Talents in Jiangsu Province in 2024,No.JSTJ-2024-380.
文摘BACKGROUND Pancreas transplantation(PT)has emerged as a critical therapeutic intervention for patients with type 1 diabetes mellitus(T1DM).This procedure restores neuroendocrine communication,which is essential for optimal pancreatic function and insulin regulation.The recovery process involves multiple phases,including neural regeneration,revascularization,and the re-establishment of synaptic connections,all of which contribute to the restoration of both endocrine and neurological functions.AIM To systematically examine the mechanisms underlying neurological recovery following PT,to explore the role of endocrine factors in restoring neurofunctional integrity,and to evaluate the impact of immunosuppressive therapy on nerve regeneration and its clinical outcomes.METHODS A comprehensive literature search was conducted across international databases such as PubMed,Web of Science,and Cochrane Library to identify studies addressing PT,neurological recovery,and endocrine regulation.Inclusion criteria encompassed randomized controlled trials,cohort studies,and systematic reviews.The review focused on the neurogenic mechanisms activated post-transplantation,the effect of glycemic control on nerve repair,and the implications of immunosuppressive drugs on the process of neurological recovery.RESULTS A total of 211 articles were initially identified through the literature search across international databases such as PubMed,Web of Science,and Cochrane Library.Following a detailed evaluation and the application of inclusion and exclusion criteria,56 articles were further reviewed,and 8 were selected for the final analysis.Additionally,a comprehensive patent search yielded 168 patents,out of which 6 were selected for further examination.These sources,including both journal literature and patents,offer significant insights into the mechanisms of neurological recovery and endocrine function following PT,with an emphasis on nerve regeneration,glycemic control,and the impact of immunosuppressive therapy.CONCLUSION PT represents a promising intervention for restoring both endocrine and neurological functions in patients with T1DM.Glycemic control,neural regeneration,and the restoration of neuroendocrine signaling are key components of successful recovery.While the procedure yields substantial improvements in nerve function,challenges persist,particularly in patients with long-standing diabetes or severe neuropathy.The dual impact of immunosuppressive drugs on immune suppression and neurotoxicity necessitates careful management.Future research should focus on refining immunosuppressive protocols and exploring advanced therapeutic options,including stem cell-based interventions,to enhance neural regeneration and further improve clinical outcomes.
基金Supported by Heilongjiang Provincial Natural Science Foundation Team Project,No.TD2020H002.
文摘BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisum with obstruction of the minor papilla,or an abnormal patulous orifice of the minor papilla during endoscopic retrograde cholangiopancreatography(ERCP).However,the relatively low pa-tency and small opening of the minor papillae pose technical challenges.AIM To evaluate the technical success,clinical success,stone clearance,and safety pro-file of EMPI for diagnosis and treatment of symptomatic pancreatic diseases.METHODS Patients diagnosed with symptomatic pancreatic diseases and EMPI between February 1996 and February 2023 were included.The primary outcomes were the initial technical success,defined as successful deep cannulation via the minor papilla(DCMP;access of the guidewire to the upstream pancreatic duct via the minor papilla)alone,overall technical success,defined as successful DCMP alone and successful DCMP with additional needle-knife precut minor papillotomy(NKPMP),and immediate clinical success,defined as>50%improvement in abdominal pain after therapeutic EMPI.Secondary outcomes included long-term clinical success at 1,3,and 7 years,pancreatic stone clearance,and procedure-related early and late adverse events(AEs).RESULTS Overall,43 patients,32 with obstructive chronic pancreatitis,8 with pancreatic divisum,and 3 with intraductal papillary mucinous neoplasm were included.The initial and overall technical success rates were 74.4%(32/43)and 88.4%(38/43),respectively.The immediate clinical success rate was 79.1%(34/43),and the long-term clinical success rates at 1,3,and 7 years were 74.7%,55.3%,and 41.5%,respectively,among the 22 patients with a follow-up period of 57.5(7-266)months.Complete and partial success of pancreatic stone clearance was achieved in 53.9%(7/13)and 15.4%(2/13),respectively.Early AEs included post-ERCP pancreatitis(PEP,n=5)and self-limiting bleeding(n=1);surgery therapy was required for 1 case with severe PEP and conservative management for the other 4 with mild PEP.Late AEs included minor papilla stricture(n=1)after endoscopic minor papillotomy and pancreatic duct stricture(n=1)after double pancreatic stent placement;no specific treatment was implemented for these events.CONCLUSION EMPI is feasible,effective,and safe for symptomatic pancreatic diseases,in terms of the technical and clinical success,stone clearance,and incidence and severity of AEs.NKPMP appears to enhance technical success.However,potential risks of developing PEP and late AEs should be kept in mind.
基金supported by a grant from the National Natural Science Foundation of China(82202974).
文摘To the Editor:Pancreatic acinar cell carcinoma(PACC),with primary compo-nent similar to acinar cells,represents merely 1%-2%of pancreatic exocrine neoplasms[1].As a high-grade malignancy,PACC has the potential to manifest in any anatomical region of the pancreas,while mostly in the head of the pancreas[2].The initial symptoms of PACC may not be obvious.Upon diagnosis,the tumor typi-cally manifests as a substantial size,resulting in compression of adjacent organs and subsequent non-specific gastrointestinal mani-festations.These complications encompass abdominal pain,nausea,diarrhea,and weight loss[3].Nevertheless,the incidence of bile duct obstruction and jaundice is relatively modest.Despite being classified as an aggressive tumor,PACC exhibits a slightly slower disease progression compared to pancreatic ductal adenocarcinoma(PDAC).Currently,the median survival of PACC ranges from 18 to 47 months[4].Here,we presented a unique occurrence of PACC with liver metastases,aiming to enhance comprehension of the disease and diminish the probability of misdiagnosis.
文摘Intraductal papillary mucinous neoplasm(IPMN)and intraductal papillary neoplasm of the bile duct(IPNB)are mucinous cystic tumors with intraductal papillary growth and malignant potential.Their concurrent occurrence is exceptionally rare.CASE SUMMARY A 58-year-old Chinese man presented with recurrent upper abdominal pain.Imaging and laboratory tests revealed lesions consistent with IPNB and IPMN.Postoperative pathological examination confirmed IPNB with high-grade dysplasia and main-duct type IPMN with low-grade dysplasia.The patient underwent extrahepatic bile duct resection with Roux-en-Y choledochoenterostomy and distal pancreatectomy.He had an excellent prognosis with no tumor recurrence during the 30-month follow-up.CONCLUSION This case emphasizes the importance of comprehensive preoperative assessment and individualized management for these complex tumors.Further research is needed to understand their pathogenesis and improve treatment strategies.
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 grants from the National Natu-ral Science Foundation of China(81302161 and 82003103)the Science and Technology Department of Sichuan Province(2021YFS0375 and 2020YJ0450).
文摘A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).
