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Role of pancreatoscopy in management of pancreatic disease:A systematic review 预览
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作者 Tarun Kaura Field F Willingham Saurabh Chawla 《世界胃肠内镜杂志:英文版(电子版)》 2019年第2期155-167,共13页
BACKGROUND Per-oral pancreatoscopy(POP)plays a role in the diagnosis and therapy of pancreatic diseases.With recent technological advances,there has been renewed interest in this modality.AIM To evaluate the efficacy ... BACKGROUND Per-oral pancreatoscopy(POP)plays a role in the diagnosis and therapy of pancreatic diseases.With recent technological advances,there has been renewed interest in this modality.AIM To evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODS To determine the safety and efficacy of POP in the management of pancreatic diseases,a systematic search was conducted in MEDLINE,EMBASE and Ovid.Articles in languages other than English and case reports were excluded.All published case series were eligible.Data specific to POP were extracted from studies,which combined cholangiopancreatoscopy.Ten studies were included in the analysis of POP therapy for pancreatic stone disease,and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia.The examined data were subcategorized according to adjunctive modalities,such as direct tissue sampling,cytology,the role of intraoperative POP,intraductal ultrasound(IDUS)and POP combined with image-enhancing technology.RESULTS The success rate for complete ductal stone clearance ranged from 37.5%-100%.Factors associated with failure included the presence of strictures,multiple stones and the inability to visualize the target area.Although direct visualization can identify malignant and premalignant conditions,there is significant overlap with benign diseases.Visually-directed biopsies provide a high degree of accuracy,and represent a unique approach for tissue acquisition in patients with ductal abnormalities.Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions.Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy.The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSION Current evidence supports wider adoption of pancreatoscopy,as it is safe and effective.Improved patient selection and utilization of novel technologies may further enhance its rol 展开更多
关键词 PANCREATOSCOPY Cholangiopancreatoscopy Chronic pancreatitis PANCREATIC DUCT stones INTRADUCTAL papillary MUCINOUS neoplasm PANCREATIC cancer PANCREATIC DUCT STRICTURE
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Contribution of pancreatic enzyme replacement therapy to survival and quality of life in patients with pancreatic exocrine insufficiency 预览
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作者 Peter Layer Nataliya Kashirskaya Natalya Gubergrits 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第20期2430-2441,共12页
The objective of this study was to analyze the current evidence for the use of pancreatic enzyme replacement therapy (PERT) in affecting survival and quality of life in patients with pancreatic exocrine insufficiency ... The objective of this study was to analyze the current evidence for the use of pancreatic enzyme replacement therapy (PERT) in affecting survival and quality of life in patients with pancreatic exocrine insufficiency (PEI). Systematic searches of the literature were performed using the PubMed database. Articles were selected for inclusion if they reported findings from trials assessing the effects of PERT on quality of life, survival, malabsorption, growth parameters (such as height, body weight and body mass index), or gastrointestinal symptoms (such as abdominal pain, stool consistency and flatulence). PERT improved PEI-related malabsorption and weight maintenance in patients with cystic fibrosis, chronic pancreatitis, pancreatic cancer, and post-surgical states. In patients with chronic pancreatitis, PERT improved PEI-related symptoms and quality of life measures. Several small retrospective studies have also suggested that PERT may have a positive impact on survival, but long-term studies assessing this effect were not identified. PERT is effective for treating malnutrition and supporting weight maintenance, and it is associated with improved quality of life and possibly with enhanced survival in patients with PEI. However, there is evidence that not all patients with PEI receive adequate PERT. Future work should aim to assess the long-term effects of PERT on the survival of patients with PEI. 展开更多
关键词 PANCREATIC EXOCRINE INSUFFICIENCY PANCREATIC enzyme replacement therapy SURVIVAL Quality of life MALABSORPTION CYSTIC fibrosis Chronic pancreatitis PANCREATIC cancer Post-surgical states
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胰腺实性假乳头状瘤超声误诊分析 预览
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作者 王大伟 柏刚 +2 位作者 张文君 谢超 何晓伟 《临床误诊误治》 2019年第4期5-9,共5页
目的分析胰腺实性假乳头状瘤(solid-pseudopapillary tumor of pancreas, SPTP)超声误诊原因,提高超声医师对本病的认识。方法回顾性分析我院经手术病理检查证实的20例SPTP超声误诊病例资料。结果本组4例酗酒者、2例胰腺炎病史者及2例... 目的分析胰腺实性假乳头状瘤(solid-pseudopapillary tumor of pancreas, SPTP)超声误诊原因,提高超声医师对本病的认识。方法回顾性分析我院经手术病理检查证实的20例SPTP超声误诊病例资料。结果本组4例酗酒者、2例胰腺炎病史者及2例胰腺外伤者,在随访既往疾病时发现胰腺病灶;3例甲状腺功能亢进症患者及1例长期节食者,入院后常规检查发现胰腺病变;8例无明确既往史者在体检时发现胰腺病变。20例超声首诊均误诊,分别误诊为假性囊肿8例、胰腺癌6例、胰岛细胞瘤4例、无功能性胰腺神经内分泌肿瘤2例,均行手术治疗经病理检查证实为SPTP,且胰管及胆管均未见扩张。结论 SPTP临床表现不典型,超声声像图具有一定的特征性,特别是当年轻女性胰腺区出现较大的囊实性包块时,应想到本病可能并加以鉴别,确诊需依赖手术病理检查。 展开更多
关键词 实性假乳头状瘤 胰腺 超声检查 误诊 胰腺假囊肿 胰腺肿瘤
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Advanced diagnostics for pancreatic cysts: Confocal endomicroscopy and molecular analysis 预览
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作者 Claire Durkin Somashekar G Krishna 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第22期2734-2742,共9页
Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo crosssectional imaging. Current methods for the diagnosis and ... Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo crosssectional imaging. Current methods for the diagnosis and risk-stratification of pancreatic cysts are suboptimal, resulting in both unnecessary surgical resection and overlooked cases of neoplasia. Accurate diagnosis is crucial for guiding how a pancreatic cyst is managed, whether with surveillance for low-risk lesions or surgical resection for high-risk lesions. This review aims to summarize the current literature on confocal endomicroscopy and cyst fluid molecular analysis for the evaluation of pancreatic cysts. These recent technologies are promising adjuncts to existing approaches with the potential to improve diagnostic accuracy and ultimately patient outcomes. 展开更多
关键词 PANCREATIC CYSTS CONFOCAL ENDOMICROSCOPY MOLECULAR analysis MOLECULAR biomarkers PANCREATIC cancer
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Biliary leakage following pancreaticoduodenectomy:Prevalence,risk factors and management 预览
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作者 Ayman El Nakeeb Mohamed El Sorogy +5 位作者 Hosam Hamed Rami Said Mohamad Elrefai Helmy Ezzat Waleed Askar Ahmed M Elsabbagh 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第1期67-72,共6页
Background:Few studies investigated biliary leakage after pancreaticoduodenectomy(PD)especially when compared to postoperative pancreatic fistula(POPF).This study was to determine the incidence of biliary leakage afte... Background:Few studies investigated biliary leakage after pancreaticoduodenectomy(PD)especially when compared to postoperative pancreatic fistula(POPF).This study was to determine the incidence of biliary leakage after PD,predisposing factors of biliary leakage,and its management.Methods:We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center,Mansoura University,Egypt.According to occurrence of postoperative biliary leakage,patients were divided into two groups.Group(1)included patients who developed biliary leakage and group(2)included patients without identified biliary leakage.The preoperative data,operative details,and postoperative morbidity and mortality were analyzed.Results:The study included 555 patients.Forty-four patients(7.9%)developed biliary leakage.Ten patients(1.8%)had concomitant POPF.Multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage,and no history of preoperative endoscopic retrograde cholangiopancreatiography(ERCP)as protective factor.Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying,and wound infection.The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group.Non-surgical management was needed in 40 patients(90.9%).Only 4 patients(9.1%)required re-exploration due to biliary peritonitis and associated POPF.The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group(6.8%vs 3.9%,P=0.05).Conclusions:Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage,and no history of preoperative ERCP is protective factor.Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF.However,biliary leakage can be conservatively managed in majority of cases. 展开更多
关键词 PANCREATIC head carcinoma Pancreaticodudenetomy POSTOPERATIVE PANCREATIC FISTULA BILIARY LEAKAGE
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Blumgart’s technique of pancreaticojejunostomy:Analysis of safety and outcomes 预览
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作者 Vishal Gupta Saket Kumar +5 位作者 Vivek Gupta Pradeep Joshi Rahul Rahul Rakesh Kumar Yadav Amit Dangi Abhijit Chandra 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第2期181-187,共7页
Background:Blumgart’s pancreaticojejunostomy(PJ)has been described with low pancreatic leak rates.This study aimed to evaluate our experience with this technique regarding the pancreatic leak and other perioperative ... Background:Blumgart’s pancreaticojejunostomy(PJ)has been described with low pancreatic leak rates.This study aimed to evaluate our experience with this technique regarding the pancreatic leak and other perioperative outcomes.Methods:We performed a single-center retrospective analysis of a cohort of 81 patients who underwent pancreaticoduodenectomy in our department from January 2011 to February 2018.The primary endpoint was the occurrence of a clinically relevant postoperative pancreatic fistula(CR-POPF)and analysis of its risk factors.Results:The CR-POPF rate was 12.3%.Fistula risk score(FRS)was the only significant risk factor for the occurrence of overall POPF in multivariate analysis.However,none of the other factors including FRS was found to be significantly associated with CR-POPF risk.A strong positive correlation was found between the CR-POPF and the incidence of delayed gastric emptying,post-pancreatectomy hemorrhage and increased length of hospital stay.Conclusion:Blumgart’s technique is a safe technique of pancreatico-enteric anastomosis with low rates of CR-POPF.CR-POPF with this technique is independent of most of the preoperative and intraoperative factors.Therefore,this technique can be used for all types of the pancreas with consistently good results. 展开更多
关键词 PANCREATICODUODENECTOMY Pancreatico-jejunal ANASTOMOSIS Postoperative PANCREATIC FISTULA PANCREATIC leak
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Instant evaluation of contrast enhanced endoscopic ultrasound helps to differentiate various solid pancreatic lesions in daily routine 预览
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作者 Klaus Kannengiesser Reiner Mahlke +3 位作者 Frauke Petersen Anja Peters Torsten Kucharzik Christian Maaser 《世界临床病例杂志》 2019年第1期19-27,共9页
BACKGROUND Contrast enhanced harmonic endoscopic ultrasound(CEH-EUS)is a spreading technique;some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative analysis.AIM To examine t... BACKGROUND Contrast enhanced harmonic endoscopic ultrasound(CEH-EUS)is a spreading technique;some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative analysis.AIM To examine the value of CEH-EUS for differentiating various pancreatic lesions in everyday routine with qualitative and quantitative analysis.METHODS Data of 55 patients with pancreatic lesions who underwent CEH-EUS were analysed retrospectively.Perfusion characteristics were classified by the investigator qualitatively immediately upon investigation,quantitative analysis was performed later on.Samples from fine needle aspiration(EUS-FNA)or surgical specimen served as gold standard.RESULTS CEH-EUS showed 39 hypoenhanced lesions,3 non-enhanced and 13 hyperenhanced lesions.Concordance of the investigators qualitative classification of peak contrast enhancement with quantitative analysis later on was 100%,while other parameters such as arrival time,time to peak or area under the curve did not show additional value.34 of 39 hypoenhanced lesions were pancreatic adenocarcinoma;of the hyperenhanced lesions 4 were inflammatory,3 neuroendocrine carcinomas,1 lymphoma,1 insulinoma and 4 metastases(2 of renal cell carcinoma,2 of lung cancer).Non-enhanced lesions showed up as necroses.Sensitivity for the detection of pancreatic adenocarcinoma was 100%,specificity 87.2%for hypoenhancement alone;in otherwise healthy pancreatic tissue all hypoenhanced lesions were pancreatic adenocarcinoma(sensitivity and specificity 100%,PPV and NPV for adenocarcinoma 100%).CONCLUSION This study again shows the excellent value of CEH-EUS in everyday routine for diagnostics of various focal pancreatic lesions suggesting that qualitatively assessed hypoenhancement is highly predictive for adenocarcinoma.Additional quantitative analysis of perfusion parameters does not add diagnostic yield.In case of the various hyperenhanced pancreatic lesions in our data set,histologic sampling is essential for further treatment. 展开更多
关键词 ENDOSCOPIC ULTRASOUND CONTRAST ENHANCED ENDOSCOPIC ULTRASOUND PANCREATIC adenocarcinoma Neuroendocrine carcinoma PANCREATIC metastases Lymphoma
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The impact of extent of pancreatic and venous resection on survival for patients with pancreatic cancer 预览
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作者 Matteo Serenari Giorgio Ercolani +7 位作者 Alessandro Cucchetti Matteo Zanello Enrico Prosperi Guido Fallani Michele Masetti Raffaele Lombardi Matteo Cescon Elio Jovine 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第4期389-394,共6页
Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgica... Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgical therapy in this disease.This study aimed to investigate the impact of extent of pancreatic and venous resection on short-and long-term outcomes in patients with pancreatic adenocarcinoma(PDAC).Methods:This was a retrospective study from a prospectively maintained database of pancreatic resections for PDAC.Short-and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy(TP)or pancreaticoduodenectomy(PD)with simultaneous portal vein(PV)and/or superior mesenteric vein(SMV)resection.Venous resections were carried out as tangential venous resection(TVR)or segmental venous resection(SVR).Patients were divided into 4 groups:(1)PD+TVR,(2)PD+SVR,(3)TP+TVR,(4)TP+SVR.Uni-and multivariate Cox regression analysis were performed to identify factors associated with survival.Results:Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for PDAC.Among them,25 were submitted to PD+TVR(25.3%),12 to PD+SVR(12.1%),23 to TP+TVR(23.2%),and 39 to TP+SVR(39.4%).Overall,major morbidity(Clavien-Dindo grade≥IIIA)was 26.3%.Thirty-and 90-day mortality were 3%and 11.1%,respectively.There were no significant differences among groups in terms of short-term outcomes.Median overall survival of patients submitted to PD+TVR was significantly higher than those to TP+SVR(29.5 vs 7.9 months,P=0.001).Multivariate analysis identified TP(HR=2.11;95%CI:1.31–3.44;P=0.002)and SVR(HR=2.01;95%CI:1.27–3.15;P=0.003)as the only independent prognostic factors for overall survival.Conclusions:Up-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC.Perioperative treatments in high-risk surgical groups may improve such poor outcomes. 展开更多
关键词 Pancreatic resection Vascular resection Pancreatic cancer surgery
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STIM1 overexpression in hypoxia microenvironment contributes to pancreatic carcinoma progression 预览
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作者 Jian Wang Junling Shen +3 位作者 Kaili Zhao Jinmeng Hu Jiuxing Dong Jianwei Sun 《癌症生物学与医学:英文版》 CAS CSCD 2019年第1期100-108,共9页
Objective: Stromal interaction molecule 1(STIM1) overexpression has been reported to play an important role in progression of several cancers. However, the mechanism of STIM1 overexpression and its relationship with h... Objective: Stromal interaction molecule 1(STIM1) overexpression has been reported to play an important role in progression of several cancers. However, the mechanism of STIM1 overexpression and its relationship with hypoxia in pancreatic ductal adenocarcinoma(PDAC) remains unclear.Methods: STIM1 and HIF-1α expression was tested using immunohistochemistry in tissue microarray(TMA) including pancreatic cancer and matched normal pancreatic tissues, and their relationships with clinicopathological parameters were statistically analyzed. q-PCR, Western blot, Ch IP, and luciferase assay were employed to 030 analyze transcriptional regulation between HIF-1α and STIM1 in pancreatic cancer PANC-1 cells.Results: Both STIM1 and HIF-1α showed higher positive rates and up-regulated expression in cancer tissues compared to that of normal tissues(P < 0.05). The Kaplan–Meier method revealed that higher HIF-1α and STIM1 expression levels were significantly correlated with decreased disease-free survival(P = 0.025 and P = 0.029, respectively). The expression of HIF-1α showed a significant positive correlation with that of STIM1 in cancer tissues(rs = 0.3343, P = 0.0011) and pancreatic cancer cell lines.Furthermore, Ch IP and luciferase assays confirmed that HIF-1α bound to the STIM1 promoter and regulated its expression in PANC-1 cells.Conclusions: In hypoxia microenvironment, up-regulated expression of STIM1 mediated by HIF-1α promotes PDAC progression. HIF-1α and STIM1 are potential prognostic markers and/or therapeutic targets for PDAC treatment. 展开更多
关键词 PANCREATIC CANCER STIM1 HIF-1Α
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KMT2D deficiency enhances the anti-cancer activity of L48H37 in pancreatic ductal adenocarcinoma 预览
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作者 Si-Si Li Wei-Liang Jiang +8 位作者 Wen-Qin Xiao Kai Li Ye-Fei Zhang Xing-Ya Guo Yi-Qi Dai Qiu-Yan Zhao Ming-Jie Jiang Zhan-Jun Lu Rong Wan 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第8期599-621,共23页
BACKGROUND Novel therapeutic strategies are urgently needed for patients with a delayed diagnosis of pancreatic ductal adenocarcinoma(PDAC)in order to improve their chances of survival.Recent studies have shown potent... BACKGROUND Novel therapeutic strategies are urgently needed for patients with a delayed diagnosis of pancreatic ductal adenocarcinoma(PDAC)in order to improve their chances of survival.Recent studies have shown potent anti-neoplastic effects of curcumin and its analogues.In addition,the role of histone methyltransferases on cancer therapeutics has also been elucidated.However,the relationship between these two factors in the treatment of pancreatic cancer remains unknown.Our working hypothesis was that L48H37,a novel curcumin analog,has better efficacy in pancreatic cancer cell growth inhibition in the absence of histonelysine N-methyltransferase 2D(KMT2D).AIM To determine the anti-cancer effects of L48H37 in PDAC,and the role of KMT2D on its therapeutic efficacy.METHODS The viability and proliferation of primary(PANC-1 and MIA PaCa-2)and metastatic(SW1990 and ASPC-1)PDAC cell lines treated with L48H37 was determined by CCK8 and colony formation assay.Apoptosis,mitochondrial membrane potential(MMP),reactive oxygen species(ROS)levels,and cell cycle profile were determined by staining the cells with Annexin-V/7-AAD,JC-1,DCFH-DA,and PI respectively,as well as flow cytometric acquisition.In vitro migration was assessed by the wound healing assay.The protein and mRNA levels of relevant factors were analyzed using Western blotting,immunofluorescence and real time-quantitative PCR.The in situ expression of KMT2D in both human PDAC and paired adjacent normal tissues was determined by immunohistochemistry.In vivo tumor xenografts were established by injecting nude mice with PDAC cells.Bioinformatics analyses were also conducted using gene expression databases and TCGA.RESULTS L48H37 inhibited the proliferation and induced apoptosis in SW1990 and ASPC-1 cells in a dose-and time-dependent manner,while also reducing MMP,increasing ROS levels,arresting cell cycle at the G2/M stages and activating the endoplasmic reticulum(ER)stress-associated protein kinase RNA-like endoplasmic reticulum kinase/eukaryotic initiation factor 2� 展开更多
关键词 Pancreatic neoplasms CURCUMIN analog HISTONE METHYLTRANSFERASE 2D THERAPEUTIC effects BIOINFORMATICS
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Nanotrap-enabled quantification of KRAS-induced peptide hydroxylation in blood for cancer early detection
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作者 Zaian Deng Zhen Zhao +9 位作者 Bo Ning Jeffery Basilio Karen Mann Jie Fu Yajun Gu Yuanqing Ye Xifeng Wu Jia Fan Paul Chiao Tony Hu 《纳米研究:英文版》 SCIE EI CAS CSCD 2019年第6期1445-1452,共8页
Circulating peptide is a potential source of biomarkers for cancer detection.However,the existence of large molecular weight proteins in plasma have a disastrous effect on circulating peptides isolating and detecting.... Circulating peptide is a potential source of biomarkers for cancer detection.However,the existence of large molecular weight proteins in plasma have a disastrous effect on circulating peptides isolating and detecting.Herein,nanotrap fractionation following by mass spectrometry have been applied to quantify the levels of bradykinin (BK) and hydroxylated bradykinin (Hyp-BK) as a relative measure of KRAS-regulated prolyl-4-hydroxylase alpha-1 (P4HA1) which may serve as early diagnosis marker for pancreatic ductal adenocarcinoma (PDAC).We found that P4HA1 can be upregulated by KRASG12v,which is a PDAC driver mutation,using HPNE/KRAS and HPNE cells.And we revealed that P4HA1 is overexpressed in PDAC tumors,compared to normal and inflamed pancreatic tissues.RNA interference revealed that P4HA1 activity was primarily responsible for Hyp-BK production.Mass spectrometry analysis revealed that plasma Hyp-BK/BK ratio was higher in PDAC than pancreatitis patients and healthy controls,while the area under the receiver operating characteristic (ROC) curve (AUC) is 0.8209 (95%Cl,0.7269-0.9149).The Hyp-BK/BK association with PDAC was reproduced in another cohort,where this ratio was found to increase with advancing tumor stage.These novel findings paved the way for wider applications of Nanotrap coupled mass spectrometry as a powerful tool for revealing biosignatures from plasma. 展开更多
关键词 nanotrap HYDROXYLATION level BRADYKININ PANCREATIC DUCTAL ADENOCARCINOMA
Aeromonas veronii biovar veronii and sepsis-infrequent complication of biliary drainage placement: A case report 预览
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作者 Manlio Monti Arianna Torri +4 位作者 Elena Amadori Alice Rossi Giulia Bartolini Chiara Casadei Giovanni Luca Frassineti 《世界临床病例杂志》 2019年第6期759-764,共6页
BACKGROUND Aeromonas species are uncommon pathogens in biliary sepsis and cause substantial mortality in patients with impaired hepatobiliary function. Asia has the highest incidence of infection from Aeromonas, where... BACKGROUND Aeromonas species are uncommon pathogens in biliary sepsis and cause substantial mortality in patients with impaired hepatobiliary function. Asia has the highest incidence of infection from Aeromonas, whereas cases in the west are rare. CASE SUMMARY We report the case of a 64-year-old woman with advanced pancreatic cancer and jaundice who manifested fever, abdominal pain, severe thrombocytopenia, anemia and kidney failure following the insertion of a percutaneous transhepatic biliary drainage. Blood culture results revealed the presence of Aeromonas veronii biovar veronii (A. veronii biovar veronii). After antibiotic therapy and transfusions, the life-threatening clinical conditions of the patient improved and she was discharged. CONCLUSION This was a rare case of infection, probably the first to be reported in West countries, caused by A. veronii biovar veronii following biliary drainage. A finding of Aeromonas must alert clinician to the possibility of severe sepsis. 展开更多
关键词 AEROMONAS veronii BIOVAR veronii AEROMONAS Pancreatic cancer CHOLANGITIS Sepsis BILIARY TRACT infection Case report
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Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi: A case report 预览
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作者 Luca Morelli Niccolò Furbetta +6 位作者 Desirée Gianardi Matteo Palmeri Gregorio Di Franco Matteo Bianchini Gianni Stefanini Simone Guadagni Giulio Di Candio 《世界临床病例杂志》 2019年第12期1461-1466,共6页
BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of ... BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option. 展开更多
关键词 Case report da Vinci XI EndoWrist STAPLER Walled-off pancreatic necrosis TilePro MINIMALLY-INVASIVE surgery
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Zinc deficiency in patients with chronic pancreatitis 预览
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作者 Miroslav Vujasinovic Aleksandra Hedstrom +4 位作者 Patrick Maisonneuve Roberto Valente Henrik von Horn J-Matthias Lohr Stephan L Haas 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期600-607,共8页
BACKGROUND Zinc is a key element in numerous proteins and plays an important role in essential cell functions such as defense against free radicals and DNA damage repair.Chronic pancreatitis(CP)is a chronic inflammati... BACKGROUND Zinc is a key element in numerous proteins and plays an important role in essential cell functions such as defense against free radicals and DNA damage repair.Chronic pancreatitis(CP)is a chronic inflammation with progressive fibrosis of pancreas ultimately resulting in pancreatic exocrine insufficiency(PEI),which is associated with malnutrition.Studies analyzing zinc levels in patients with CP are sparse and lead to conflicting results.AIM To investigate serum zinc levels in patients with CP of various etiologies.METHODS Between October 2015 and March 2018,patients with a diagnosis of CP were identified and recruited from the Pancreatic Outpatient Clinic at the Karolinska University Hospital in Stockholm,Sweden.Demographic,clinical and laboratory data were analyzed.Etiology of CP was determined according to the MANNHEIM classification system into the following etiological subcategories:alcohol consumption,nicotine consumption,hereditary factors,efferent pancreatic duct factors and immunological factors.Pancreatic exocrine function was defined as normal(fecal elastase 1>200μg/g),mildly reduced(100-200μg/g)and severely reduced(fecal elastase 1<100μg/g).RESULTS A total of 150 patients were included in the analysis.Zinc deficiency(<11μmol/L)was present in 39(26.0%)of patients:22 females and 17 males.In the group of patients with zinc deficiency,76.7%of patients had an exocrine pancreatic insufficiency(FE-1<200μg/g).Older age was significantly associated with low zinc levels.Following a univariate analysis,patients aged 60-69 and patients≥70 years of age had a significantly higher prevalence of zinc deficiencies compared to patients<40 years of age[OR:3.8,95%CI(1.08-13.4);P=0.04];[OR 6.26,95%CI(1.94-20.2),P>0.002].Smoking and number of packyears were additionally associated with low zinc levels.The risk of zinc deficiency in current smokers and smokers with≥20 pack-years was approximately three times higher compared to those who had never smoked.Gender,body mass index,etiology of CP,presence of di 展开更多
关键词 Zinc PANCREAS PANCREATIC EXOCRINE INSUFFICIENCY Chronic PANCREATITIS MALNUTRITION
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Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19–9 level as a prognostic factor in patients with resected pancreatic cancer 预览
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作者 Teruhisa Sakamoto Hiroaki Saito +3 位作者 Masataka Amisaki Naruo Tokuyasu Soichiro Honjo Yoshiyuki Fujiwara 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第3期278-284,共7页
Background: Carbohydrate antigen 19–9(CA19-9) is the most frequently used tumor marker and serves as a prognostic indicator in patients with pancreatic cancer(PC). The platelet-to-lymphocyte ratio(PLR) is thought to ... Background: Carbohydrate antigen 19–9(CA19-9) is the most frequently used tumor marker and serves as a prognostic indicator in patients with pancreatic cancer(PC). The platelet-to-lymphocyte ratio(PLR) is thought to be an inflammation-related serum marker. An elevated PLR represents increased inflammatory status and is associated with poor prognosis in patients with various cancers including PC. Methods: This study involved 103 patients with a histopathological diagnosis of pancreatic ductal adenocarcinoma who underwent pancreatectomy. The patients were assessed to determine the prognostic significance of the combination of the PLR and CA19-9 level. Results: Based on the receiver operating characteristic analysis results, the patients were divided into PLR H igh(PLR ≥ 129.1) andPLRLow(PLR < 129.1) groups and into CA19-9High(CA19-9 ≥ 74.0 U/mL) and CA19-9Low(CA19-9 < 74.0 U/mL) groups. The cumulative 5-year overall survival(OS) and disease-specific survival(DSS) rates significantly differed by both the PLR(PLR H igh group: 19.5% and 22.9%;PLRLow group: 39.1% and 45.9%) and CA19-9(CA19-9 H igh group: 19.1% and 25.6%;CA19-9Low group: 41.0% and 41.0%). We then divided the patients into Groups A(PLR L ow/CA19-9Low), B(PLR Low/CA19-9High or PLRHigh/CA19-9Low), and C(PLR H igh/CA19-9High). The cumulative 5-year OS rates in Groups A, B, and C were 44.0%, 31.9%, and 11.9%, respectively( P = 0.002). The cumulative 5-year DSS rates in Groups A, B, and C were 47.7%, 36.4%, and 16.8%, respectively( P = 0.002). Multivariate analysis revealed that the combination of the PLR and CA19-9 was an independent prognostic factor in patients with resected PC. Conclusions: The combination of the PLR and CA19-9 is useful for predicting the prognosis of patients with resected PC. 展开更多
关键词 CA19-9 PANCREATIC cancer Platelet-to-lymphocyte RATIO Prognosis
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Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging 预览
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作者 Luca Morelli Simone Guadagni +11 位作者 Valerio Borrelli Roberta Pisano Gregorio Di Franco Matteo Palmeri Niccolò Furbetta Dario Gambaccini Santino Marchi Piero Boraschi Luca Bastiani Alessandro Campatelli Franco Mosca Giulio Di Candio 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第18期2217-2228,共12页
BACKGROUND Patients with pancreatic cystic neoplasms (PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime imagebased surveillance follow-up. In these patients, ... BACKGROUND Patients with pancreatic cystic neoplasms (PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime imagebased surveillance follow-up. In these patients, the current European evidencedbased guidelines advise magnetic resonance imaging (MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound (US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by US. AIM To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of MRI. METHODS We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US findings. In this communication, we reported the clinical results of this alternative followup, and the results of a comparative cost-analysis between our surveillance protocol (abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance protocol.RESULTS In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1±18.2 mo. Surgery was required in two patients (1%) because of the appearance of suspicious features at imaging (with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN appearance in 28 patients (14%). These c 展开更多
关键词 Ultrasound Pancreatic CYSTIC neoplasms Magnetic resonance imaging SURVEILLANCE
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Non-invasive detection of pancreatic cancer by measuring DNA methylation of Basonuclin 1 and Septin 9 in plasma
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作者 Xiao-Bin Li Jun Ma +9 位作者 Zi-Wen Liu Wen-Fei He Zong-Ze Li Ming Cui Huang Hao Guang-Peng Zhou Lei You James Wang Xiao-Liang Han Yu-Pei Zhao 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第12期1504-1506,共3页
Pancreatic cancer (PC), a deadly malignancy with an overall 5-year survival rate of 5% to 15%, is ranked as the seventh leading cause of cancer death in the world in spite of its low occurrence rate.[1,2] Early detect... Pancreatic cancer (PC), a deadly malignancy with an overall 5-year survival rate of 5% to 15%, is ranked as the seventh leading cause of cancer death in the world in spite of its low occurrence rate.[1,2] Early detection appears to be the most effective approach to improve the overall survival of patients with PC. However, the difficulty in early detection of PC is a lack of specific symptoms and reliable biomarkers. Currently, carbohydrate antigen 19-9 (CA 19-9) is a serum biomarker that is widely used in PC detection. However, 10% of patients with PC cannot produce CA 19-9 and serum CA 19-9 is frequently absent in patients with early-stage cancer. Furthermore, CA 19-9 is often found to be elevated in benign conditions or in other cancers, making its utility limited. Therefore, it is important to identify new diagnostic biomarkers to improve PC detection. 展开更多
关键词 NON-INVASIVE detection pancreatic cancer MEASURING DNA METHYLATION
Heterogeneity of cannabinoid ligand-induced modulations in intracellular Ca^2+ signals of mouse pancreatic acinar cells in vitro
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作者 Kun-kun Xia Jian-xin Shen +5 位作者 Ze-bing Huang Hui-min Song Ming Gao De-jie Chen Shui-jun Zhang Jie Wu 《中国药理学报:英文版》 SCIE CAS CSCD 2019年第3期410-417,共8页
We recently reported that a CB2R agonist,GW405833(GW),reduced both the ACh-induced Ca^2+ oscillations and the L-arginineinduced Ca2+signal enhancement in mouse pancreatic acinar cells,suggesting that GW-induced inhibi... We recently reported that a CB2R agonist,GW405833(GW),reduced both the ACh-induced Ca^2+ oscillations and the L-arginineinduced Ca2+signal enhancement in mouse pancreatic acinar cells,suggesting that GW-induced inhibition may prevent the pathogenesis of acute pancreatitis.In this study,we aim to evaluate the effects of other cannabinoid ligands on Ca^2+ signaling in acinar cells.Patch-clamp whole-cell recordings were applied to measure ACh-induced intracellular Ca^2+ oscillations in pancreatic acinar cells acutely dissociated from wild-type(WT),CB1R knockout(KO),and CB2R KO mice,and the pharmacological effects of various cannabinoid ligands on the Ca^2+ oscillations were examined.We found that all the 8 CB2R agonists tested inhibited AChinduced Ca^2+ oscillations.Among them,GW,JWH133,and GP1a caused potent inhibition with IC50 values of 5.0,6.7,and 1.2μmol/L,respectively.In CB2R KO mice or in the presence of a CB2R antagonist(AM630),the inhibitory effects of these 3 CB2R agonists were abolished,suggesting that they acted through the CB2Rs.The CB1R agonist ACEA also induced inhibition of Ca^2+ oscillations that existed in CB1R KO mice and in the presence of a CB1R antagonist(AM251),suggesting a non-CB1R effect.In WT,CB1R KO,and CB2R KO mice,a nonselective CBR agonist,WIN55,212-2,inhibited Ca^2+ oscillations,which was not mediated by CB1Rs or CB2Rs.The endogenous cannabinoid substance,2-arachidonoylglycerol(2-AG),did not show an inhibitory effect on Ca^2+ oscillations.In conclusion,CB2R agonists play critical roles in modulating Ca^2+ signals in mouse pancreatic acinar cells,while other cannabinoid ligands modulate Ca^2+ oscillations in a heterogeneous manner through a CB receptor or non-CB-receptor mechanism. 展开更多
关键词 CANNABINOID CB2 RECEPTOR CB1 RECEPTOR ENDOCANNABINOID Ca^2+ oscillations pancreatic acinar cells PATCH-CLAMP
Sustained co-delivery of gemcitabine and cis-platinum via biodegradable thermo-sensitive hydrogel for synergistic combination therapy of pancreatic cancer
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作者 Kun Shi Bingxin Xue +5 位作者 Yanpeng Jia Liping Yuan Ruxia Han Fan Yang Jinrong Peng Zhiyong Qian 《纳米研究:英文版》 SCIE EI CAS CSCD 2019年第6期1389-1399,共11页
Pancreatic cancer is one of the most devastating cancers with poor prognosis and no significant change in the survival rate over the past decades.Localized targeted drug delivery through interventional endoscopic ultr... Pancreatic cancer is one of the most devastating cancers with poor prognosis and no significant change in the survival rate over the past decades.Localized targeted drug delivery through interventional endoscopic ultrasonography-guided fine-needle injection (EUS-FNI) is an attractive and minimally invasive strategy for inoperable pancreatic cancer.An injectable in-situ formed long-lasting drug delivery system is a promising alternative for the localized treatment of pancreatic cancer via EUS-FNI.Here,a biodegradable thermo-sensitive copolymer hydrogel for the co-delivery of anticancer agents gemcitabine (GEM) and cis-platinum (DDP) was developed.This hydrogel is a free flowable liquid at room temperature that changes into a semi-solid hydrogel following injection in response to the physiological temperature.Both in vitro and in vivo drug release behaviors indicate sustained drug release of this delivery system.Synergistic cellular proliferation inhibition and desirable apoptosis promotion have been found when pancreatic cancer Bxpc-3 cells were co-cultured with this GEM-DDP/hydrogel system.After a single intratumoral injection,the dual-drug loaded hydrogel formulation exhibited superior anti-tumor efficacy and minimized systemic side effect on pancreatic cancer xenograft mouse model in comparison to the intravenously injected free GEM and DDP combination.In addition,a strong synergistic therapeutic effect of the GEM-DDP/hydrogel system against pancreatic cancer has been found in vitro and in vivo compared to the single-drug loaded hydrogel composites.The obtained findings suggest this developed thermo-sensitive copolymer hydrogel system as a potential universal carrier for the localized targeted delivery of multi-drugs,for use in a variety of inoperable solid tumors. 展开更多
关键词 localized drug delivery SUSTAINED release THERMO-SENSITIVE HYDROGEL combination therapy pancreatic cancer
Genetic testing vs microforceps biopsy in pancreatic cysts:Systematic review and meta-analysis 预览
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作者 Sandra Faias Luisa Pereira +2 位作者 Angelo Luis Paula Chaves Marilia Cravo 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第26期3450-3467,共18页
BACKGROUND Carcinoembryonic antigen(CEA)and cytology in pancreatic cystic fluid are suboptimal for evaluation of pancreatic cystic neoplasms.Genetic testing and microforceps biopsy are promising tools for pre-operativ... BACKGROUND Carcinoembryonic antigen(CEA)and cytology in pancreatic cystic fluid are suboptimal for evaluation of pancreatic cystic neoplasms.Genetic testing and microforceps biopsy are promising tools for pre-operative diagnostic improvement but comparative performance of both methods is unknown.AIM To compare the accuracy of genetic testing and microforceps biopsy in pancreatic cysts referred for surgery.METHODS We performed a literature search in Medline,Scopus,and Web of Science for studies evaluating genetic testing of cystic fluid and microforceps biopsy of pancreatic cysts,with endoscopic ultrasound with fine-needle aspiration(EUSFNA)prior to surgery and surgical pathology as reference standard for diagnosis.We evaluated the diagnostic accuracy for:1-benign cysts;2-mucinous low-risk cysts;3-high-risk cysts,and the diagnostic yield and rate of correctly identified cysts with microforceps biopsy and molecular analysis.We also assessed publication bias,heterogeneity,and study quality.RESULTS Eight studies,including 1206 patients,of which 203(17%)referred for surgery who met the inclusion criteria were analyzed in the systematic review,and seven studies were included in the meta-analysis.Genetic testing and microforceps biopsies were identical for diagnosis of benign cysts.Molecular analysis was superior for diagnosis of both low and high-risk mucinous cysts,with sensitivities of 0.89(95%CI:0.79-0.95)and 0.57(95%CI:0.42-0.71),specificities of 0.88(95%CI:0.75-0.95)and 0.88(95%CI:0.80-0.93)and AUC of 0.9555 and 0.92,respectively.The diagnostic yield was higher in microforceps biopsies than in genetic analysis(0.73 vs 0.54,respectively)but the rates of correctly identified cysts were identical(0.73 with 95%CI:0.62-0.82 vs 0.71 with 95%CI:0.49-0.86,respectively).CONCLUSION Genetic testing and microforceps biopsies are useful second tests,with identical results in benign pancreatic cysts.Genetic analysis performs better for low-and high-risk cysts but has lower diagnostic yield. 展开更多
关键词 Pancreatic CYSTS ENDOSCOPIC ULTRASOUND ENDOSCOPIC ULTRASOUND with fineneedle ASPIRATION Genetic testing Microforceps BIOPSY Molecular analysis KRAS Carcinoembryonic antigen CYTOLOGY
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