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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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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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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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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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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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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
CUDC-907 displays potent antitumor activity against human pancreatic adenocarcinoma in vitro and in vivo through inhibition of HDAC6 to downregulate c-Myc expression
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作者 Xu-hong Fu Xiong Zhang +8 位作者 Hong Yang Xiao-wei Xu Zong-long Hu Juan Yan Xing-ling Zheng Rong-rui Wei Zhu-qing Zhang Mei-yu Geng Xun Huang 《中国药理学报:英文版》 SCIE CAS CSCD 2019年第5期677-688,共12页
Pancreatic adenocarcinoma is a highly malignant cancer that often involves a deregulation of c-Myc. It has been shown that c-Myc plays a pivotal role in the regulation of a variety of physiological processes and is in... Pancreatic adenocarcinoma is a highly malignant cancer that often involves a deregulation of c-Myc. It has been shown that c-Myc plays a pivotal role in the regulation of a variety of physiological processes and is involved in early neoplastic development, resulting in poor progression. Hence, suppression of c-Myc overexpression is a potential strategy for pancreatic cancer therapy. CUDC-907 is a novel dual- acting inhibitor of phosphoinositide 3-kinase (PI3K) and histone deacetylase (HDAC). It has shown potential efficiency in patients with lymphoma, multiple myeloma, or thyroid cancer, as well as in solid tumors with c-Myc alterations, but the evidence is lacking for how CUDC-907 regulates c-Myc. In this study, we investigated the effect of CUDC-907 on human pancreatic cancer cells in vitro and in vivo. Our results showed that CUDC-907 potently inhibited the proliferation of 9 pancreatic cancer cell lines in vitro with IC50 values ranging from 6.7 to 54.5 nM. Furthermore, we revealed the antitumor mechanism of CUDC-907 in Aspc-1, PANC-1, and Capan-1 pancreatic cancer cells: it suppressed the HDAC6 subunit, thus downregulating c-Myc protein levels, which was a mode of action distinct from the existing mechanisms. Consistently, the extraordinary antitumor activity of CUDC-907 accompanied by downregulation of c-Myc and Ki67 expression in tumor tissue was observed in a human pancreatic cancer Aspc-1 xenograft nude mouse model in vivo. Our results suggest that CUDC-907 can be a valuable therapeutic option for treating pancreatic adenocarcinoma. 展开更多
关键词 PANCREATIC ADENOCARCINOMA CUDC-907 C-MYC HDAC PI3K
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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Multivariate Analysis of Prognosis in Patients with Pancreatic Cancer 预览
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作者 Cai Li Li Xiao Yi Gu +2 位作者 Lei Qian Yu Di Liu Jiu Wei Cui 《肿瘤营养学杂志(英文)》 2019年第2期91-102,共12页
Objective Pancreatic cancer is a highly malignant digestive system tumor. The prognosis of pancreatic cancer may be affected by many factors. But there is a lack of research on the multivariate analysis of prognostic ... Objective Pancreatic cancer is a highly malignant digestive system tumor. The prognosis of pancreatic cancer may be affected by many factors. But there is a lack of research on the multivariate analysis of prognostic factors of pancreatic cancer. This study aimed to explore the factors that multivariate influence the prognosis of pancreatic cancer. Methods We conducted a retrospective cohort study using electronic medical record database from The First Hospital of Jilin University from January 2014 to December 2016. Clinical information, such as TNM stage, serum tumor markers, serum albumin and the patient-generated subjective global assessment (PG-SGA), were collected. Kaplan- Meier method was used to calculate survival rate. The survival curve was compared with the Log-rank test. A multivariate analysis was performed for each prognostic factor using the Cox proportional hazards model. The significance level was 0.05. Results 1. The median overall survival time (OS) of 493 patients was 10 months. The 1-year, 2-year, and 3-year cumulative survival rates were 41.5%, 20.6%, and 9.9%, respectively. Univariate survival analysis revealed that TNM stage (P < 0.001), treatment regimen (P < 0.001), CA125 (P < 0.001), the level of serum albumin (P = 0.014), and nutritional status (P = 0.006) were significantly correlated with prognosis of pancreatic cancer. COX proportional hazards regression model showed that TNM stage (P = 0.038), Carbonhydrate antigen 125 (CA125)(P = 0.003) and the level of serum albumin were independent factors affecting the median OS. The prognosis of patients with Ⅳ stage, elevated levels of serum albumin group and elevated levels of CA125 group were poor. 2. Seventy-three patients with pancreatic cancer underwent surgical resection. The median postoperative survival time was 28 months. The 1-year, 2-year, and 3-year cumulative survival rates were 74.4%, 47.7%, and 21.4%, respectively. Univariate analysis revealed that TNM stage (P = 0.032), pathological type (P = 0.012), hypoglycemia (P = 0.040), 展开更多
关键词 PANCREATIC cancer Tumor MARKERS SERUM ALBUMIN PROGNOSIS
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18F-FDG PET/CT在胰腺继发性恶性肿瘤诊治中的应用价值 预览
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作者 王巍 刘俊 +2 位作者 阚英 刘洁 杨吉刚 《临床和实验医学杂志》 2019年第4期426-430,共5页
目的 探讨正电子发射计算机断层/计算机断层扫描(18F-FDG PET/CT)在胰腺继发性恶性肿瘤诊治中的价值。方法 回顾性分析2016年2月至2018年10月在首都医科大学附属北京友谊医院核医学科行18F-FDG PET/CT检查的患者中最终确诊为恶性肿瘤胰... 目的 探讨正电子发射计算机断层/计算机断层扫描(18F-FDG PET/CT)在胰腺继发性恶性肿瘤诊治中的价值。方法 回顾性分析2016年2月至2018年10月在首都医科大学附属北京友谊医院核医学科行18F-FDG PET/CT检查的患者中最终确诊为恶性肿瘤胰腺转移的患者病例资料,共19例患者,其中儿童患者6例,成人患者13例。儿童患者中,淋巴瘤3例,横纹肌肉瘤1例,横纹肌肉瘤伴神经源性分化小圆细胞恶性肿瘤1例,上皮样恶性神经鞘瘤1例。成人患者中,淋巴瘤4例,白血病1例,上皮来源恶性肿瘤7例(原发肺癌2例、原发肾癌1例、原发结肠癌2例,原发喉癌1例,原发胃癌1例),间叶组织来源1例,7例患者于化疗后复查18F-FDG PET/CT。记录每个患者胰腺病灶的SUVmax值、全身各部位的病灶分布以及治疗前后病灶的SUV值变化情况。结果 胰腺受累部位均有不同程度的FDG代谢增高,儿童恶性肿瘤累及胰腺较成人更为常见,且胰腺的受累不容易早期作出准确诊断;17例患者与原发肿瘤同时发现胰腺转移,全身其他部位亦发现多处病灶,极大地改变了临床分期;7例患者于化疗后复查18 F-FDG PET/CT,结果显示胰腺病灶消失或代谢明显减低,提示治疗取得了很好的效果。结论 18F-FDG PET/CT在胰腺转移性/继发性恶性肿瘤诊断和疗效评估中有一定的应用价值。 展开更多
关键词 胰腺 继发性恶性肿瘤 18F-FDG PET/CT
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Pancreatic necrosis: Complications and changing trend of treatment 预览
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作者 Mamoon Ur Rashid Ishtiaq Hussain +5 位作者 Sundas Jehanzeb Waqas Ullah Saeed Ali Akriti Gupta Jain Neelam Khetpal Sarfraz Ahmad 《世界胃肠外科杂志:英文版(电子版)》 2019年第4期198-217,共20页
Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution;som... Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution;some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered. 展开更多
关键词 Pancreatic necrosis NECROSECTOMY Open SURGERY MINIMALLY INVASIVE SURGERY COMPLICATIONS TREATMENT Review article
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Gambogic acid-encapsulated polymeric micelles improved therapeutic effects on pancreatic cancer
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作者 Yan Wang Xinxin Wang +6 位作者 Jing Zhang Li Wang Chunqing Ou Yaqian Shu Qinjie Wu Guolin Ma Changyang Gong 《中国化学快报:英文版》 SCIE CAS CSCD 2019年第4期885-888,共4页
Gambogic acid(GA) is a natural product with potent anticancer activity in vitro.However,poorwatersolubility and systematic toxicity limit the further clinical application of GA. Micellization of hydrophobic molecule c... Gambogic acid(GA) is a natural product with potent anticancer activity in vitro.However,poorwatersolubility and systematic toxicity limit the further clinical application of GA. Micellization of hydrophobic molecule could effectively ameliorate aqueous dispersity of GA and induce better blood retention and tumor accumulation, hence lead to improved stability and therapeutic effect of GA. In this study, monomethyl poly(ethylene glycol)-poly(ε-caprolactone)-poly(trimethylene carbonate)(MPEG-P(CL-ran-TMC)) was used to encapsulate GA by a single-step solid dispersion method to form a GA encapsulated MPEG-P(CL-ran-TMC) micelles (GA micelles). GA micelles were characterized with a small particle size (44 ±1 nm), high drug loading content(26.28%± 0.12%) and high-effici encyencapsulation (87.59%± 0.41%). Compared with free GA, GA micelles showed better dispersion in water, prolonged release behavior in vitro, and enhanced tumor cellular uptake. GA micelles could also effectively induce apoptosis in AsPC-1 cells. Compared with free GA, GA micelles exhibited superior antitumor efficacy and better apoptosis induced effect in a subcutaneous xenograft mouse model of AsPC-1 cells. In conclusion, GA micelles which showed high-efficiency anti-tumor effect in vitro and in vivo may serve as a candidate for pancreatic cancer therapy. 展开更多
关键词 Gambogic acid PANCREATIC CANCER POLYMERIC micelles DRUG delivery CANCER therapy
Age,socioeconomic features,and clinical factors predict receipt of endoscopic retrograde cholangiopancreatography in pancreatic cancer 预览
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作者 Sheila D Rustgi Sunil P Amin +5 位作者 Michelle K Kim Satish Nagula Nikhil A Kumta Christopher J DiMaio Paolo Boffetta Aimee L Lucas 《世界胃肠内镜杂志:英文版(电子版)》 2019年第2期133-144,共12页
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the recommended technique for biliary decompression in pancreatic cancer.Previous studies have suggested racial,socioeconomic and geographic difference... BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the recommended technique for biliary decompression in pancreatic cancer.Previous studies have suggested racial,socioeconomic and geographic differences in diagnosis,treatment and outcomes of pancreatic cancer patients.AIM To examine geographic,racial,socioeconomic and clinical factors associated with utilization of ERCP.METHODS Surveillance,Epidemiology and End Results and linked Medicare claims data were used to identify pancreatic cancer patients between 2000-2011.Claims data were used to identify patients who had ERCP and other treatments.The primary outcome was receipt of ERCP.Chi-squared analyses were used to compare demographic information.Trends in use of ERCP over time were assessed using Cochran Armitage test.Adjusted odds ratios(aORs)and 95%confidence intervals(CIs)for receipt ERCP were calculated using logistic regression,RESULTS Among 32510 pancreatic cancer patients,14704(45.2%)underwent ERCP.Patients who had cancer located in the head of the pancreas(aOR 3.27,95% CI:2.99-3.57),had jaundice(aOR 7.59,95% CI:7.06-8.17),cholangitis(aOR 4.22,95% CI:3.71-4.81)or pruritus(aOR 1.42,95% CI:1.22-1.66)and lived in lower education zip codes(aOR 1.14,95%CI:1.04-1.24)were more likely to receive ERCP.In contrast,patients who were older(aOR 0.88,95% CI:0.83,0.94),not married(aOR 0.92,95% CI:0.86,0.98),and lived in a non-metropolitan area(aOR 0.89,95% CI:0.82,0.98)were less likely to receive ERCP.Compared to white patients,non-white/non-black patients(aOR 0.83,95% CI:0.70-0.97)were less likely to receive ERCP.Patients diagnosed later in the study period were less likely to receive ERCP(aOR 2004-2007 0.85,95% CI:0.78-0.92;aOR 2008-2011 0.76,95% CI:0.70-0.83).After stratifying by indications for ERCP including jaundice,racial differences persisted(aOR black patients 0.80,95% CI:0.67-0.95,nonwhite/nonblack patients 0.73,95% CI:0.58-0.91).Among patients with jaundice,those who underwent surgery were less likely to undergo ERCP(aOR 0.60,95% CI:0.52,0.69). 展开更多
关键词 Pancreatic cancer Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY SOCIOECONOMIC DISPARITIES RACIAL DISPARITIES JAUNDICE Outcomes research
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Human antigen R mediated post-transcriptional regulation of inhibitors of apoptosis proteins in pancreatic cancer 预览
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作者 Ausra Lukosiute-Urboniene Aldona Jasukaitiene +3 位作者 Giedre Silkuniene Vidmantas Barauskas Antanas Gulbinas Zilvinas Dambrauskas 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第2期205-219,共15页
AIM To determine the association of human antigen R(HuR)and inhibitors of apoptosis proteins(IAP1,IAP2)and prognosis in pancreatic cancer.METHODS Protein and mRNA expression levels of IAP1,IAP2 and HuR in pancreatic d... AIM To determine the association of human antigen R(HuR)and inhibitors of apoptosis proteins(IAP1,IAP2)and prognosis in pancreatic cancer.METHODS Protein and mRNA expression levels of IAP1,IAP2 and HuR in pancreatic ductal adenocarcinoma(PDAC)were compared with normal pancreatic tissue.The correlations among IAP1/IAP2 and HuR as well as their respective correlations with clinicopathological parameters were analyzed.The Kaplan-Meier method and log-rank tests were used for survival analysis.Immunoprecipitation assay was performed to demonstrate HuR binding to IAP1,IAP2 mRNA.PANC1 cells were transfected with either anti-HuR siRNA or control siRNA for 72 h and quantitative reverse transcription polymerase chain reaction(RT-PCR),western blot analysis was carried out.RESULTS RT-PCR analysis revealed that HuR,IAP1,IAP2 mRNA expression were accordingly 3.3-fold,5.5-fold and 8.4 higher in the PDAC when compared to normal pancreas(P<0.05).Expression of IAP1 was positively strongly correlated with HuR expression(P<0.05,r=0.783).Western blot analysis confirmed RTPCR results.High IAP1 expression,tumor resection status,T stage,lymph-node metastases,tumor differentiation grade,perineural and lymphatic invasion were identified as significant factors for shorter survival in PDAC patients(P<0.05).Immunohistological analysis showed that HuR was mainly expressed in the ductal cancer cell’s nucleus and less so in cytoplasm.RNA immunoprecipitation analysis confirmed IAP1 and IAP2 post-transcriptional regulation by HuR protein.Following siHuR transfection,IAP1 mRNA and protein levels were decreased,however IAP2 expression levels were increased.CONCLUSION HuR mediated overexpression of IAP1 significantly correlates with poor outcomes and early progression of pancreatic cancer.Further studies are needed to assess the underlying mechanisms. 展开更多
关键词 Pancreatic cancer INHIBITORS of apoptosis PROTEINS HUMAN ANTIGEN R POSTTRANSCRIPTIONAL regulation
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Central role of Yes-associated protein and WW-domain-containing transcriptional co-activator with PDZ-binding motif in pancreatic cancer development 预览
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作者 Enrique Rozengurt Guido Eibl 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第15期1797-1816,共20页
Pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease with no efficacious treatment options. PDAC incidence is projected to increase, which may be caused at least partially by the obesity epidemic. Signific... Pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease with no efficacious treatment options. PDAC incidence is projected to increase, which may be caused at least partially by the obesity epidemic. Significantly enhanced efforts to prevent or intercept this cancer are clearly warranted. Oncogenic KRAS mutations are recognized initiating events in PDAC development, however, they are not entirely sufficient for the development of fully invasive PDAC. Additional genetic alterations and/or environmental, nutritional, and metabolic signals, as present in obesity, type-2 diabetes mellitus, and inflammation, are required for full PDAC formation. We hypothesize that oncogenic KRAS increases the intensity and duration of the growth-promoting signaling network. Recent exciting studies from different laboratories indicate that the activity of the transcriptional co-activators Yes-associated protein (YAP) and WW-domaincontaining transcriptional co-activator with PDZ-binding motif (TAZ) play a critical role in the promotion and maintenance of PDAC operating as key downstream target of KRAS signaling. While initially thought to be primarily an effector of the tumor-suppressive Hippo pathway, more recent studies revealed that YAP/TAZ subcellular localization and co-transcriptional activity is regulated by multiple upstream signals. Overall, YAP has emerged as a central node of transcriptional convergence in growth-promoting signaling in PDAC cells. Indeed, YAP expression is an independent unfavorable prognostic marker for overall survival of PDAC. In what follows, we will review studies implicating YAP/TAZ in pancreatic cancer development and consider different approaches to target these transcriptional regulators. 展开更多
关键词 Pancreatic cancer Yes-associated protein and WW-domain-containing TRANSCRIPTIONAL CO-ACTIVATOR with PDZ-binding motif Oncogenic Kras Obesity Signaling network and LOOPS
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Is irreversible electroporation safe and effective in the treatment of hepatobiliary and pancreatic cancers? 预览
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作者 Li-Ming Wu Le-Le Zhang +1 位作者 Xin-Hua Chen Shu-Sen Zheng 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第2期117-124,共8页
Background:Irreversible electroporation(IRE)is a novel ablative technique for hepatobiliary and pancreatic cancers.This review summarizes the data regarding the safety and efficacy of IRE in the treatment of hepatobil... Background:Irreversible electroporation(IRE)is a novel ablative technique for hepatobiliary and pancreatic cancers.This review summarizes the data regarding the safety and efficacy of IRE in the treatment of hepatobiliary and pancreatic cancers.Data sources:Studies were identified by searching PubMed and Embase for articles published in English from database inception through July 31,2017.For inclusion,each clinical study had to report morbidity and survival data on hepatobiliary and pancreatic cancers treated with IRE and contain at least 10 patients.Studies that met these criteria were included for analysis.Two authors assessed each clinical study for data extraction.The controversial parts were resolved through discussion with seniors.Results:A total of 24 clinical studies were included.Fourteen focused on hepatic ablation with IRE comprising 437 patients with 666 lesions of different tumor types.Two patients(0.5%)died after the IRE procedure.Morbidity of hepatic ablation with IRE ranged from 7%to 35%.Most complications were mild.Complete response for hepatic tumors was reported as 57%–97%.Ten studies with 455 patients focused on pancreatic IRE.The overall mortality of IRE in pancreatic cancer was 2%.Overall severe morbidity of IRE in pancreatic cancer ranged from 0 to 20%.The median overall survival after IRE ranged from 7 to 23 months.Patients treated with IRE combined with surgical resection showed a longer overall survival.Conclusions:IRE significantly improves the prognosis of advanced hepatobiliary and pancreatic malignances,and companied with less complications.Hence,IRE is a relatively safe and effective non-thermal ablation strategy and potentially recommended as an option for therapy of patients with hepatobiliary and pancreatic malignances. 展开更多
关键词 IRREVERSIBLE ELECTROPORATION Hepatic CANCER PANCREATIC CANCER
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Value of Texture Analysis of Intravoxel Incoherent Motion Parameters in Differential Diagnosis of Pancreatic Neuroendocrine Tumor and Pancreatic Adenocarcinoma 预览
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作者 Yingwei Wang Xinghua Zhang +5 位作者 Botao Wang Ye Wang Mengqi Liu Haiyi Wang Huiyi Ye Zhiye Chen 《中国医学科学杂志:英文版》 CAS CSCD 2019年第1期1-9,共9页
Objective To evaluate the value of texture features derived from intravoxel incoherent motion (IVIM) parameters for differentiating pancreatic neuroendocrine tumor (pNET) from pancreatic adenocarcinoma (PAC). Methods ... Objective To evaluate the value of texture features derived from intravoxel incoherent motion (IVIM) parameters for differentiating pancreatic neuroendocrine tumor (pNET) from pancreatic adenocarcinoma (PAC). Methods Eighteen patients with pNET and 32 patients with PAC were retrospectively enrolled in this study. All patients underwent diffusion-weighted imaging with 10 b values used (from 0 to 800 s/mm2). Based on IVIM model, perfusion-related parameters including perfusion fraction (f), fast component of diffusion (Dfast) and true diffusion parameter slow component of diffusion (Dslow) were calculated on a voxel-by-voxel basis and reorganized into gray-encoded parametric maps. The mean value of each IVIM parameter and texture features [Angular Second Moment (ASM), Inverse Difference Moment (IDM), Correlation, Contrast and Entropy] values of IVIM parameters were measured. Independent sample t-test or Mann-Whitney U test were performed for the betweengroup comparison of quantitative data. Regression model was established by using binary logistic regression analysis, and receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency. Results The mean f value of the pNET group were significantly higher than that of the PAC group (27.0% vs. 19.0%, P = 0.001), while the mean values of Dfast and Dslow showed no significant differences between the two groups. All texture features (ASM, IDM, Correlation, Contrast and Entropy) of each IVIM parameter showed significant differences between the pNET and PAC groups (P=0.000-0.043). Binary logistic regression analysis showed that texture ASM of Dfast and texture Correlation of Dslow were considered as the specific imaging variables for the differential diagnosis of pNET and PAC. ROC analysis revealed that multiple texture features presented better diagnostic performance than IVIM parameters (AUC 0.849-0.899 vs. 0.526-0.776), and texture ASM of Dfast combined with Correlation of Dslow in the model of logistic regression had largest area under R 展开更多
关键词 NEUROENDOCRINE tumor PANCREATIC ADENOCARCINOMA TEXTURE analysis intravoxel INCOHERENT motion differential diagnosis
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Rare sequalae of hiatal hernia causing pancreatitis and hepatitis:A case report 预览
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作者 Muhammad Umar Kamal Ahmed Baiomi +1 位作者 Mohamad Erfani Harish Patel 《世界胃肠内镜杂志:英文版(电子版)》 2019年第3期249-255,共7页
Hiatal hernia(HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.79-year-old female with multiple comorbidities presente... Hiatal hernia(HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.79-year-old female with multiple comorbidities presented to emergency department with complaints of weight loss for 6 mo and abdominal pain for one day. Physical examination revealed cachectic and dehydrated female and bowel sounds could be auscultated on the right side of chest. Computed tomography of the chest and abdomen revealed interval enlargement of a massive HH,containing stomach and much of the bowel as well as pancreas and distal extrahepatic biliary duct, probably responsible for obstructive effect upon same. There was increased prominence of the pancreas consistent with pancreatitis. There was a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. Patient clinical status improved with conservative treatment.HH presenting with acute pancreatitis is a serious diagnostic and therapeutic challenge. The initial management is conservative, even if the abdominal content has herniated to mediastinum. The incentive spirometry can be utilized in the conservative of the large HH. After stabilization of the patient, elective surgical intervention remains the mainstay of the management. Definitive treatment will vary from case to case depending on the acuity of situation and comorbidities. 展开更多
关键词 Hiatal HERNIA PANCREATITIS HEPATITIS Para-esophageal HERNIA Gastropexy Pancreatic HERNIATION DIAPHRAGMATIC HERNIA Percutaneous endoscopic GASTROSTOMY Case report
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