Anomalous Junction Research Articles

Current Practice of Laparoscopic Surgery for Choledochal Cyst in Children -a Survey on Opinion and Experience Among IPEG Members

PurposeLaparoscopic resection of choledochal cyst (CC) has become a popular approach. As the discussion about optimal treatment and technical strategies continues, we aimed to investigate perspectives of IPEG members. MethodsAn online survey was conducted in 2023 on behalf of the IPEG Research Committee. IPEG members were asked to complete an anonymous questionnaire that included 36 items on the management of CC. Result148 members responded to the survey (North America:49/Asia:44/Europe:23/South America:21/Others:11) and 116 completed all questions. Most surgeons (92.5%) operate on less than 5 cases annually. Diagnostic tools of choice were Magnetic Resonance Imaging (MRI, 95.9%) and ultrasonography (US, 74.5%). Regarding fusiform-type CC, operative indications were cyst size greater than 10 mm (68.9%), typical symptoms (78.5%), or anomalous pancreatico-biliary junction (63.8%). In unilateral intrahepatic biliary cysts (type IVa) cases, 81.3% of respondents do not perform a simultaneous liver resection with the initial cyst resection. While 22.0% resect the CC at diagnosis, even if asymptomatic, a larger group of surgeons (41%; 49/118) wait until the infant reaches six months. Intraoperative cholangiography and choledochoscopy are performed routinely by 38.9% and 13.7%, respectively. The majority (52.5%) ligates the common bile duct stump just below the CC. Laparoscopic reconstructions are performed by retrocolic hepatico-jejunostomy (48.3%) or hepatico-duodenostomy (45.8%) at similar rates, but when done open, 71.2% of respondents prefer retrocolic hepatico-jejunostomy. For the laparoscopic anastomosis, interrupted sutures with intracorporeal knot tying were most often utilized (48.3%). ConclusionInidividual pediatric surgeons treat a small number of patients with CC each year. Laparosopic and open reconstruction techniques vary, likely due to technical challenges. Level of EvidenceIII.

Patient-derived induced pluripotent stem cells with a MERTK mutation exhibit cell junction abnormalities and aberrant cellular differentiation potential.

Human induced pluripotent stem cell (hiPSC) technology is a valuable tool for generating patient-specific stem cells, facilitating disease modeling, and investigating disease mechanisms. However, iPSCs carrying specific mutations may limit their clinical applications due to certain inherent characteristics. To investigate the impact of MERTK mutations on hiPSCs and determine whether hiPSC-derived extracellular vesicles (EVs) influence anomalous cell junction and differentiation potential. We employed a non-integrating reprogramming technique to generate peripheral blood-derived hiPSCs with and hiPSCs without a MERTK mutation. Chromosomal karyotype analysis, flow cytometry, and immunofluorescent staining were utilized for hiPSC identification. Transcriptomics and proteomics were employed to elucidate the expression patterns associated with cell junction abnormalities and cellular differentiation potential. Additionally, EVs were isolated from the supernatant, and their RNA and protein cargos were examined to investigate the involvement of hiPSC-derived EVs in stem cell junction and differentiation. The generated hiPSCs, both with and without a MERTK mutation, exhibited normal karyotype and expressed pluripotency markers; however, hiPSCs with a MERTK mutation demonstrated anomalous adhesion capability and differentiation potential, as confirmed by transcriptomic and proteomic profiling. Furthermore, hiPSC-derived EVs were involved in various biological processes, including cell junction and differentiation. HiPSCs with a MERTK mutation displayed altered junction characteristics and aberrant differentiation potential. Furthermore, hiPSC-derived EVs played a regulatory role in various biological processes, including cell junction and differentiation.

Anomalous Josephson Effect in a Planar Hybrid Structure with the Spin–Orbit Coupling

The way of formation of controlled phase inhomogeneity in a hybrid structure consisting of a short Josephson junction between two superconducting thin films, with one electrode partially coated with a ferromagnetic insulator, has been theoretically studied. The joint action of spin splitting and the Rashba spin–orbit coupling at the superconductor–ferromagnet interface leads to the generation of a spontaneous supercurrent, which changes the transport properties of the junction. The critical current and the current–phase relation of this hybrid structure have been calculated; it has been shown that this structure can be used to form an anomalous φ0 Josephson junction with the phase shift φ0 smoothly varying over a wide range.

An unusual variation of type IIIC anomalous pancreaticobiliary junction (APBJ)

An unusual variation of type IIIC anomalous pancreaticobiliary junction (APBJ)

Switching current distributions in ferromagnetic anomalous Josephson junctions

We investigate the switching current distributions of ferromagnetic anomalous Josephson junctions subjected to a linearly increasing bias current. Our study uncovers a significant correlation between the position of the switching current distributions and crucial system parameters, such as the strength of the spin–orbit coupling and the Gilbert damping parameter. This indicates that these parameters can be directly determined through experimental measurements. By conducting a comprehensive analysis of the interplay among noise, magnetization, phase dynamics, and the statistical properties of the switching current distribution, we deepen our understanding of these intriguing cryogenic spintronics devices. These findings hold potential for applications in the field of quantum computing architectures and information processing technologies.

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study.

Horizontal duodenal papilla (HDP) is not an uncommon ectopic major papilla. The impact of HDP on the occurrence of pancreaticobiliary diseases remains unclear. Here, we explored the associations in patients who underwent magnetic resonance cholangiopancreatography (MRCP). Consecutive patients who underwent MRCP at Xijing Hospital (Xi'an, China) between January 2020 and December 2021 were eligible. Patients were divided into HDP and regular papilla (RP) according to the position of the major papilla. The primary outcome was the proportion of congenital pancreaticobiliary diseases. A total of 2,194 patients were included, of whom 72 (3.3%) had HDP. Compared with the RP group (n = 2,122), the HDP group had a higher proportion of congenital pancreaticobiliary diseases, especially choledochal cyst (CC) or anomalous pancreaticobiliary junction (APBJ) (6.9% vs 1.4%, P = 0.001). More gallbladder cancer (6.9% vs 1.2%, P < 0.001) and pancreatic cysts (27.8% vs 16.3%, P = 0.01) were also identified in the HDP group. Morphologically, the HDP group had a longer extrahepatic bile duct (8.4 [7.6-9.3] cm vs 7.2 [6.5-8.1] cm, P < 0.001), and larger angles between the common bile duct-duodenum and pancreatic duct-duodenum. Multivariate analysis showed that the presence of HDP was an independent risk factor for gallbladder cancer. This study confirmed that HDP was not rare in patients underwent MRCP. A higher prevalence of congenital pancreaticobiliary malformations (especially CC or APBJ), gallbladder cancer and pancreatic cysts was observed in patients with HDP, as well as distinctive morphologic features.

An Unusual Variant of Anomalous Pancreaticobiliary Junction.

A 27-year-old previously healthy African American female presented to the Emergency Department with an acute onset of epigastric abdominal pain and nausea. Laboratory studies proved unremarkable. CT scan demonstrated intrahepatic and extrahepatic biliary ductal dilation with possible stones within the common bile duct. The patient was discharged with a surgery follow-up appointment. Laparoscopic cholecystectomy with intraoperative cholangiography was performed 3weeks later due to concern for choledocholithiasis. The intraoperative cholangiogram showed multiple abnormalities, concerning for an infectious or inflammatory process. Magnetic resonance cholangiopancreatography (MRCP) demonstrated a suspected anomalous pancreaticobiliary junction and cystic lesion near the pancreatic head. Endoscopic retrograde cholangiopancreatography (ERCP) for cholangioscopy showed normal-appearing pancreaticobiliary mucosa with 3 tributaries directly from the pancreas entering the bile duct and an ansa orientation to the pancreatic duct. Biopsies of the mucosa were benign. Annual MRCP and MRI to assess for findings concerning for neoplasm given the anomalous pancreaticobiliary junction were recommended.

Field-free anomalous junction and superconducting diode effect in spin-split superconductor/topological insulator junctions

We study the transport properties of a diffusive Josephson junction between two spin-split superconductors (SCs) made of SC-ferromagnetic insulator bilayers on top of a three-dimensional topological insulator. We derive the corresponding Usadel equation describing the quasiclassical Green's functions in these systems and first solve the equation analytically in the weak-proximity case. We demonstrate the appearance of an anomalous phase in the absence of an external magnetic field. We also explore nonreciprocal electronic transport. Specifically, we calculate the diode efficiency of the junction $\ensuremath{\eta}$ by solving the Usadel equation. We obtain a sizable diode effect even at zero applied magnetic field. We discuss how the diode efficiency $\ensuremath{\eta}$ depends on the different parameters and find a nonmonotonic behavior of $\ensuremath{\eta}$ with temperature.

CASE OF SYNCHRONOUS HEPATOBILIARY TUMOUR; DIAGNOSTIC DILEMMA

Synchronous biliary tract tumours are very rare. Synchronous double cancers of the extrahepatic bile duct with-out abnormal pancreatobiliary junction are extremely rare, and to date only 4 cases have been reported in the English literature [1-3]. Until now less than 10 cases have been reported all over the world. Usually, the coexistence is attributed to abnormal pancreatobiliary junction [4-6], local spread or metastasis or de novo. In cases apart from anomalous pancreatobiliary junction, p53 mutations have been associated with simultaneous cancers. Contrast enhanced tomography is done as the initial investigation and FDG-PET is increasingly being used in the staging work up. When there is a suspicion of periampullary growth on cross sectional imaging, side viewing scopy is done to evaluate the lesion and take biopsies. The case presented here is interesting as PET showed metabolically active lesions in the the gall bladder and periampullary region, the latter being subtle on endoscopy.

Diagnostic challenge: Mirizzi syndrome with anomalous pancreaticobiliary junction.

Diagnostic challenge: Mirizzi syndrome with anomalous pancreaticobiliary junction.

The Progress of the Quantum Hall Effect

Contemporarily, various novel phenomena related to quantum Hall effect and many extended versions of Hall effects were discovered. This big family of Hall effect has given rise to the development in many fields including condensed matter physics, and relevant research (e.g., topological insulators, topological superconductors), remains a hot topic nowadays. This paper will focus on the application of quantum Hall effect in state-of-art researches, especially in superconductor-related field. Information retrieve and literature analysis are the main methods used in this review. First, a brief introduction of the definition for different kinds of Hall effects will be given. Afterwards, applications of quantum Hall effect will be discussed, including an unconventional CDW discovered in a kamoge superconductor, Josephson Junction presenting a quantum Hall effect and the quantum anomalous Hall effect-based Josephson Junction. Subsequently, the limitations in these researches and problems remaining to be solved by further research will be shown. These researches have great significance in achieving quantum computation. Overall, these results shed light on guiding further studies for Hall effect.

Locking of magnetization and Josephson oscillations at ferromagnetic resonance in a φ0 junction under external radiation

We demonstrate the locking by external electromagnetic radiation of magnetic precession in the $ \varphi_0 $ Josephson junction through Josephson oscillations in the region of ferromagnetic resonance. This leads to a step in the dependence of the magnetization on the bias current, the position of which is determined by the radiation frequency and the shape of the resonance curve. In junctions with a strong spin-orbit coupling, states with negative differential resistance appear on the IV-characteristic, resulting in an additional locking step. A detailed study of the time dependence of voltage and magnetization and their Fourier transforms shows that the corresponding oscillations have the same frequency as the oscillations at the first step, but they have a different amplitude and different dependence on the radiation frequency. This makes it possible to control not only the frequency, but also the amplitude of the magnetic precession in the locking region. It opens up unique perspectives for the control and manipulation of magnetic moment in hybrid systems such as anomalous Josephson junctions.

Triple cancer of gallbladder, common bile duct and papilla of Vater: Report of a case and review of literature.

Introduction and importanceSynchronous malignancies of gallbladder and biliary tree are together rare entity whose pathogenesis is yet unknown. We report the case of a triple synchronous cancer of 3 distinct location: gallbladder, common bile duct (CBD) and papilla of Vater.Case presentationAn 84-years-old woman, was admitted to our Hospital with clinics features of obstructive jaundice.Dilatation of the biliary tree and CBD without evidence of gallstones was seen at US. CT scan confirmed distal CBD obstruction.An endo-US showed a nodule of the head of pancreas infiltrating the lower CBD.Finally, hepatic-MRI displayed a gallbladder malignancy with invasion of CBD.Preoperative staging showed 3 diagnostic suspicions: carcinoma of CBD on CT, pancreatic carcinoma on endo-US and malignancy of gallbladder on MRI.A cephalic duodenopancreatectomy and radical gallbladder resection was performed.Final pathology revealed 3 distinct location of moderately differentiated adenocarcinomas: Gallbladder, CBD and Vater's papilla.Microscopic examination didn't detect any direct continuity between the 3 tumors. Metastases were identified in the pancreaticoduodenal, peri-hepatic and peri-gastric lymph nodes.Clinical discussionLiterature displayed 22 cases of synchronous malignancies of gallbladder and CBD and 1 case of triple cancer with associated Vater's papilla carcinoma.In most of these cases, an association with an anomalous pancreatic-bile duct junction was reported.Although the real incidence remain unknown, it was reported to occur in 5–10% of CBD cancers.ConclusionSuspicion of such combination of cancer should be remembered, especially when preoperative investigations don't allow a precise localization of tumor in the biliary tree.

S1689 Anomalous Biliary-pancreatic Junction: A Case of Recurrent Pancreatitis and Implicit Bias

Introduction: Implicit bias is defined as the attitudes or stereotypes that unconsciously affect our understanding, actions, and decisions. Physicians must make a concerted attempt not to fall prey to implicit bias as this can lead to differences in the quality of care between patients. We describe a case of implicit bias secondary to a diagnosis of anomalous biliary pancreatic junction (ABPJ). Case Description/Methods: A 50-year-old Hispanic woman with an extensive psychiatric history, polysubstance abuse, and recurrent pancreatitis presented with abdominal pain. Given her history, the etiology of recurrent pancreatitis was deemed to be due to polysubstance abuse. CT abdomen showed a dilated common bile duct, dilated pancreatic duct, and pancreatic calcifications consistent with a history of chronic pancreatitis. Review of previous medical records showed that a prior MRCP had revealed duplication of the biliary ductal system. The medial duct draining the right lobe of the liver, anastomosed with the pancreatic duct to form a common channel that opened into the duodenum. The lateral duct drained the left lobe of the liver and opened it into the duodenum through a separate papilla. Gastroenterology was consulted and a diagnosis of ABPJ was made. Consequently, the patient's episodes of pancreatitis were thought to be secondary to ABPJ. Patient then underwent an ERCP with pancreatic sphincterotomy and stent placement, leading to significant symptom resolution. Discussion: ABPJ is a congenital malformation where the biliary and the pancreatic ducts join outside the wall of the duodenum. Incidence is estimated to be 1.5 – 3.2 % among all patients that undergo an ERCP. Since the function of the duodenal papilla does not traverse the length of the common duct, regurgitation of pancreatic and biliary secretions occurs. In most cases, the pressure in the pancreatic duct is higher, resulting in the reflux of pancreatic juice into the biliary tract and subsequent development of biliary tract malignancy. In a rare minority of cases, bile can reflux into the pancreatic ductal system, causing recurrent pancreatitis. ABPJ is a rare and under-recognized cause of recurrent pancreatitis in the adult population. Often, the diagnosis of ABPJ is overshadowed by the treating physician’s implicit bias due to patient factors such as ethnicity, age, past medical history, etc. A high index of suspicion is required to make an accurate diagnosis leading to prompt intervention, thus avoiding delay in care and associated morbidity.Figure 1.: CT scan showing collection in Gall Bladder fossa.

S1659 A Case of Gallbladder Agenesis and Anomalous Pancreaticobiliary Junction With Chronic Choledocholithiasis and Secondary Biliary Cirrhosis

S1659 A Case of Gallbladder Agenesis and Anomalous Pancreaticobiliary Junction With Chronic Choledocholithiasis and Secondary Biliary Cirrhosis

S1616 Primary Carcinosarcoma of the Gallbladder: An Unfortunate Fate From Anomalous Pancreaticobiliary Junction

S1616 Primary Carcinosarcoma of the Gallbladder: An Unfortunate Fate From Anomalous Pancreaticobiliary Junction

Nadir Bir Konjenital Safra Anomalisi: Pankreatikobiliyer Bilişim Anomalisi

20-year-old female patient was admitted with complaints of girdle-like abdominal pain, nausea and vomiting. A history of pancreatitis 2 years ago was found in the patient’s anamnesis. Physical examination showed tenderness in the epigastric region, other system examinations were normal. In laboratory tests, amylase was found as 1249 ıu/l, lipase was found as 1068 u/l, CRP (C-Reaktif Protein) was found as 49.83mg/l and they were found to be high. Liver function tests, kidney function tests and electrolytes were found to be normal. In the abdomen ultrasonography, pancreas was reported to have increased size and mild edema. The patient was hospitalized with these findings and intravenous fluid replacement was started. Magnetic resonance cholangiopancreatography (MRCP) was performed on the patient whose vital findings were stable. MRCP showed that common bile duct and pancreatic duct were joined at 17 mm proximal from the normal anatomic location. Anomalous pancreaticobiliary junction (APBJ) is a rare congenital anomaly and in recent years its diagnosis frequency has increased due to the widespread use of advanced radiological examinations such as MRCP. The purpose of this case presentation was to present the APBJ that we detected with MRCP in a patient with recurrent pancreatitis attacks.

Secretin-Enhanced MRCP: How and Why-AJR Expert Panel Narrative Review.

Secretin-enhanced MRCP (S-MRCP) has advantages over standard MRCP for imaging of the pancreaticobiliary tree. Through the use of secretin to induce fluid production from the pancreas and leveraging of fluid-sensitive MRCP sequences, S-MRCP facilitates visualization of ductal anatomy, and the findings provide insight into pancreatic function, allowing radiologists to provide additional insight into a range of pancreatic conditions. This narrative review provides detailed information on the practical implementation of S-MRCP, including patient preparation, logistics of secretin administration, and dynamic secretin-enhanced MRCP acquisition. Also discussed are radiologists' interpretation and reporting of S-MRCP examinations, including assessments of dynamic compliance of the main pancreatic duct and of duodenal fluid volume. Established indications for S-MRCP include pancreas divisum, anomalous pancreaticobiliary junction, Santorinicele, Wirsungocele, chronic pancreatitis, main pancreatic duct stenosis, and assessment of complex postoperative anatomy. Equivocal or controversial indications are also described along with an approach to such indications. These indications include acute and recurrent acute pancreatitis, pancreatic exocrine function, sphincter of Oddi dysfunction, and pancreatic neoplasms.

Causes and Countermeasures of Difficult Selective Biliary Cannulation: A Large Sample Size Retrospective Study.

Selective biliary cannulation is a difficult part of endoscopic retrograde cholangiopancreatography (ERCP). Therefore, endoscopists have focused on how to improve the cannulation success rate and reduce the postoperative complication rate. This study aims to provide practical advice on safe operation for endoscopists. Data from the ERCP database of our medical center from January 2008 to December 2017 were retrospectively reviewed. All patients underwent ERCP for the first time. Data pertaining to diseases, anatomic factors, difficult cannulation rates, cannulation success rates, and postoperative complication rates for various assistive cannulation techniques were analyzed by using the Pearson χ2 tests and Fisher exact tests. The difficult cannulation rate was 8.1%. The main influencing factors were benign and malignant biliary stricture, duodenal papillae or ampullary tumors, thick and long duodenal papillae, peridiverticular papillae, ectopic papillae, edematous papillae, ulcerative papillae, anomalous pancreaticobiliary junction, and Billroth II gastrectomy. The postoperative complication rates and overall cannulation success rates of 7 assistive techniques were not statistically different (P>0.05), but the overall complication rates were statistically different (P<0.05). Needle-knife precut sphincterotomy had the highest rate of complications. Benign and malignant biliary stricture, duodenal papillae or ampullary tumors, thick and long duodenal papillae, peridiverticular papillae, ectopic papillae, edematous papillae, ulcerative papillae, anomalous pancreaticobiliary junction, and Billroth II gastrectomy were the main factors of difficult selective biliary cannulation. The overall incidence of needle-knife precut sphincterotomy complications was higher than that of other techniques, but various assistive techniques were safe and effective in our single center.

Frequency of gall bladder carcinoma in cholecystectomies performed for symptomatic cholelithiasis.

It was a Letter to the Editor to find out the frequency of carcinoma gall bladder in patients which were presented with symptomatic cholelithiasis. Carcinoma of the gallbladder is a rear malignancy with 5 year survival rate of 5%. Carcinoma gall bladder is the most common billiary tract malignancy, it is also 5th most common in gastrointestinal malignancies 1. In Pakistan the incidence of carcinoma gallbladder among patients having symptomatic cholelithiasis is 6 to 28%2. Patients with symptomatic gall stones had more risk for developing carcinoma gallbladder as compared to asymptomatic gall stones. Large stones in cholelithiasis are more dangerous than small stones as stone size reaches &gt;3cm risk increases upto 10 fold. Gallbladder polyps &gt;10mm, calcified(porcelain) gallbladder, choledochal cyst, seclerosing cholangitis, anomalous pancreaticobillary junctions and exposure to carcinogens are other risk factors3. Continuous...