Duct Obstruction Research Articles

Abstract B080: A porcine model of pancreatic ductal adenocarcinoma for human scale translational cancer research

Abstract Pancreatic ductal adenocarcinoma (PDAC) remains a highly fatal form of cancer, requiring urgent advancements in diagnostic and therapeutic strategies. Although PDAC mouse models have been crucial in advancing our comprehension of the disease, they present some limitations in replicating key human PDAC aspects. In this study, we present the development of the first large animal model of pancreatic cancer via Cre activatable mutations in the endogenous KRAS and TP53 genes 1,2. In order to activate these mutations in the pancreas, two Cre driver pig lines expressing Cre recombinase from PTF1A 3 and PDX1 were created. Crossing both Cre lines with pigs carrying latent KRAS G12D and TP53 R167H alleles produced double (KC) and triple (KPC) genetically modified animals. Pathological analyses revealed the presence of inter- and intralobular fibrosis with multifocal acinar-to-ductal metaplasia (ADM), some low-grade PanINs, dysplasia, inflammation and duct obstruction in most of the KPC pigs between 3 to 6 months of age. Interestingly, the majority of these pigs already exhibited local metastasis in the lymph nodes, suggesting that the metastatic potential is established early in the tumorigenic process. Age-matched KC pigs exhibited mainly ADM with dysplasia. Flow cytometry and RNA expression analyses of the established pancreatic tumour primary cells revealed a pronounced epithelial-to-mesenchymal transition (EMT). Moreover, both bulk tumour samples and primary tumour cells showed high expression of the pancreatic cancer stem cell marker CD44, with differential expression of its isoforms, including the major isoform and variants 6 and 9. In addition, histological and molecular analyses revealed notable similarities between pig and human PDAC, including molecular subtypes, neuronal invasion and loss of acinar identity. These findings highlight the unique advantage of the pig PDAC model, that allows longitudinal and multi-regional tumour sampling in the absence of any therapeutic interventions. This makes it a valuable tool for developing new diagnostic and therapeutic approaches that can greatly improve patient outcomes in the long run.

Characterizing magnetohydrodynamic effects on developed nanofluid flow in an obstructed vertical duct under constant pressure gradient

Abstract This research endeavors to conduct an examination of the thermal characteristics within the duct filled with the copper nanoparticles and water as base fluid. In exhaust systems, like car exhausts, chimneys, and kitchen hoods, duct flows are crucial. These systems safely discharge odors, smoke, and contaminants into the atmosphere after removing them from enclosed places. The study focuses on a laminar flow regime that is both hydrodynamically and thermally developed, with a specified constraints at any cross-sectional plane. To address this, we employ the finite volume method as it stands as a judicious choice, offering a balance between computational efficiency and solution accuracy. Notably, we have observed that the deceleration of flow induced by elevated Rayleigh numbers can be effectively regulated by the application of an appropriately calibrated external magnetic field. The prime parameters of the problem with ranges are: pressure gradient ( 1 ≤ p 0 ≤ 100 ) (1\le {p}_{0}\le 100) , Hartmann number ( 0 ≤ Ha ≤ 50 ) (0\le \text{Ha}\le 50) , Rayleigh number ( 1 , 000 ≤ Ra ≤ 40 , 000 ) (1,000\le \text{Ra}\le 40,000) , and magnetic parameter ( 0 ≤ M ≤ 50 ) (0\le M\le 50) . Furthermore, our analysis reveals that the Nusselt number exhibits a nearly linear correlation with the nanoparticle volume fraction parameter, a trend observed across a range of Rayleigh numbers and magnetic parameter values. We have noted that a mere 20% nanoparticle volume fraction can result in up to 62% rise in the Nusselt number while causing an almost 50% decrease in the factor f Re. This research framework serves as a robust foundation for understanding the intricate interplay between magnetic influences and thermal-hydraulic behavior within the delineated system.

Azoospermia: Etiology, Diagnosis and Management

Male infertility is on the rise over the past few years, and azoospermia is one of the most common causes. It has two primary subtypes: non-obstructive azoospermia (NOA), where the spermatogenesis is hindered, and obstructive azoospermia (OA), when there appears to be a ductal obstruction while spermatogenesis is normal. Azoospermia is characterised by the absence of sperm in two or more ejaculates. Making the azoospermic man have his own biological child is now becoming a reality with the advent of TESE and ICSI procedures, followed by the latest advancements like the combination of imaging studies, Full-Field Optical Coherence Tomography (FFOCT), stem cell therapy, platelet-rich plasma therapy, and gene therapy, which are emerging as newer tools for effective treatment. The key aim of this article is to highlight the concept of azoospermia and focus on its evaluation and management through present-day developments in andrology and medically assisted reproduction (MAR). A detailed literature review is performed through Pubmed, Science Direct, the Online Library, and Scopus.

Laparoscopic Right Hemi-hepatectomy of the Bile Duct-Obstructed Area Guided by Real-Time Fluorescence Imaging.

The regions of the liver with cholestasis caused by biliary tumors or thrombosis can be distinctly identified using indocyanine green (ICG) fluorescence imaging.1 The authors' team reported the application of bile-duct obstructed area imaging (BOAI) to assist open hepatectomy for intrahepatic cholangiocarcinoma (ICC) combined with intrahepatic bile duct obstruction previously.2 This video is the first report of real-time BOAI-guided three-dimensional (3D) laparoscopic hepatectomy using a 3D-4K fluorescence imaging system. A 65-year-old man was admitted to the authors' institution with clonorchiasis. Preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed an obstruction and diffuse dilation of the right hepatic duct. A 15-min retention of ICG (ICG R15) was performed 5 days before the operation, with a 3.3% result. Preoperative planning involved performing laparoscopic right hemi-hepatectomy with regional lymph node dissection assisted by visualization technology.3 During the procedure, significant fluorescence accumulation in the right liver was shown by fluorescence imaging. With the guidance of real-time BOAI (Fig. 1), the regions of biliary obstruction were precisely resected, and the middle hepatic vein (MHV) was passively and adequately exposed on the cutting plane. Fig. 1 Administration steps for real-time bile duct-obstructed area imaging. A ICG is injected intravenously 3-5 days before operation at a dose of 0.5 mg/kg. B ICG is accumulated in the whole liver within a few minutes after injection. C ICG is selectively absorbed by the liver and excreted into the intestines, whereby it is retained in areas of biliary obstruction RESULTS: The histopathologic diagnosis indicated high-grade intraepithelial neoplasia of the right bile duct tumor without lymph node metastases and clonorchiasis. The duration of the operation was 300 min, with an intraoperative blood loss of 50 ml. No postoperative complications occurred, and the patient was discharged after 7 days. Laparoscopic right hemi-hepatectomy for the bile-duct obstructed area with the guidance of real-time BOAI is feasible and effective.

Pancreatic extracorporeal shock wave lithotripsy: a key technology truly improves treatment model for pancreatic stones

Abstract Chronic pancreatitis (CP) is characterized by irreversible destruction of pancreatic parenchyma, inflammatory cell infiltration and progressive fibrosis of pancreatic tissue. Obstruction of pancreatic duct by pancreatic stone is the common pathological change in the course of CP with the incidence of over 50 % at the diagnosis of CP. These ductal stones would cause pancreatic parenchymal hypertension and local ischemia, which was eventually followed by recurrent episodes of painful pancreatitis or other manifestations of pancreatic exocrine and endocrine insufficiency. Removing pancreatic stones has been confirmed as the core to reduce pressure, improve drainage and lessen pain. Surgical therapy achieves satisfying pain relief with more complications, higher cost and less repeatability compared with endoscopic therapy. Endoscopic retrograde cholangiopancreatography, which used to be the standard endoscopic therapy for pancreatic stones, would fail if these stones are large or complex, while pancreatic extracorporeal shock wave lithotripsy (P-ESWL), which has been applied since 1987, could overcome this problem. Up to now, a large number of guidelines have recommended the P-ESWL as the first-line treatment strategy for radiopaque obstructive main pancreatic duct stones larger than 5 mm located in the head/body of the pancreas, and P-ESWL had completely changed the traditional treatment model for CP patients with pancreatic stones. In this article, we will focus on the technical progress, efficacy, safety and potential research areas of P-ESWL, we also give us suggestions for lithotripters improvement.

Steering through parotid calculi in a 35 year old female: A case report

Sialolithiasis, the predominant affliction affecting salivary glands, constitutes approximately half of all major salivary gland pathologies. The vast majority of salivary gland calculi, roughly 80-90%, are located in the submandibular gland, with 5-10% in the parotid gland, and an estimated 0-5% in the sublingual and other minor salivary glands. Typically, sialolithiasis manifests in adults between the ages of 30 and 60, with a greater occurrence in males. This malady is predominantly observed in adults and is infrequent in children. Herein, we present a case study of calculus retrieval in a 35-year-old woman, characterized by recurrent swelling and pain in the left parotid gland, exacerbated during meals due to ductal obstruction impeding saliva flow. This hindrance impedes gland drainage, resulting in inflamed ducts. Sialadenitis subsided following calculus removal.

Hydrogen explosion characteristics in the obstructed chamber by changing blockage ratio among adjacent obstacles

Using the experimental and large eddy simulation (LES) methods, the impacts of equivalence ratio and adjacent obstacle blockage ratio on flame propagation, flame moving velocity, and explosion overpressure in a closed obstructed duct are investigated. The results indicate that the developed LES method is able to reproduce the tendency of flame propagation, flame moving velocity, and explosion overpressure of BR = 30%, 50%, 70% and BR = 70%, 50%, 30%. The early flame propagation and flame moving velocity are not affected by the first obstacle. As the explosion flame passes through the three obstacles, the flame acceleration and deceleration occur in sequence due to the decreasing cross-section and vortex-flame interaction, eventually forming three ascending peak flame moving velocity. The higher vorticity magnitude of BR = 70%, 50%, 30% and BR = 30%, 50%, 70% is mainly concentrated in the early stage and later stage of hydrogen explosion, which directly results in the fact that the flame acceleration and rise rate of explosion overpressure of BR = 70%, 50%, 30% is higher than that of BR = 30%, 50%, 70%. Additionally, the maximum value of flame moving velocity and explosion overpressure of BR = 30%, 50%, 70% is higher than that of BR = 70%, 50%, 30%.

Submandibular Gland Pathogenesis Following SARS-CoV-2 Infection and Implications for Xerostomia.

Although SARS-CoV-2 induces mucin hypersecretion in the respiratory tract, hyposalivation/xerostomia has been reported by COVID-19 patients. We evaluate the submandibular gland (SMGs) pathogenesis in SARS-CoV-2-infected K18-hACE2 mice, focusing on the impact of infection on the mucin production and structural integrity of acini, ductal system, myoepithelial cells (MECs) and telocytes. The spike protein, the nucleocapsid protein, hACE2, actin, EGF, TNF-α and IL-1β were detected by immunofluorescence, and the Egfr and Muc5b expression was evaluated. In the infected animals, significant acinar hypertrophy was observed in contrast to ductal atrophy. Nucleocapsid proteins and/or viral particles were detected in the SMG cells, mainly in the nuclear membrane-derived vesicles, confirming the nuclear role in the viral formation. The acinar cells showed intense TNF-α and IL-1β immunoexpression, and the EGF-EGFR signaling increased, together with Muc5b upregulation. This finding explains mucin hypersecretion and acinar hypertrophy, which compress the ducts. Dying MECs and actin reduction were also observed, indicating failure of contraction and acinar support, favoring acinar hypertrophy. Viral assembly was found in the dying telocytes, pointing to these intercommunicating cells as viral transmitters in SMGs. Therefore, EGF-EGFR-induced mucin hypersecretion was triggered by SARS-CoV-2 in acinar cells, likely mediated by cytokines. The damage to telocytes and MECs may have favored the acinar hypertrophy, leading to ductal obstruction, explaining xerostomia in COVID-19 patients. Thus, acinar cells, telocytes and MECs may be viral targets, which favor replication and cell-to-cell viral transmission in the SMG, corroborating the high viral load in saliva of infected individuals.

Increased ERCP-related adverse event from premature urgent ERCP following symptom onset in acute biliary pancreatitis with cholangitis

Acute biliary pancreatitis (ABP) with cholangitis requires endoscopic retrograde cholangiopancreatography (ERCP) within 24 h to resolve ductal obstruction. However, this recommendation is based on the timing of emergency room (ER) visits. We wanted to determine the optimal timing of ERCP for ABP based on the timing of symptom onset, not the timing of the ER visit. We retrospectively reviewed 162 patients with ABP with cholangitis who underwent urgent ERCP (within 24 h of ER admission). Area under the receiver operating characteristic (ROC) curve (AUC) was analyzed to determine differences in complication rates according to time from symptom onset. A difference in ERCP-related adverse events (AEs) was identified, and Youden’s J statistic was used to determine a cutoff time from symptom onset (18 h). We compared mortality and complications based on this cutoff. Based on time to symptom onset, significantly higher rates of aspiration pneumonia (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.15–13.92, P = 0.021) and post-ERCP hypotension (OR 11.9, 95% CI 1.39–101.33, P = 0.005) were observed in the ≤ 18-h group than in the > 18-h group. The study found that patients who underwent ERCP within 18 h of symptom onset is associated with an increased risk of ERCP-related AEs.

A novel 3D-printed pancreaticojejunostomy device containing nano-silver antibacterial coating prevents infection and pipe clogging after pancreatic surgery

The pancreaticojejunostomy device is an exogenous object positioned at the junction between the jejunum and the pancreatic duct. Bacteria can readily settle on its surface, forming a biofilm, potentially leading to inflammation at the anastomotic site, resulting in overgrowth and narrowing of the anastomosis. Furthermore, biofilm formation on the inner surface of the lumen can obstruct the outflow duct of pancreatic fluid. This study aims to develop an innovative 3D pancreaticojejunostomy device coated with nano-silver for antibacterial properties. Chitosan serves as the coating medium, loaded with nano-silver particles. The presence of nano-silver in the coating is confirmed by observing its surface morphology and elemental composition and examining drug release patterns via inductively coupled plasma (ICP) analysis. Moreover, we validated its biocompatibility, antibacterial performance, and pancreas toxicity through in vitro and in vivo experiments. The results affirm the successful fabrication of this pancreaticojejunostomy device, highlighting its nano-silver coating and its antibacterial efficacy, as well as its satisfactory in vivo and in vitro biocompatibility and drug release capabilities. To sum up, this antibacterial 3D pancreaticojejunostomy device is promising to prevent infections and inflammatory reactions around the site and duct obstruction caused by bacterial biofilms.

An NCDB analysis of the predictive factors associated with the receival of tumor resection in mucinous cystadenoma of the pancreas.

e16356 Background: Mucinous cystadenoma (MCN) of the pancreas is characterized by mucin-producing cystic tumors that may lead to pancreatic ductal obstruction. While many of these cystic lesions are benign, there exists a notable risk for malignancy. Presently, the standard approach to managing MCN involves surveillance. Surgical resection is considered after evaluating histological features, the patient's age, surgical risk, and tumor size. Previous studies have linked surgical resection to favorable overall outcomes. However, no studies have investigated the predictive factors correlated to receiving surgery in MCN patients. This study aims to utilize the National Cancer Database (NCDB) to analyze factors that determine receival of tumor resection in patients with MCN of the pancreas. Methods: The NCDB was used to identify patients diagnosed with MCN of the pancreas from 2004 to 2019 using the histology codes 8470 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Multilevel Logistic Regression were performed, and data were analyzed using SPSS version 27. Statistical significance was set at α = 0.05. Results: 827 patients with MCN of the pancreas formed the initial sample. 552 patients received a tumor resection whereas 274 patients did not receive surgery ( 66.7% vs 33.1%, respectively). Surgical patients experienced significantly longer overall survival than nonsurgical patients ( 111.2 months vs. 20.1 months, p < 0.001). Complete tumor resection with no residual tumor cells was associated with improved outcomes in MCN( p < 0.001). Metastasis to distant sites was associated with decreased likelihood of receiving surgery ( p < 0.001). Well and moderately differentiated disease, stage I, II, and II disease, treatment at an academic facility, and private insurance status were associated with increased likelihood of receiving tumor resection ( p < 0.001). Income status and race did not appear to impact overall survival of these patients. Adjuvant therapies did not appear to impact overall survival of these patients. Conclusions: The results of this research align with other studies, affirming that surgical resection yields superior outcomes in patients with MCN of the pancreas. Factors such as well or moderately differentiated disease, early-stage diagnosis, treatment at academic facilities, and private insurance status increased the likelihood of tumor resection. Distant metastasis reduced the likelihood of receiving surgery. Complete tumor removal without presence of residual tumor cells post-surgery is correlated with improved survival. Income status and race did not appear to impact overall survival, and adjuvant therapies showed no discernible effect. To improve current treatment protocols for patients with MCN of the pancreas, more research needs to be conducted on the predictive factors of receiving surgery.

1. Medical Management of Pancreatitis Pain

Chronic pain is the most distressing feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). Pain can arise from injury, inflammation, obstruction of ducts, neuritis, and/or inherent problems with pain processing and tolerance in the brain and nervous system. Professor Singh provides expert guidance on how he approaches patients with chronic pancreatic pain.

Holmium Laser Incision of Ejaculatory Duct (HoLIED): Surgical Procedure

Introduction: Ejaculatory duct obstruction is a well-known cause of infertility and many other symptoms, such as hematospermia and lower urinary tract symptoms. Diagnosis is made based on the medical history and a series of imaging tests identifying the obstructed ducts. Transurethral resection of the ejaculatory ducts is the mainstay treatment to release the obstruction. In this step-by-step surgical video, we will describe a novel technique using the holmium laser to incise the ejaculatory ducts in a patient with chronic lower urinary tract symptoms, hematospermia, and persistent urethral discharge. Materials and Methods: A pelvic MRI was obtained in workup of the above issues and identified a complex ejaculatory duct cyst. The patient consented for Holmium Laser Incision of Ejaculatory Duct. A holmium laser fiber was used through a 24F rigid cystoscope to unroof the ejaculatory duct cyst, resulting in the drainage of a dark brown fluid. Following unroofing of the cyst, the ejaculatory ducts were identified using a 17F rigid cystoscope and a 16F Foley catheter was inserted. Results: The Foley catheter was removed on POD1, and the patient was able to void. His symptoms improved progressively with time and antibiotics. A repeat MRI was obtained several months postoperatively and showed the resolution of the cystic lesion. Conclusion: Holmium Laser Incision of Ejaculatory Duct is safe and feasible procedure allowing to treat ejaculatory duct obstruction without increased risk of complications.

Toll-like receptor 4 in pancreatic damage and immune infiltration in acute pancreatitis.

Acute pancreatitis is a complex inflammatory disease resulting in extreme pain and can result in significant morbidity and mortality. It can be caused by several factors ranging from genetics, alcohol use, gall stones, and ductal obstruction caused by calcification or neutrophil extracellular traps. Acute pancreatitis is also characterized by immune cell infiltration of neutrophils and M1 macrophages. Toll-like receptor 4 (TLR4) is a pattern recognition receptor that has been noted to respond to endogenous ligands such as high mobility group box 1 (HMGB1) protein and or exogenous ligands such as lipopolysaccharide both of which can be present during the progression of acute pancreatitis. This receptor can be found on a variety of cell types from endothelial cells to resident and infiltrating immune cells leading to production of pro-inflammatory cytokines as well as immune cell activation and maturation resulting in the furthering of pancreatic damage during acute pancreatitis. In this review we will address the various mechanisms mediated by TLR4 in the advancement of acute pancreatitis and how targeting this receptor could lead to improved outcomes for patients suffering from this condition.

Partial facial paralysis induced by sialolithiasis of the parotid gland: a case report

BackgroundFacial paralysis due to parotid sialolithiasis-induced parotitis is a unusual clinical phenomenon that has not been reported in prior literature. This scenario can present a diagnostic challenge due to its rarity and complex symptomatology, particularly if a patient has other potential contributing factors such as facial trauma or bilateral forehead botox injections as in this patient. This case report elucidates such a complex presentation, aiming to increase awareness and promote timely recognition among clinicians.Case presentationA 56-year-old male, with a medical history significant for hyperlipidemia, recurrent parotitis secondary to parotid sialolithiasis, and recent bilateral forehead cosmetic Botox injections presented to the emergency department with right lower facial drooping. This onset was about an hour after waking up and was of 4 h duration. The patient also had a history of a recent ground level fall four days prior that resulted in facial trauma to his right eyebrow without any evident neurological deficits in the region of the injury. A thorough neurological exam revealed sensory and motor deficits across the entirety of the right face, indicating a potential lesion affecting the buccal and marginal mandibular branches of the facial nerve (CN VII). Several differential diagnoses were considered for the lower motor neuron lesion, including soft tissue trauma or swelling from the recent fall, compression due to the known parotid stone, stroke, and complex migraines. An MRI of the brain was conducted to rule out a stroke, with no significant findings. A subsequent CT scan of the neck revealed an obstructed and dilated right Stensen's duct with a noticeably larger and anteriorly displaced sialolith and evidence of parotid gland inflammation. A final diagnosis of facial palsy due to parotitis secondary to sialolithiasis was made. The patient was discharged and later scheduled for a procedure to remove the sialolith which resolved his facial paralysis.ConclusionsThis case emphasizes the need for a comprehensive approach to the differential diagnosis in presentations of facial palsy. It underscores the potential involvement of parotid sialolithiasis, particularly in patients with a history of recurrent parotitis or facial trauma. Prompt recognition of such uncommon presentations can prevent undue interventions, aid in timely appropriate management, and significantly contribute to the patient's recovery and prevention of long-term complications.

Exploring the variations of the pancreatic ductal system: a systematic review and meta-analysis of observational studies.

The exocrine part of the pancreas has a duct system called the pancreatic ductal system (PDS). Its mechanism of development is complex, and any reorganization during early embryogenesis can give rise to anatomical variants. The aim of this study is to collect, classify, and analyze published evidence on the importance of anatomical variants of the PDS, addressing gaps in our understanding of such variations. The MEDLINE, Web of Science, Embase, and Google Scholar databases were searched to identify publications relevant to this review. R studio with meta-package was used for data extraction, risk of bias estimation, and statistical analysis. A total of 64 studies out of 1,778 proved suitable for this review and metanalysis. The meta-analysis computed the prevalence of normal variants of the PDS (92% of 10,514 subjects). Type 3 variants and "descending" subtypes of the main pancreatic duct (MPD) predominated in the pooled samples. The mean lengths of the MPD and accessory pancreatic duct (APD) were 16.53 cm and 3.36 cm, respectively. The mean diameters of the MPD at the head and the APD were 3.43 mm and 1.69 mm, respectively. The APD was present in only 41% of samples, and the long type predominated. The pancreatic ductal anatomy is highly variable, and the incorrect identification of variants may be challenging for surgeons during ductal anastomosis with gut, failure to which may often cause ductal obstruction or pseudocysts formation.

Effects of nasal desmopressin spray versus topical epinephrine on surgical field clarity and hemodynamics in endonasal dacryocystorhinostomy: a randomized clinical study

Background A bloodless surgical field coupled with stable hemodynamics is pivotal for successful surgical intervention, especially in endonasal surgeries. This study investigates the effect of intranasal desmopressin spray in reducing surgical bleeding and on hemodynamics compared with topical epinephrine in patients scheduled for endonasal dacryocystorhinostomy (DCR). Methods Fifty-two patients were randomly allocated into two groups in this double-blind clinical study: Desmopressin group (n=26): patients received two puffs of desmopressin acetate 10 μg/puff in the side of the nasal cavity ipsilateral to the obstructed lacrimal duct (20 µg totally) 60 min before the surgery. Epinephrine group (n=26): patients received topical 1 : 100 000 epinephrine in the nasal cavity ipsilateral to the obstructed lacrimal duct via 3 soaked packs placed in the middle meatus for 5 min after induction of general anesthesia and before the start of surgery. Results The median clarity of the surgical field based on the BOEZAART grading system was significantly clearer in the desmopressin group compared with epinephrine group. The duration of surgery was significantly shorter in the desmopressin group (66.92±5.04 min) compared with epinephrine group (71.73±5.45 min). Mean arterial blood pressure (MABP) and heart rate (HR) were statistically significant higher in epinephrine group compared to the desmopressin group at 2 and 5 min after topical epinephrine compared with desmopressin group. Conclusion Pre-emptive 20 ug single dose of intranasal desmopressin provides a clear surgical field with no hemodynamics effects compared with topical epinephrine in patients undergoing endonasal dacryocystorhinostomy. Clinicaltrial.gov (ref: NCT05507476, date of registration: 18-8–2022).

Efficacy Analysis of Physical Therapy in Treating Chronic Prostatitis: Unblocking Obstructed Glandular Ducts Could Be a Novel Treatment Strategy.

This study investigates the efficacy of physical therapy in treating chronic prostatitis grounded on the glandular duct blockage theory. The study includes patients who were diagnosed and treated for chronic prostatitis between November 2022 and July 2023 at Renhui clinic in Jiangmen, Guangdong and Renhui frontline clinic in Shenzhen Guangdong. The recorded data includes the frequency of physical therapies including prostate massages, rectal probe high-frequency vibration treatment, and low-intensity extracorporeal shockwave therapy (Li-ESWT). Post-treatment urine sediment was collected for microscopic examination, and the scores of each patient on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the Premature Ejaculation Diagnostic Tool (PEDT) were recorded pre- and post-treatment in order to calculate the effectiveness rate. The study involved a total of 48 patients, of which 26 were diagnosed with premature ejaculation. On average, each patient received 2.1 prostate massages, underwent 4.1 rectal probe high-frequency vibration treatments, and 8.3 Li-ESWT sessions. Following treatment, the initial microscopic examination of the urine sediment revealed aged white blood cell clusters, prostate calculi clusters, and inactive sperm clusters, all appearing in the shape of glandular tubes. The mean NIH-CPSI scores pre- and post-treatment were 27.2±6.9 and 18.0±6.6, respectively, indicating an effectiveness rate of 81.3%. The average PEDT scores pre- and post-treatment were 14.5±3.5 and 10.5±4.2, respectively, with an effectiveness rate of 53.8%. Unblocking obstructed glandular ducts might provide a novel therapeutic strategy for treating chronic prostatitis.

Drug-Induced Parotitis—A Rarity?

Abstract Unilateral parotitis is due to ductal obstruction. Bilateral parotitis occurs due to viral infections such as mumps, bacterial infections, Sjögren syndrome, and ductal obstruction. Drug-induced parotitis is a relatively uncommon adverse reaction, and it can be unilateral and bilateral. Unilateral causes of drug-induced parotitis can be due to clozapine, chlorpromazine, l-asparaginase, and α-methyldopa, whereas bilateral causes can be due to thioridazine, sulfadiazine, phenylbutazone, oxyphenylbutazone, nitrofurantoin, and valproic acid. Adverse reactions to sulfonamide are rare and manifest as rashes or urticaria. Herein, we report a case of acute unilateral parotitis occurring as a result of cotrimoxazole that resolved within 48 hours after discontinuation of therapy, which highlights that sulfonamide therapy can cause parotitis. Early clinical suspicion and discontinuation of therapy help in the prompt resolution of the allergic reaction to cotrimoxazole.

Metformin Attenuates TGF-β1-Induced Fibrosis in Salivary Gland: A Preliminary Study.

Fibrosis commonly arises from salivary gland injuries induced by factors such as inflammation, ductal obstruction, radiation, aging, and autoimmunity, leading to glandular atrophy and functional impairment. However, effective treatments for these injuries remain elusive. Transforming growth factor-beta 1 (TGF-β1) is fundamental in fibrosis, advancing fibroblast differentiation into myofibroblasts and enhancing the extracellular matrix in the salivary gland. The involvement of the SMAD pathway and reactive oxygen species (ROS) in this context has been postulated. Metformin, a type 2 diabetes mellitus (T2DM) medication, has been noted for its potent anti-fibrotic effects. Through human samples, primary salivary gland fibroblasts, and a rat model, this study explored metformin's anti-fibrotic properties. Elevated levels of TGF-β1 (p < 0.01) and alpha-smooth muscle actin (α-SMA) (p < 0.01) were observed in human sialadenitis samples. The analysis showed that metformin attenuates TGF-β1-induced fibrosis by inhibiting SMAD phosphorylation (p < 0.01) through adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)-independent pathways and activating the AMPK pathway, consequently suppressing NADPH oxidase 4 (NOX4) (p < 0.01), a main ROS producer. Moreover, in rats, metformin not only reduced glandular fibrosis post-ductal ligation but also protected acinar cells from ligation-induced injuries, thereby normalizing the levels of aquaporin 5 (AQP5) (p < 0.05). Overall, this study underscores the potential of metformin as a promising therapeutic option for salivary gland fibrosis.