Juice Leakage Research Articles

Identification of a pancreatic juice-specific fluorescent probe through 411 probes activated by aminopeptidases/proteases or phosphatases/phosphodiesterases

BackgroundThis study is a retrospective review aimed to identify pancreatic juice-specific fluorescent probes to visualize pancreatic juice using a library of 381 aminopeptidase/protease-activatable fluorescent probes and 30 phosphatase/phosphodiesterase probes. In 2013, we developed a fluorescence imaging technique using a chymotrypsin probe to visualize pancreatic juice, linked to postoperative pancreatic fistula (POPF). This probe required addition of trypsin to convert pancreatic chymotrypsinogen to chymotrypsin. Recently we accessed libraries of enzyme-activatable fluorescent probes to find specific probes that facilitated target-specific imaging. MethodsPancreatic juice and ascitic fluid samples were collected in eight patients undergoing pancreaticoduodenectomy. Reaction rates of pancreatic juice to background ascitic fluids were calculated for these 411 fluorescent probes. ResultsForty-four fluorescent probes were screened in terms of high reactivity with pancreatic juice. Only one candidate probe targeting ectonucleotide pyrophosphatase/phosphodiesterase (ENPP) 1 was selected for a pancreatic juice-specific fluorescent probe. Inhibitor experiments and Western blotting supported the presence of ENPP1 in the pancreatic juice. ConclusionsENPP1-targeting fluorescent probe may have the potential to visualize pancreatic juice leakage during surgery. This finding may allow surgeons to suture close leaking sites and decide the necessity of prophylactic abdominal drains; however, the role of ENPP1 in pancreatic juice remains to be clarified.

Rate And Grade of Postoperative Pancreatic Fistula After Modified Blumgart Pancreaticojejunostomy in Pancreaticoduodenectomy

Introduction: Pancreaticoduodenectomy (PD), commonly known as the Whipple procedure, is the standard surgical approach for treating pancreatic and periampullary cancers. Despite advancements in surgical techniques, postoperative pancreatic fistula (POPF) remains one of the most significant complications following PD, contributing to increased morbidity. This study aims to evaluate the development and severity of POPF in patients undergoing PD with the Modified Blumgart Pancreaticojejunostomy. Methods: This Cross-sectional Observational study was carried out among the indoor patients of surgery units in Dhaka Medical College & Hospital, Dhaka, from January 2023 to December 2023. All patients who experienced Pancreatoduodenectomy in the Surgery department of Dhaka Medical College & Hospital during the study period were considered as the study population. A total of 30 patients were selected as study subjects by purposive sampling technique. Consent from patients and relevant authorities was taken. Univariate and multivariate analysis of the data was carried out using a statistical analysis software program. Descriptive analysis of continuous variables was carried out and showed as the means ± SD. Result: This study involved 30 patients, with the majority (36.6%) aged between 40-50 years and male predominance (63.3%). Most patients (50%) were diagnosed preoperatively with periampullary carcinoma, followed by pancreatic carcinoma (40%). Postoperative pancreatic fistula occurred in 13.3% of patients, with the majority (75%) being Grade B fistulas, and 25% classified as Grade A. No Grade C fistulas were observed. Conclusion: Placing sutures between the pancreatic tissue and the jejunum carries a risk of pancreatic juice leakage due to needle holes or injury to the pancreatic tissue, particularly in patients with a soft pancreas. Therefore, this study suggests that an anastomosis technique utilizing fewer sutures may be more advantageous. The original Blumgart anastomosis employed four to six trans pancreatic/jejunal seromuscular sutures, whereas our approach utilized only one to three. Additionally, the modified Blumgart technique ensured complete coverage of the pancreatic stump with jejunal serosa through the modified lateral suture that penetrates the seromuscular layer of the jejunum

Treatment and Prognosis for Pancreatic Duct Disruption Associated With Pancreatic Cancer: A Case Series of 15 Patients.

Background Pancreatic duct (PD) disruption can occasionally be attributed to pancreatic cancer. Therapeutic interventions for PD disruption due to pancreatic cancer and their influence on pancreatic cancer prognosis remain unclear. This study investigated the therapeutic modalities and prognostic implications of PD disruption in pancreatic cancer. Methods This retrospective study included 15 patients with PD disruption concomitant with pancreatic cancer between April 2011 and March 2023. As an endoscopic intervention for PD disruption, endoscopic pancreatic stenting (EPS) or endoscopic ultrasonography-guided pancreatic fluid collection drainage (EUS-PFD) was performed. Technical success was defined as stent placement and clinical success was defined as an improvement in PD disruption. Results Of the 15 cases of PD disruption, two involved only pancreatic juice leakage without symptoms, four involved pancreatic pseudocyst (PPC) without infection, and nine involved PPC with infection. Four patients underwent EPS, nine underwent EUS-PFD, and two underwent lumen-apposing metal stent placement. All patients achieved both technical and clinical success without complications. The clinical stage of pancreatic cancer ranged from carcinoma in situ to the metastatic phase. For the treatment of pancreatic cancer, five patients underwent surgical resection, and eight underwent chemotherapy. There was no obvious recurrence of peritoneal sowing. The median overall survival from the diagnosis of pancreatic cancer in the resected and non-resected cases was 74 and 9.6 months, respectively. Conclusion Endoscopic intervention was effective in all cases of PD disruption due to pancreatic cancer. Furthermore, even in cases of pancreatic cancer after PD disruption, survival rates were similar to those in cases without PD disruption and were achieved through surgical resection or chemotherapy.

The potential of calcium nanoparticles in posthaverst conservation of fresh-cut seedless watermelon (Citrullus lanatus)

In fresh cut (FC) watermelon, texture loss on the flesh leads to tissue softening and greater water soaking, reducing the shelf life. This study was assessed the effect of calcium nanoparticles (NP) [CaO-NP and Ca(OH)2-NP] at three concentrations (100, 150, and 200 mg L−1) compared to control (water) and CaCl2 (1 %, w/v), on FC seedless watermelon. Treatments were applied by 3-min immersion and stored for 12 d at 5 ± 1 °C. Quality, oxidative stress and softening variables were determined every four days. The postharvest quality variables for all treatments were subjected to principal component analysis (PCA), followed by cluster analysis, using the first three dimensions obtained from PCA (explaining 71.68 %). The PCA results showed that visual quality (VQ) was the most influential variable. The treatments with Ca(OH)2-NP positively affected FC watermelon while the treatments with CaO-NP showed a negative correlation. Furthermore, the PCA analysis showed a negative correlation between visual quality and the variables juice leakage (JL) and weight loss (WL). Cluster analysis showed that Ca(OH)2-NP treatments at 8 and 12 d were globally closer to the control at 0 d followed by all treatments applied at 4 d of storage. In general, positive effects were observed in the FC seedless watermelon treated with 100 and 150 mg L−1 Ca(OH)2-NP, compared to the FC seedless watermelon treated with CaO-NP in the same concentrations, in the parameters of water soaking, lipid peroxidation and in the PME activity after 12 d of storage. FC seedless watermelon treated with 100, 150 and 200 mg L−1 Ca(OH)2-NP showed 2.2, 4.4 and 3.2 times less water soaking, respectively, compared to the values observed in the same concentrations of CaO-NP. A similar trend was observed in the values of lipid peroxidation parameters and PME activity, where 2.5, 3.2 and 2.7 times less lipid peroxidation and 1.2, 1.4 and 1.8 times lower PME activity were observed. No differences were detected in CAT and POD activities between CaO-NP and Ca(OH)2-NP treatments. In general, the best quality results were obtained in the FC seedless watermelon fruit treated with the different concentrations of Ca(OH)2-NP.

Application of active and environment-friendly poly (3-hydroxybutyrate)/grapeseed oil/MgO nanocomposite packaging for prolonging the shelf-life of cherry tomatoes (Solanum lycopersicum L. var.cerasiforme)

Active packaging is one of the emerging technologies for maintaining the safety and quality of fresh produce. This work assessed the effectiveness of an active and eco-friendly poly (3-hydroxybutyrate) (PHB) based film loaded with 5 wt% grapeseed oil (GS) and 0.7 wt% MgO nanoparticles (MgO NPs) prepared via sonication-assisted solution casting route for storage and handling of the cherry tomatoes. The shelf-life study of cherry tomatoes in active (PHB/5GS/0.7MgO) packaging was carried out for 23 days in ambient room conditions, and results are compared with the storage of cherry tomatoes without packaging (control), in low-density polyethylene (LDPE) packaging, and in PHB packaging. Various parameters, viz. Visual appearance, weight loss, firmness, total soluble solids (TSS), titratable acidity (TA), ripening index, pH, color, and organoleptic factors, were evaluated every 3 days for cherry tomatoes in various storage groups. The results from the shelf-life study clearly showed that the cherry tomatoes stored in PHB/5GS/0.7MgO packaging experienced better preservation of quality than those in other storage groups, with no signs of surface wrinkling, shrinkage, microbial growth, or juice leakage till day 21 of their storage. This was further evidenced by minimal weight loss (4.45 ± 0.06% on day 21), minimal change in titratable acidity (0.74 ± 0.01% on day 0–0.67 ± 0.01% on day 21), and better retention of firmness (19.89 ± 0.12 N on day 0–15.77 ± 0.37 N on day 21), pH, color, and organoleptic attributes for the cherry tomatoes stored in this packaging group. Furthermore, it was found that the migration of MgO NPs from the nanocomposite packaging to cherry tomatoes was negligible. These findings suggest that the PHB/5GS/0.7MgO nanocomposite film is a promising choice for the storage of cherry tomatoes.

Quality and shelf life of fresh-cut pineapple (Ananas comosus) coated with aloe vera and honey in the refrigerated condition

This research work aimed to investigate the effects of different concentrations of Aloe vera gel (50%, 75%, and 100%) and honey (25%, 50%, and 100%) on the physicochemical changes in fresh-cut pineapple stored at 4 °C. The pineapple pieces were prepared by washing and cutting them into 2 cm sections, followed by coating them with the Aloe vera and honey solutions for 2 min. Subsequently, the samples were stored at 4 °C for duration of 12 days. During the storage period, various parameters such as juice leakage, firmness, pH, total soluble solids, vitamin C content, colour, and microbial load were monitored. Additionally, sensory testing was conducted to evaluate the acceptability of the treated samples. The findings revealed significant differences in weight loss, vitamin C content, colour, flavor, and textural properties between the treated samples and the control group throughout the entire 12-day storage period. Among the different treatments, the application of 100% Aloe vera gel exhibited the highest effectiveness in preventing physicochemical changes and extending the shelf life of fresh-cut pineapple where as honey shows the opposite. Notably, the sample coated with 100% Aloe vera showed the highest vitamin C content (27.35 mg/100 g) at the end of the storage period where as 100% honey shows the second position. Based on the results, this study concludes that Aloe vera gel can be utilized as an efficient coating material to mitigate physicochemical and microbial changes in fresh-cut pineapple during refrigerated storage. The findings highlight the potential of Aloe vera gel is more effective then honey in every ways in preserving the quality and extending the shelf life of fresh-cut fruits, providing opportunities for practical applications in the food industry.

Efficacy and safety of tazobactam/ceftolozane in combination with metronidazole for intraabdominal infection in a hepato-biliary-pancreatic field in clinical practice

IntroductionThis single-center study evaluated the efficacy and safety of tazobactam/ceftolozane (TAZ/CTLZ) in combination with metronidazole for intraabdominal infection in a hepato-biliary-pancreatic field in clinical practice. MethodsThis study included 50 patients, including 35 with intraabdominal abscess or peritonitis, 5 with liver abscess, 4 with cholecystitis, and 6 with cholangitis with sepsis. Of the 50 patients, 29 received TAZ/CTLZ and metronidazole after a prior antibacterial therapy failure, including tazobactam/piperacillin, cefmetazole, and levofloxacin. Source control was performed in 36 patients. ResultsThe clinical response could be evaluated in 49 patients. The clinical cure rate at end-of-therapy was 91.8% (45 of 49 patients) and that at test-of-cure was 89.6% (43 of 48 patients). Of 5 patients in whom clinical response at test-of-cure was a failure, 1 developed infectious disease during chemoradiotherapy for recurrent cancer and 4 after liver resection or pancreatoduodenectomy. Three of the 4 patients were associated with pancreatic juice leakage. Isolated pathogens were eradicated or presumably eradicated in 27 of 31 (87.1%) patients in whom microbiological response at test-of-cure could be evaluated. The response rate for AmpC-producing Enterobacteriaceae was 87.5%. Nausea was observed in two patients. Aspartate and alanine aminotransferase activities were increased in 3 of the 50 (6.0%) patients. The activities improved after the antibiotic discontinuation. ConclusionsThis observational study demonstrated that TAZ/CTLZ in combination with metronidazole has a favorable effect without major drug-related adverse events for intraabdominal infection in the hepato-biliary-pancreatic field in clinical practice although the efficacy of TAZ/CTLZ may decrease in compromised patients.

Laparoscopic-assisted robotic distal gastrectomy for gastric cancer by Billroth II reconstruction.

There are several reconstructions in distal gastrectomy for gastric cancer, and there is no clear definition regarding the method selection. The optimal reconstruction is likely to vary according to the surgical setting, and the optimal reconstruction for robotic distal gastrectomy is urgently needed. In addition, as robotic gastrectomy is getting popular, cost and operative time are pressing issues of robotic gastrectomy. Gastrojejunostomy was planned with Billroth II reconstruction using a linear stapler arranged specifically for a robotic approach. After firing the stapler, the common insertion orifice of the stapler was closed using a 30 cm long non-absorbable barbed suture, and continuously, the afferent loop of the jejunum was lifted to the stomach with the same barbed suture. In addition, we introduced laparoscopic-assisted robotic gastrectomy, using extracorporeally inserted laparoscopic devices from the assistant port. Scissors, clips, and linear staplers were all laparoscopic tools inserted extracorporeally. Twenty-one gastric cancer patients underwent laparoscopic-assisted robotic distal gastrectomy by Billroth II reconstruction with our modifications. There were no anastomosis-related complications such as leakage, stenosis, or bleeding. There were 2 cases of aspiration pneumonia (Clavien-Dindo grade 2), 1 case of pancreatic juice leakage (grade 3a), and 1 case of delayed gastric emptying (grade 1). We successfully arranged Billroth II reconstruction for robotic distal gastrectomy with fewer operative and postoperative complications. Laparoscopic-assisted robotic gastrectomy using extracorporeally inserted devices, and continuous suturing using a barbed suture will reduce the time and cost of robotic gastrectomy.

ВRIEF POMOLOGICAL CHARACTERISTIC OF THREATENED FROM EXTINCTION LOCAL SWEET CHERRY CULTIVARS AND SOME FORMS OF UNIDENTIFIED ORIGIN

A brief pomological description of the sweet cherry cultivars ‘Pobeda’, ‘Kyustendilska Chrustyalka’, ‘Cherna Konyavska’ and ‘Mizia’, created in the early periods of the selection activity at the Institute of Agriculture in Kyustendil (50s - 70s of the last century) was made. Due to their low spread in the past already these cultivars are threatened with loss. All of them are characterized by large to very large, extremely tasty and firm fruits and have very good transportability. Some local forms of cherries of unknown origin, found as a result of scientific expeditions in the mountainous regions of Kyustendil district are also described. The fruit of ‘Pobeda’ and ‘Cherna Konyavska’ are easily detached from the stalks, without tearing and juice leakage, which makes them suitable for mechanized harvesting. The fruit of ‘Mizia’ have a very high resistance to mechanical pressure and are suitable for transportation. Most of the forms of unknown origin have medium to large fruits, whose diameter varies from 18.1 to 24.6 mm. One of the forms is soft but the others have firm fruits. The shape of the fruit varies from round to broadly heart-shaped. Most of them have dark red to black skin color. The taste of all is sweet and sour and only one form has a slight tartness. Single, very old trees of these varieties and forms were found in abandoned yards and fields in the villages at the western foot of the Konyavska Mountain and in the southeastern part of the Osogovo Mountain.

Responsive packaging based on imine-chitosan films for extending the shelf-life of refrigerated fresh-cut pineapple

Reversible imine chemistry has been employed to stabilize antimicrobial liquid volatiles trans-2-hexenal (HX) and salicylaldehyde (SL) to the surface of chitosan films. The reactivity of both aldehydes to amine groups of chitosan was high and the synthesis of imine bonds was assessed by ATR-FTIR. The hydrolysis of the bonds and the release of the aldehydes depended on the pH of the medium. Films exerted in vitro microbiocidal effect against E. coli, S. cerevisae and pineapple wild yeast when were immersed at pH 3.6. Finally, films were incorporated in the double-bottom of plastic containers filled with fresh-cut pineapple maintained at 4 °C for 18 days. Juice leakage from pineapple pieces triggered the release of aldehydes to the headspace of the package. Both aldehydes extended microbiological shelf-life of fruit and slowed down browning. SL increased juice leakage from fruit and affected firmness negatively. • Responsive antimicrobial packages prolonged microbial shelf-life of pineapple pieces. • Imine-chitosan films based on reversible covalent grafting of bioactive aldehydes. • Pineapple exudate triggers the hydrolysis of imine bond and release of antifungals. • Effective triggering mechanism for the release of hexenal and salicylaldehyde from films. • Hexenal and salicylaldehyde delayed browning of pineapple pieces.

ЕXPERIENCE OF LONG-TERM APPLICATION OF PERCUTANEOUS ENDOSCOPIC MICROGASTROSTOMY AS A METHOD OF ENTERIAL AND THERAPEUTIC PROVISION OF PATIENTS

Purpose. Analysis of surgical aspects of the experience of 13 years of percutaneous endoscopic microgastrostomy for enteral therapeutic provision of patients with parkinsonism.Methods. The 4-year follow-up group (2012-2021) included 20 patients aged 55 to 72 years with severe Parkinson's disease, mostly men. From 2008 to 2012, patients underwent microgastrostomy installation using a Frezenius kit. Levodopa carbidopa was injected into the jejunum through a micro-drainage gastrostomy.Results. During the 1st year of gastrostomy functioning, the following complications developed: gastric juice leakage onto the skin with the skin maceration development (2 cases), the hypergranulation development around the gastrostomy (3 cases), the gastrostomy support ring prolapse into subcutaneous fat with an abscess development (2 patients). By the end of the 4th year follow-up, 3 more patients had gastrostomy prolapse into subcutaneous tissue without suppuration. On the micro-drainage part complications were observed in the form of the bezoar formation at the tube end and micro-drainage nodulation in the stomach with the lumen obturation. The author used different methods of prevention and complications treatment in each individual case. To prevent gastric juice leakage and the proliferation of hypergranulations, tube fixation correction and local treatment are necessary; to prevent prolapse of the gastrostomy support ring, it is advisable to use a prolene mesh gasket. A gastrostomy change l with proper care is advisable 1 time in 3-4 years, micro-drainage at least 1 time in 2 years to prevent the bezoar formation on the catheter and its rupture.Conclusion. Puncture microgastrostomy performed under endoscopic control can be effectively used for a long time to inject nutritional mixtures and medicines into the gastrointestinal tract.

Short UV-C treatments extend the shelf-life of fresh-cut strawberries (Fragaria x ananassa Duch cv. Camarosa)

In recent years there has been a marked increase in the demand for fresh-cut fruit. Although these products have high user convenience, they are extremely perishable. Consequently, they must be marketed within a very short period. A number of studies have shown that brief UV-C irradiation prior to storage may reduce postharvest deterioration in whole fruit. Herein, we evaluated the influence of different UV-C dose and intensity combinations on the quality and shelf-life of fresh-cut strawberries. Fresh berries were cut in wedges and subjected to brief UV-C treatments having different combinations of radiation intensity (0, 9, or 36 W m-2) and dose (0, 2, or 4 kJ m-2). Treatments with a dosage of 4 kJ m-2 at an intensity of 36 W m-2 decreased decay, juice leakage, dehydration softening, and yeasts and mold counts. UV-C treated berries also scored better in freshness color and overall acceptability in consumer tests. The treatments did not affect the acidity, soluble solids, or phenolic compounds. Results suggest that short UV-C treatment could be useful to supplement cold storage, extending the shelf-life of fresh-cut strawberries.

Fistula Incidence after Distal Pancreatectomy

Introduction: Pancreatic juice leakage (Leak) post distal pancreatectomy (DP) is high, but only a percentage of these patients develop pancreatic fistula. The incidence of postoperative fistula after (DP) has varied in the literature between 12 to 49.3%.

Acetazolamide-eluting biodegradable tubular stent prevents pancreaticojejunal anastomotic leakage

Postoperative pancreatic fistula at the early stage can lead to auto-digestion, which may delay the recovery of the pancreaticojejunal (PJ) anastomosis. The efficacy and safety of an acetazolamide-eluting biodegradable tubular stent (AZ-BTS) for the prevention of self-digestion and intra-abdominal inflammatory diseases caused by pancreatic juice leakage after PJ anastomosis in a porcine model were investigated. The AZ-BTS was successfully fabricated using a multiple dip-coating process. Then, the drug amount and release profile were analyzed. The therapeutic effects of AZ were examined in vitro using two kinds of pancreatic cancer cell lines, AsPC-1 and PANC-1. The efficacy of AZ-BTS was assessed in a porcine PJ leakage model, with animals were each assigned to a leakage group, a BTS group and an AZ-BTS group. The overall mortality rates in these three groups were 44.4%, 16.6%, and 0%, respectively. Mean α-amylase concentrations were significantly higher in the leakage and BTS groups than in the AZ-BTS group on day 2–5 (p < 0.05 each all). The luminal diameters and areas of the pancreatic duct were significantly larger in the leakage group than in the BTS and AZ-BTS groups (p < 0.05 each all). These findings indicate that AZ-BTS can significantly suppress intra-abdominal inflammatory diseases caused by pancreatic juice leakage and also prevent late stricture formation at the PJ anastomotic site in a porcine model.

Causative bacteria associated with a clinically relevant postoperative pancreatic fistula infection after distal pancreatectomy.

Clinically relevant postoperative pancreatic fistulas (CR-POPF) occurring after distal pancreatectomy often cause intra-abdominal infections. We monitored the presence of bacterial contamination in the ascitic fluid after distal pancreatectomy to clarify the bacterial origin of intra-abdominal infections associated with CR-POPF. In 176 patients who underwent distal pancreatectomy, ascitic fluid bacterial cultures were performed on postoperative days (POD) 1-4 and when the drainage fluid became turbid. The association between postoperative ascitic bacterial contamination and CR-POPF incidence was investigated. CR-POPF occurred in 18 cases (10.2%). Among the patients with CR-POPF, bacterial contamination was detected in 0% on POD 1, in 38.9% on POD 4, and in 72.2% on the day (median, day 9.5) when the drainage fluid became turbid. A univariate analysis revealed a significant difference in ascitic bacterial contamination on POD 4 (p <0.001) and amylase level on POD 3-4 (p < 0.001). A multivariate analysis revealed the amylase level and ascitic bacterial contamination on POD 4 to be independent risk factors. In the CR-POPF group, ascitic bacterial contamination was not observed in the early postoperative stage, but the bacterial contamination rate increased after pancreatic juice leakage occurred. Therefore, CR-POPF-related infections in distal pancreatectomy may be caused by a retrograde infection of pancreatic juice.

空腸漿膜パッチおよび十二指腸憩室化にて救命しえた広範な外傷性十二指腸損傷の1例(A case of extensive traumatic duodenal injuries treated by jejunal patch and duodenal diverticulization)

要旨症例は38歳の男性。腹部鈍的外傷にて当院に搬送された。精査の結果，十二指腸損傷と診断し，受傷後2時間半ほど経過した時点で緊急手術を行った。十二指腸下行部が2/3周かつ長径10cm以上にわたり広範に損傷していた。まず局所修復法として空腸漿膜パッチにて壁損傷部位を閉鎖し，さらに修復した十二指腸下行部の狭窄がみられたため幽門側胃切除および胃空腸吻合術（Roux–en–Y法での再建）による十二指腸憩室化を同時に施行した。術後20日で独歩退院となった。外傷性十二指腸損傷の手術治療は術後合併症，特に縫合不全発生の危険性が高く予後不良とされ，損傷部位が大きく複雑になるに従い困難を極める。空腸漿膜パッチは腸管壁損傷が広範な場合においても閉鎖修復が可能でありかつ安全性も高い。さらに同時に十二指腸憩室化を組み合わせたことで修復腸管径の狭小化に伴う縫合不全や腸管内圧上昇，通過障害を回避し，極めて良好な経過を得られたと考えられた。

Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: Techniques and Literature Review of Transmural Stenting.

Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has emerged as an option in patients with failure of retrograde access to the pancreatic duct (PD) because of difficulty in cannulation or surgically altered anatomy. This article provides a comprehensive review of the techniques and outcomes of EUS-PD, especially EUS-guided pancreatic transmural stenting. The clinical data derived from a total of 401 patients were reviewed in which the overall technical and clinical success rates were 339/401 (85%, range 63%–100%) and 328/372 (88%, range 76%–100%), respectively. Short-term adverse events occurred in 25% (102/401) of the cases, which included abdominal pain (n=45), acute pancreatitis (n=17), bleeding (n=10), and issues associated with pancreatic juice leakage such as perigastric or peripancreatic fluid collection (n=9). In conclusion, although EUS-PD remains a challenging procedure with a high risk of adverse events such as pancreatic juice leakage, perforation, and severe acute pancreatitis, the procedure seems to be a promising alternative for PD drainage in patients with altered anatomy or unsuccessful endoscopic retrograde pancreatography.

A novel reaction force-fluorescence measurement system for evaluating pancreatic juice leakage from an excised swine pancreas during distal pancreatectomy.

Resection using a stapler is a popular approach to distal pancreatectomy. However, the resulting leakage of pancreatic juice represents a serious problem. We have developed a force-fluorescence measurement as a first step towards the quantitative evaluation of pancreatic leakage due to tissue tearing under compression. The system comprises a testing machine with an indenter, similar in size to a stapler, which controls compression speed and measures reaction force, and a fluorescence measurement system to measure pancreatic juice leakage. Pancreatic juice leakage is measured as the maximum value of the increasing rate of fluorescence intensity (max value). Ten excised swine pancreases were compressed at a speed of 500, 100, and 10mm/min until their thicknesses became 2mm. A strong positive correlation (0.804) was observed between the increase in max value before and after compression and the amount of reaction force drop due to tissue destruction. No pancreatic juice leakage was observed when compressed slowly (10mm/min). We have successfully developed a novel force-fluorescence measurement system that can detect and quantify pancreatic juice leakage caused by tissue tearing. This system can determine the optimal compression conditions for preventing pancreatic juice leakage.

Effect of Chitosan/Nano-Titanium Dioxide/Thymol and Tween Films on Ready-to-Eat Cantaloupe Fruit Quality

The effect of chitosan/nano-titanium dioxide coating with antimicrobial agents on ready to eat cantaloupe fruit by chilling was investigated. In comparison with uncoated samples, ascorbic acid and juice leakage in chitosan/nano-titanium dioxide (CH/TiO2) treated fruit were significantly maintained. Likewise, the decrease of malondialdehyde (MDA) and total soluble solids (TSS) in chitosan/nano-titanium dioxide/thymol/tween (CH/TiO2/TT) coated fruits was also inhibited. Total mold and yeast population counts decreased from 2.60 to 1.60 log CFU/g, respectively. Moreover, activities of water (AW) and polyphenol oxidase (PPO) were also much lower than those in control sample fruit. The results indicated that (CH/TiO2/TT) coating was effective in enhancing the shelf life with acceptable in the internal and the external cantaloupe fruit quality.

Endoscopic Ultrasound-Guided Pancreatic Transmural Stenting and Transmural Intervention.

Endoscopic ultrasound (EUS)-guided pancreatic access is an emergent method that can be divided into the two main techniques of EUS-guided rendezvous and pancreatic transmural stenting (PTS). While many reports have described EUS-guided procedures, the indications, technical tips, clinical effects, and safety of EUS-guided pancreatic duct drainage (EUS-PD) remain controversial. This review describes the current status of and problems associated with EUS-PD, particularly PTS. We reviewed clinical data derived from a total of 334 patients. Rates of technical and clinical success ranged from 63% to 100% and 76% to 100%, respectively. In contrast, the rate of procedure-related adverse events was high at 26.7% (89/334). The most frequent adverse events comprised abdominal pain (n=38), acute pancreatitis (n=15), bleeding (n=9), and issues associated with pancreatic juice leakage such as perigastric fluid, pancreatic fluid collection, or pancreatic juice leaks (n=8). In conclusion, indications for EUS-PTS are limited, as is the evidence of its viability, due to the scarcity of expert operators. Despite improvements made to various devices, EUS-PTS remains technically challenging. Therefore, a long-term, large-scale, multicenter study is required to establish this technique as a viable alternative drainage method.