Pancreatic Gland Research Articles

Radiomics and 256-slice-dual-energy CT in the automated diagnosis of mild acute pancreatitis: the innovation of formal methods and high-resolution CT.

Acute pancreatitis (AP) is a common disease, and several scores aim to assess its prognosis. Our study aims to automatically recognize mild AP from computed tomography (CT) images in patients with acute abdominal pain but uncertain diagnosis from clinical and serological data through Radiomic model based on formal methods (FMs). We retrospectively reviewed the CT scans acquired with Dual Source 256-slice CT scanner (Somatom Definition Flash; Siemens Healthineers, Erlangen, Germany) of 80 patients admitted to the radiology unit of Antonio Cardarelli hospital (Naples) with acute abdominal pain. Patients were divided into 2 groups: 40 underwent showed a healthy pancreatic gland, and 40 affected by four different grades (CTSI 0, 1, 2, 3) of mild pancreatitis at CT without clear clinical presentation or biochemical findings. Segmentation was manually performed. Radiologists identified 6 patients with a high expression of diseases (CTSI 3) to formulate a formal property (Rule) to detect AP in the testing set automatically. Once the rule was formulated, and Model Checker classified 70 patients into "healthy" or "unhealthy". The model achieved:accuracy81%, precision 78% and recall81%. Combining FMs results with radiologists agreement, and applying the mode in clinical practice, the global accuracy would have been 100%. Our model was reliable to automatically detect mild AP at primary diagnosis even in uncertain presentation and it will be tested prospectively in clinical practice.

Prospective Validation of the Pancreatic Fistula Risk Classification by the International Study Group for Pancreatic Surgery (PARIS trial).

The aim of this study was a prospective validation of the recently established ISGPS pancreas classification as a parenchymal risk classification system for pancreatic fistula after pancreatoduodenectomy. Postoperative pancreatic fistula (POPF) is the major driver for complications after partial pancreatoduodenectomy (PD). Recently, the International Study Group for Pancreatic Surgery (ISGPS) published a pancreas classification containing the parameters main pancreatic duct diameter (MPD) and pancreatic texture to help assess the risk of POPF development following pancreatoduodenectomy. From January 2020 to July 2021, 271 patients receiving elective PD were included after informed consent. The postoperative course was documented prospectively up to postoperative day 30. Among the pancreas characteristics, MPD and pancreatic texture were assessed intraoperatively at the pancreatic resection margin and the pancreatic glands were assigned to one of the four pancreas classes according to the ISGPS (A to D). The primary endpoint was POPF according to the updated ISGPS definition. Secondary endpoints comprised other post-PD morbidity and mortality. Of 271 patients, 264 had available data according to the ISGPS pancreas classification. Of those, 78 were assigned to class A (30%), 53 to class B (20%), 50 to class C (19%) and 83 to class D (31%). POPF occurred in 54 of 271 patients (19.9%). The 30-day mortality was 7/271 (2.6%), with 6/7 having developed POPF (86%). POPF rates within the classes A, B, C and D were 9.0%, 11.3%, 20.0% and 37.4%, respectively (P<0.001). In the univariable regression analysis, only patients in pancreas class D demonstrated a significantly higher risk for POPF when compared to class A (OR 6.05, 95%-CI: 2.6-15.9, P<0.001). In the multivariable regression model, patients in class D had a significantly higher risk for POPF compared to class A (OR 3.45, 95%-CI: 1.15-11.3, P=0.032). The model comprised Body Mass Index, surgery duration, microscopic fibrosis and the ISGPS pancreas classification, demonstrating an AUC-value of approximately 0.82 when tested on the PARIS dataset. This prospective trial shows that the ISGPS pancreas classification is valid. Patients in risk class D are prone to POPF independently of other factors. Therefore, all future publications on pancreatic surgery should report the risk class according to the ISGPS pancreas classification to allow for a better comparison of reported cohorts.

The Effect of Aqueous Extract of Fenugreek Plant on the Pancreas in Rabbits Induced with Diabetes and the Histological Changes Occurring in Them

The study aimed to induce alloxan-induced diabetes in local white rabbits, study its effect on the pancreas, treat them with aqueous extract of fenugreek at a concentration of 200 mg/kg orally, and observe the histological changes. To complete the study 20 white rabbits were taken and divided into three groups; 1st group is the control group and this group was dosed with distilled water. 2nd group was treated with Alloxan and was injected intraperitoneally at a dose of 175 mg/kg. 3rd group is the group that was treated with the aqueous extract of fenugreek at a concentration of 200 mg/kg for 30 days. After the end of the injection and dosing period after 30 days, the animals were killed and the pancreas was removed to perform histological techniques on them. its the group treated with alloxan was observed that the pancreas was composed of exocrine glandular lobules with enlarged secretory cells within the pancreatic acinus, with the presence of pale nuclei lacking pigment. Also, blood congestion of the blood vessels was found between the lobules of the gland and the pancreatic gland showed hyperplasia of its glandular epithelial cells with nuclei devoid of pigment due to the loss of the basal pigment in them. Blood congestion of the blood vessels appeared in the gland between the lobules, and dense colloidal fibers appeared in them and contained fibroblasts and phagocytic cells and the group treated with the aqueous extract of the fenugreek plant :The pancreatic parenchyma contained normal exocrine glandular secretion units, where the cytoplasm and nuclei of these cells were located in the form of regular axes, septations between the lobules of the pancreas surrounded by thick-walled arteries containing blood. and the islets of Lankerhans appeared between the yeast-secreting lobules of the pancreas. They contained endocrine cells of alpha and beta cells surrounded by blood sinusoids. The interstitial tissue between the lobules is composed of loose connective tissue containing colloidal fibers the pancreatic tissue contained the serous secretory vasculature of yeasts, which were uniform in shape, and between them were found blood vessels excessive with blood, where blood was found in a decomposed form in them, with the presence of small channels inside the lobules that transport yeasts.

Comparison of The Effectiveness of Aerobic Endurance Training and Resistance Exercise on Reducing Daily Blood Sugar in The Elderly at The Puter Community Health Center Bandung City

Diabetes Mellitus (DM) is a chronic condition that occurs when there is an increase in glucose levels in the blood because the body cannot produce insulin or use insulin effectively. Insulin is an important hormone produced in the body's pancreatic gland, which transports glucose from the bloodstream into the body's cells where the glucose is converted into energy. This study uses a comparative study with experimental method to find out the comparison results of the treatment given to samples from aerobic exercise intervention treatment with resistance exercise, The first group will do Aerobic Endurance Exercise by walking for 20 minutes. While the second group will do Resistance Exercise by doing strength training or resistance training for 20 minutes, rest time is 15 seconds and the movement is done as many as 2 sets and 10 repetitions. Subject characteristics based on average age (61.58 ± 6.50), body weight (71.86 ± 9.76), body height (157.27 ± 8.99), and BMI of elderly people suffering from diabetes mellitus falls into the obese category with a value of (27.71 ± 4.23). The value of aerobic before exercise is (26.41 ± 33.67) after exercise it decrease (11.74 ± 10.28), resistance exercise before exercise is (31.74 ± 54.10) after exercise it decrease (9.33 ± 23.46). In this study it can be concluded that aerobic endurance and resistance exercise can reduce the increase in blood sugar in the elderly, but when compared to the two exercises, resistance exercise suppresses the increase in blood sugar more, of course with the appropriate intensity.

Prolonged pre-firing pancreatic compression with linear staplers in distal pancreatectomy: a valuable technique for post-operative pancreatic fistula prevention

PurposePost-operative pancreatic fistula (POPF) remains the main complication after distal pancreatectomy (DP). The aim of this study is to evaluate the potential benefit of different durations of progressive stapler closure on POPF rate and severity after DP.MethodsPatients who underwent DP between 2016 and 2023 were retrospectively enrolled and divided into two groups according to the duration of the stapler closure: those who underwent a progressive compression for < 10 min and those for ≥ 10 min.ResultsAmong 155 DPs, 83 (53.5%) patients underwent pre-firing compression for < 10 min and 72 (46.5%) for ≥ 10 min. As a whole, 101 (65.1%) developed POPF. A lower incidence rate was found in case of ≥ 10 min compression (34–47.2%) compared to < 10 min compression (67- 80.7%) (p = 0.001). When only clinically relevant (CR) POPFs were considered, a prolonged pre-firing compression led to a lower rate (15–20.8%) than the < 10 min cohort (32–38.6%; p = 0.02). At the multivariate analysis, a compression time of at least 10 min was confirmed as a protective factor for both POPF (OR: 5.47, 95% CI: 2.16–13.87; p = 0.04) and CR-POPF (OR: 2.5, 95% CI: 1.19–5.45; p = 0.04) development. In case of a thick pancreatic gland, a prolonged pancreatic compression for at least 10 min was significantly associated to a lower rate of CR-POPF compared to < 10 min (p = 0.04).ConclusionA prolonged pre-firing pancreatic compression for at least 10 min seems to significantly reduce the risk of CR-POPF development. Moreover, significant advantages are documented in case of a thick pancreatic gland.

Evaluation Of Metformin Use in Type 2 Diabetes Mellitus Patients X Clinic Sei Karang

Diabetes mellitus is a disease or chronic metabolic disorder characterized by high blood sugar levels accompanied by impaired metabolism of carbohydrates, lipids and proteins as a result of insulin function insufficiency, which can be caused by impaired insulin production by the Langerhans beta cells of the pancreatic gland or caused by a lack of insulin. responsiveness of body cells to insulin. Type 2 DM is often found in around 90% of diabetes sufferers and usually occurs from the age of over 40 years in obese people. Metformin is the most frequently prescribed therapy for patients with type 2 diabetes mellitus. In addition, Metformin has a very good safety profile and is also pharmacoeconomically beneficial. The research was carried out by tracing the patient's past data from medical records obtained from the medical records unit at the X Sei Karang Clinic in the patient's medical records for 2022. Based on gender, it shows that of the 40 patients using oral anti-diabetic drugs in type II DM patients based on gender in 2022, the majority of genders are women (28 people) and the rest are men (12 people). Based on age, it shows that there are more people aged 34-60 years with a percentage of 67.5% compared to those aged 61-77 years with a percentage of 32.5%. Therapeutic use of oral antidiabetic drugs in outpatient type II DM patients at the X Sei Karang Clinic for the period October-December 2022 is Metformin with a 30% result with or without combination therapy. The accuracy of using oral anti-diabetic drugs in outpatients with type II DM at the X Sei Karang Clinic in 2022, found that the accuracy of using anti-diabetic therapy drugs at the appropriate dose was 83.33%.

Epithelial Anoctamins

When activated by increase in intracellular Ca2+, anoctamins (TMEM16 proteins) operate as phospholipid scramblases and as ion channels. Anoctamin 1 (ANO1) is the Ca2+-activated epithelial anion-selective channel that is coexpressed together with the abundant scramblase ANO6 and additional intracellular anoctamins. In salivary and pancreatic glands, ANO1 is tightly packed in the apical membrane and secretes Cl−. Epithelia of airways and gut use cystic fibrosis transmembrane conductance regulator (CFTR) as an apical Cl− exit pathway while ANO1 supports Cl− secretion mainly by facilitating activation of luminal CFTR and basolateral K+ channels. Under healthy conditions ANO1 modulates intracellular Ca2+ signals by tethering the endoplasmic reticulum, and except of glands its direct secretory contribution as Cl− channel might be small, compared to CFTR. In the kidneys ANO1 supports proximal tubular acid secretion and protein reabsorption and probably helps to excrete HCO3−in the collecting duct epithelium. However, under pathological conditions as in polycystic kidney disease, ANO1 is strongly upregulated and may cause enhanced proliferation and cyst growth. Under pathological condition, ANO1 and ANO6 are upregulated and operate as secretory channel/phospholipid scramblases, partly by supporting Ca2+-dependent processes. Much less is known about the role of other epithelial anoctamins whose potential functions are discussed in this review.

A New Step-Up Dual Endoscopic Approach for Large-Size Infected Pancreatic Necrosis: Percutaneous Endoscopic Necrosectomy Followed by Transluminal Endoscopic Drainage/Necrosectomy.

Acute pancreatitis in 10% to 20% of cases can be associated with necrosis of the pancreatic gland, peripancreatic tissue, or both. We report a case series of a new endoscopic approach to treat infected pancreatic necrosis (IPN). Consecutive patients with IPN, extending from the perigastric area up to the paracolic gutters or into the pelvis, were prospectively studied from January 2017 to June 2022. The treatment protocol was radiologic percutaneous drainage as the first step, followed by fully covered metal stent placement (FC-SEMS) in the track of the catheter. Percutaneous endoscopic necrosectomy (PEN) was performed 2 to 4 days later using a flexible endoscope through the percutaneous tract. About 2 to 4 weeks later, when a matured sac was visible, EUS-guided endoscopic transluminal drainage (ETD) with lumen-apposing metal stents (LAMS) was performed. Control of sepsis with resolution of collection(s) was the primary outcome measure. We included 18 patients, males in 50% of cases with age 60±12 years old. Most frequent cause of pancreatitis was biliary (7 cases) followed by alcoholic in 6 cases; in 3 cases pancreatitis was caused by hyperlipemia and in 2 cases was idiopathic. Mean size of WON was 18±2cm. For PEN, SEMSs used were esophageal FC-SEMS. LAMS used for ETD were Hot Axios, Hot Spaxus and Nagistent. Mean time of endoscopic intervention for PEN and ETD was 18±3 and 37±4 days, respectively. In 5 cases adverse events occurred: 3 cases of overinflations resolved with introduction of Verres needles in abdomen. In 2 cases postprocedural GI bleeding required endoscopic intervention. In all cases control of sepsis was reached together with resolution of collections. No cases of deaths were observed. Step-up percutaneous and transluminal endoscopic necrosectomy therapy is an effective strategy for large-size IPN with combined central and peripheral necrosis.

Performance of the 2019 ACR/EULAR Classification Criteria for IgG4-Related Disease in a Large Chinese Cohort.

The purpose of this research was to ascertain the effectiveness of the newly established criteria for classifying IgG4-related disease (IgG4-RD), as applied to a large Chinese cohort in real-world clinical settings. Patient data were procured from the digital health records of 4 prominent academic hospitals. The criterion standard for identifying IgG4-RD patients was from a seasoned rheumatologist. The control group consisted of individuals with other ailments such as cancer, other forms of pancreatitis, infectious diseases, and illnesses that mimic IgG4-RD. A total of 605 IgG4-RD patients and 760 mimickers were available for analysis. The 2019 EULAR/ACR criteria have a sensitivity of 69.1% and a specificity of 90.9% in this large Chinese cohort. IgG4-RD had a greater proportion of males (55.89% vs 36.25%, p < 0.001), an older average age at diagnosis (54.91 ± 13.44 vs 48.91 ± 15.71, p < 0.001), more pancreatic (29.59% vs 6.12%, p < 0.001) and salivary gland (63.30% vs 27.50%, p < 0.001) involvement, and a larger number of organ involvement (3.431 ± 2.054 vs 2.062 ± 1.748, p < 0.001) compared with mimickers. The 2019 EULAR/ACR criteria are effective in classifying IgG4-RD in Chinese patients, demonstrating high specificity and moderate sensitivity.

Long-term follow-up study of necrotising pancreatitis: interventions, complications and quality of life

ObjectiveTo describe the long-term consequences of necrotising pancreatitis, including complications, the need for interventions and the quality of life.DesignLong-term follow-up of a prospective multicentre cohort of 373 necrotising pancreatitis patients...

Abstract C055: Activation of oncogenes within Tff2 expressing cells of the pancreatic ductal glands results in increased lineage stemness preceding tumorigenesis: Insights from an inducible mouse model and derived organoids

Abstract Introduction: Adult stem cell dysregulation can initiate cancer. Pancreatic ductal glands (PDGs) act as a stem cell niche for the pancreatic main duct epithelium (MD). Previous studies have shown that Tff2+ cells within the PDGs give rise to progeny that migrate to the MD epithelium during inflammation. In human IPMN, the PDGs have been shown to comprise the basal proliferative compartment of these neoplasms. Here we investigate the effect of oncogenic activation and tumor suppressor deletion within Tff2+ PDG cells. Methods: We utilized Tff2CreERT2;Rosa26mT/mG;KrasLSL-G12D;P53fl/fl mice (TTKP) to activate oncogenes in Tff2+ cells and GFP tag this lineage in vivo and ex vivo. Cre activity was induced by tamoxifen injection in TTKP experimental or Tff2CreERT2;Rosa26mT/mG (TT) control mice. Pancreata were collected at pre-determined time points post-tamoxifen with GFP tagged, Tff2 lineage cells quantified and compared between groups at each timepoint. For ex vivo experiments, ductal cells were isolated from tamoxifen-naïve TTKP pancreata via magnetic-assisted cell sorting, grown in 3D culture and induced via 4OHT. GFP+ cells were sorted, cultured, and orthotopically implanted in athymic nude mice. Tumors were collected before reaching 20mm in diameter. Spatial RNA sequencing (spRNAseq) was performed on frozen tissue sections and analyzed with R package Seurat. Cross-species analysis utilized human PDAC scRNAseq reference datasets. Results: TTKP mice developed lineage-traced PDAC eight weeks after tamoxifen induction. In vivo lineage tracing showed a significant increase of GFP+ Tff2-lineage cells in PDGs and MD between TTKP and TT mice at all analyzed time points (4-, 6- and 8-weeks post tamoxifen, ≥ 3 mice each). GFP-positive PDGs exhibited progressive PanIN-like changes before PDAC formation. Tff2-PDG cells in TT mice function as transient amplifying cells, expanding within PDGs and to the MD during inflammation and contracting upon resolution. Oncogenic activation (sans inflammation) in Tff2-PDG cells led to sustained GFP+ cell presence in PDGs and MD, indicating increased stem-like behavior preceding neoplasia. Orthotopic organoid experiments resulted in GFP+ tumor formation. SpRNAseq analysis indicated enrichment of "Ductal cell type 2" in TTKP tumors, particularly overlying the main duct epithelium. Conclusion: Our study demonstrates that dysregulation of the Tff2-lineage in PDGs can initiate PDAC. Oncogenic activation in Tff2+ cells increases their stemness as indicated by lineage expansion in PDGs and MD preceding PanIN and PDAC formation. Orthotopic organoid implantation experiments further validate the tumor-initiating capacity of Tff2+ ductal cells. Spatial transcriptomics analysis confirms the presence of similar cell types identified in human scRNAseq studies within TTKP tumors. These findings strongly support the role of PDGs as a potential niche of origin for human PDAC and provide additional insights into an under-studied disease initiating process. Citation Format: Kyle L. McAndrews, Pinaki Mondal, Dulce Maroni, Dongdong Wang, Michael A. Hollingsworth, Sarah P. Thayer. Activation of oncogenes within Tff2 expressing cells of the pancreatic ductal glands results in increased lineage stemness preceding tumorigenesis: Insights from an inducible mouse model and derived organoids [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr C055.

Secretin: a hormone for HCO3- homeostasis.

Secretin is a key hormone of the intestinal phase of digestion which activates pancreatic, bile duct and Brunner gland HCO3- secretion. Recently, the secretin receptor (SCTR) was also found in the basolateral membrane of the beta-intercalated cell (B-IC) of the collecting duct. Experimental addition of secretin triggers a pronounced activation of urinary HCO3- excretion, which is fully dependent on key functional proteins of the B-IC, namely apical pendrin and CFTR and the basolateral SCTR. Recent studies demonstrated that the SCTR knock-out mouse is unable to respond to an acute base load. Here, SCTR KO mice could not rapidly increase urine base excretion, developed prolonged metabolic alkalosis and exhibited marked compensatory hypoventilation. Here, we review the physiological effects of secretin with distinct focus on how secretin activates renal HCO3- excretion. We describe its new function as a hormone for HCO3- homeostasis.

Botanical Sources, Pharmacokinetics, and Therapeutic Efficacy of Palmatine and Its Derivatives in the Management of Cancer: A Comprehensive Mechanistic Analysis

Natural compounds and their derivatives have been identified as valuable sources of therapeutic ingredients for cancer treatment. The naturally occurring phytochemical palmatine (isoquinoline alkaloid) is extracted from plant parts (rhizomes, roots, stems, stem barks, and others) and has protective effects including antioxidant, anti‐inflammatory, and anticancer. This study aims to summarize the anticancer potential of palmatine and its derivatives in the treatment of numerous types of cancer with molecular mechanisms. We also include the pharmacokinetic features, botanical origin, and toxicological characteristics of palmatine and its derivatives. For this, data have been collected from plausible different electronic databases, including PubMed, Google Scholar, PubChem, Science Direct, Web of Science, Scopus, Springer Link, and Wiley Online. The findings demonstrate that palmatine and its derivatives have a protective anticancer effect against a variety of cancers, including breast, colorectal, gastric, ovarian, prostate, pancreatic, skin, hepatocellular cancer, and mammary gland tumors. They provoke their anticancer properties against various cancer cell lines via modifying molecular mechanisms like induction of oxidative stress, cytotoxicity, apoptosis, inhibition of cell invasion and migration, arresting the cell cycle at the S phase, antiproliferative, and antiangiogenic effects. It is suggested that palmatine and its derivatives may be a good option in the development of novel drugs for cancer therapy in the future.

ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis

Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors related to malnutrition. Therefore, patients with chronic pancreatitis should be considered at risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered.

Stereotactic Ablative Radiotherapy for the Treatment of Glandular Metastases from Renal Cell Carcinoma.

Glandular metastases including pancreatic and adrenal sites of disease are associated with renal cell carcinoma (RCC) of indolent biology. Adrenal and pancreatic metastases may develop in isolation or involve other organs and are associated with prolonged survival. Glandular metastases can be treated with systemic therapy, stereotactic ablative radiotherapy (SAbR) or surgical resection and the optimal management of these patients is unknown. There is paucity of data on SAbR for RCC glandular metastases. We hypothesize that ablative doses of radiation therapy utilizing SAbR are associated with high rates of local control greater than 90%, with minimal or no acute grade 3 toxicities or higher with this approach. Here, we report local control (LC), progression-free survival (PFS), overall survival (OS) rates as well as toxicities related to SAbR for RCC metastases to the pancreatic and adrenal glands. This IRB-approved, single-institution, retrospective study included patients with RCC metastases to the adrenal glands and pancreas treated with SAbR. Data on patient demographics, functional status, tumor characteristics, International Metastatic RCC Database Consortium (IMDC) risk category, local and systemic treatments, toxicities, and outcomes were collected and analyzed. RECIST 1.1 principals were utilized to determine LC rates and PFS. PFS was determined from the initiation of SAbR to progression (at SAbR-treated or other sites), or death. OS was defined from the start of SAbR to death. Two independent reviewers assessed these measures and analyzed patient electronic health records for toxicities using CTCAE v5 and relatedness scores. A total of 50 RCC patients were included in this study with 36 adrenal and 20 pancreatic metastases treated with SAbR. Median dose fractionation used was 40 Gray delivered in 5 fractions. Sixteen patients (32%) were treatment naïve with oligometastatic disease, and thirty-four (68%) were oligo-progressive on systemic therapy with 1-3 prior lines of systemic therapy. For treated adrenal metastatic lesions at 1 year, patients demonstrated a 75.3% OS, 46.7% PFS, and LC of 93.3%. For treated pancreatic metastatic lesions at 1 year, patients demonstrated a 100% OS, 48.6% PFS, and LC of 100%. At 1 year, there was an OS of 82.2%, PFS of 48.2%, and LC of 95.9 % in the combined cohort. The percentage of patients experiencing an acute grade 2 or 3 toxicity attributed to adrenal or pancreatic gland SAbR was 7.4%. There were no acute grade >3 toxicities. The percentage of patients experiencing a late grade 2 or 3 toxicity was 9.3%. Median time to late adverse events was 37.4 months. SAbR of RCC metastases to the pancreas and adrenal glands is feasible, safe and appears to be effective. Median PFS and OS in this cohort compared favorably to those reported in historical cohorts and is consistent with indolent disease.

Esophageal Atresia and Gastric Ectopic Pancreas: Is There a Real Association?

Heterotopic pancreas (HP) is a condition in which there is well-differentiated pancreatic tissue that lacks any anatomic or vascular contact with the pancreatic gland. It normally arises from the stomach but can be found in other locations. Although it is usually asymptomatic, obstructive symptoms, bleeding, or malignant degeneration can occur. The incidence is very low, but it is significantly more common in patients with esophageal atresia (EA). The aim of this study is to evaluate the incidence of HP in patients with and without EA and to compare the results in both groups. We conducted a 2-year prospective study in pediatric patients who benefited from an upper gastrointestinal endoscopy. Patients were divided into two groups: group "A" comprised patients with EA and group "B" those without EA. The variables analyzed were the clinical presentation, presence of HP, location, associated malformations, genetic disorders, and management. A total of 192 consecutive patients were included in the study: 51 (26.6%) in group A and 141 (73.4%) in group B. Indications for endoscopy in group B were eosinophilic esophagitis in 37 (19.2%) patients, celiac disease in 23 (11.95%) patients, and other disorders in 81 (42.2%) patients. Gastric HP was found in seven patients, all of them in group A. All lesions were hosted in the prepyloric antrum. The prevalence of HP in groups A and B was 13.7 and 0%, respectively (p < 0.05). Female gender was predominant in patients with AE and HP, this result being statistically significant (p = 0.044). No other associated malformation or genetic syndrome studied showed association with HP. Only one patient debuted with upper gastrointestinal (GI) bleeding and required excision, while six patients were asymptomatic. The mean follow-up was 54 months (range: 45-78 months). The incidence of gastric HP is more common in patients with EA, with the female gender being a risk factor for their association. Active search and follow-up is recommended as it may become symptomatic anytime and need resection.

Screening of Neuroprotective Action of Hydroethanolic Extract of Leaf of &lt;i&gt;Clematis buchananiana&lt;/i&gt; in Diabetic-Induced Neuropathy

Diabetic neuropathy is the most dangerous complication of diabetes which is very difficult to treat. Diagnosis in the early stage prevents worse outcomes of the illness. Determine the pharmacological effect of hydroethanolic extract of Clematis buchananiana leaves was investigated and screened for determination of neuroprotective effect in diabetic-induced neuropathy using Wistar rats. Streptozotocin normally induces diabetes within 3 days. The destruction of the beta cells present in the pancreatic gland leads to diabetes. The confirmation of diabetes was done with the help of a glucometer. The experimental models used for the assessment of analgesic activity in Wistar albino rats included the tail immersion method and acetic acid-induced writhing method. After completion of the research study, it was found that the animals treated with standard drug (Gabapentin, 100 mg/kg) had maximum analgesic action, followed by a higher dose of hydroethanolic extract of Clematis buchananiana leaf (HEELCB, 400 mg/kg). The major observation was that hydroethanolic extract of Clematis buchananiana has significant analgesic action and it validates the traditional claim of the plant as an analgesic agent.

A postnatal network of co-hepato/pancreatic stem/progenitors in the biliary trees of pigs and humans

A network of co-hepato/pancreatic stem/progenitors exists in pigs and humans in Brunner’s Glands in the submucosa of the duodenum, in peribiliary glands (PBGs) of intrahepatic and extrahepatic biliary trees, and in pancreatic duct glands (PDGs) of intrapancreatic biliary trees, collectively supporting hepatic and pancreatic regeneration postnatally. The network is found in humans postnatally throughout life and, so far, has been demonstrated in pigs postnatally at least through to young adulthood. These stem/progenitors in vivo in pigs are in highest numbers in Brunner’s Glands and in PDGs nearest the duodenum, and in humans are in Brunner’s Glands and in PBGs in the hepato/pancreatic common duct, a duct missing postnatally in pigs. Elsewhere in PDGs in pigs and in all PDGs in humans are only committed unipotent or bipotent progenitors. Stem/progenitors have genetic signatures in liver/pancreas-related RNA-seq data based on correlation, hierarchical clustering, differential gene expression and principal component analyses (PCA). Gene expression includes representative traits of pluripotency genes (SOX2, OCT4), endodermal transcription factors (e.g. SOX9, SOX17, PDX1), other stem cell traits (e.g. NCAM, CD44, sodium iodide symporter or NIS), and proliferation biomarkers (Ki67). Hepato/pancreatic multipotentiality was demonstrated by the stem/progenitors’ responses under distinct ex vivo conditions or in vivo when patch grafted as organoids onto the liver versus the pancreas. Therefore, pigs are logical hosts for translational/preclinical studies for cell therapies with these stem/progenitors for hepatic and pancreatic dysfunctions.

Benefits of pancreatic parenchymal endoscopic ultrasonography in predicting microscopic precancerous lesions of pancreatic cancer

Pancreatic cancer primarily arises from microscopic precancerous lesions, such as pancreatic intraepithelial neoplasia (PanIN) and acinar-to-ductal metaplasia (ADM). However, no established method exists for predicting pancreatic precancerous conditions. Endoscopic ultrasonography (EUS) can detect changes in pancreatic parenchymal histology, including fibrosis. This study aimed to elucidate the relationship between pancreatic parenchymal EUS findings and microscopic precancerous lesions. We retrospectively analyzed 114 patients with pancreatobiliary tumors resected between 2010 and 2020 and evaluated the association between pancreatic parenchymal EUS findings and the number of PanIN, ADM, and pancreatic duct gland (PDG). Of the 114 patients, 33 (29.0%), 55 (48.2%), and 26 (22.8%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. Multivariate analyses revealed that abnormal EUS findings were significantly associated with the frequency of PanIN (hyperechoic foci/stranding without lobularity: OR [95% CI] = 2.7 [1.0–7.3], with lobularity: 6.5 [1.9–22.5], Ptrend = 0.01) and ADM (hyperechoic foci/stranding without lobularity: 3.1 [1.1–8.2], with lobularity: 9.7 [2.6–36.3], Ptrend = 0.003) but not with PDG (hyperechoic foci/stranding without lobularity: 2.2 [0.8–5.8], with lobularity: 3.2 [1.0–10.2], Ptrend = 0.12). We observed a trend toward a significantly higher number of precancerous lesions in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. Pancreatic parenchymal EUS findings were associated with the increased frequency of PanIN and ADM. Lobularity may help predict the increased number of precancerous lesions.

The effects of eugenol on histological, enzymatic, and oxidative parameters in the major salivary glands and pancreas of healthy male Wistar rats

ObjectiveWe evaluated the effects of eugenol on histological, enzymatic, and oxidative parameters in the pancreas, parotid, submandibular, and sublingual glands of healthy male rats. DesignTwenty-four adult Wistar rats were assigned into four groups (n = 6/group). Control rats received 2% Tween-20 (eugenol vehicle), whereas the other animals received 10, 20, and 40 mg kg−1 eugenol through gavage daily for 60 d. Major salivary and pancreatic glands were weighed and preserved fixed for microscopic analysis and frozen for in vitro assays. ResultsEugenol did not alter glands’ weight and serum amylase activity regardless of the concentration. The highest dose of eugenol caused an increase in pancreatic amylase activity and a reduction of lipase activity from serum and pancreas. Eugenol at 40 mg kg−1 diminished the activity of SOD and FRAP in the submandibular gland and CAT and FRAP in the sublingual gland. However, it did not exert any effect on GST regardless of the gland. Additionally, 40 mg kg−1 eugenol increased MDA levels in pancreatic, parotid, and submandibular glands and NO levels in the sublingual. The concentrations of eugenol induced distinct responses in the glands regarding the activity of Na+/K+, Mg2+, and total ATPase activity. They also affected histomorphometrical and histochemistrical parameters in the submandibular gland only. ConclusionsResults indicated that 40 mg kg−1 eugenol altered most of the biochemical and oxidatived parameters of digestive glands. Only submandibular glands presented histological changes after eugenol exposure suggesting potential implications for its function.