Pancreas最新文献

Objectives: Pancreatic cancer and prediabetes pose significant public health challenges. Given the lack of strong evidence we performed a meta-analysis to assess the risk of pancreatic cancer in prediabetes.

Materials and methods: We performed a thorough search of the major databases over the last 10 years to identify relevant articles. The pooled odds ratio (OR) and hazard ratio (HR) were combined to calculate the effect size (ES).

Results: We analyzed 5 studies including 5,425,111 prediabetic individuals and 16,096,467 normoglycemic population across 5 countries with a median follow-up of 8.5 years. We identified a noteworthy association between prediabetes and pancreatic cancer, reporting an unadjusted ES of 1.36 (95% confidence interval [CI] 1.05-1.77, P = 0.02) and an adjusted ES of 1.40 (1.23-1.59, P < 0.01). Subgroup analyses by age revealed variations in risk, with studies involving participants aged 60 and above exhibiting a higher ES (ES 1.83, 95% CI 1.28-2.62, P < 0.01). Geographical differences were also observed, with Japanese studies reporting a higher risk (ES 1.89, 95% CI 1.15-3.10, P < 0.01) compared with those from the United States (ES 1.32, 95% CI 1.13-1.53, P < 0.01).

Conclusions: We identified 40% higher risk of pancreatic cancer in patients with prediabetes than those with normal blood glucose necessitating urgent attention for further research and policy change.

Abstract: Pancreas is a vital gland of gastrointestinal system with exocrine and endocrine secretory functions, interweaved into essential metabolic circuitries of the human body. Pancreatic ductal adenocarcinoma (PDAC) represents one of the most lethal malignancies, with a 5-year survival rate of 11%. This poor prognosis is primarily attributed to the absence of early symptoms, rapid metastatic dissemination, and the limited efficacy of current therapeutic interventions. Despite recent advancements in understanding the etiopathogenesis and treatment of PDAC, there remains a pressing need for improved individualized models, identification of novel molecular targets, and development of unbiased predictors of disease progression. Here we aim to explore the concept of precision medicine utilizing 3-dimensional, patient-specific cellular models of pancreatic tumors and discuss their potential applications in uncovering novel druggable molecular targets and predicting clinical parameters for individual patients.

Objectives: This study aimed to identify the risk factors for acute pancreatitis (AP) in young adults in their 20s based on data from the nationwide cohort in South Korea.

Materials and methods: From the 2009 national health examination database of South Korea, a total of 471,098 individuals between the ages of 20 and 29 were analyzed. To identify the newly developed AP, the linked claims database was used.

Results: The incidence rates of AP were 18.8 and 9.8 per 100,000 person-years in male and female participants, respectively. Alcohol consumption and smoking were associated with the heightened risk of AP. The risk of AP development was increased as daily alcohol consumption increased. In addition, ex-smokers and current smokers showed higher AP risk than never smokers. Hypertriglyceridemia and obesity were associated with the increased AP risk as well. Compared with female participants, male participants showed a higher risk of AP in univariate analysis but showed a lower risk of AP in multivariate analysis.

Conclusions: In the young adult population, alcohol consumption, smoking, hypertriglyceridemia, and obesity were associated with an elevated risk of developing AP. It is important to identify and manage the modifiable AP risk factors in young adults to minimize the socioeconomic burden of AP.

Objectives: Detecting choledocholithiasis in acute biliary pancreatitis (ABP) is crucial. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) identify common bile duct stones. EUS offers better accuracy than MRCP but with sedation risks. We studied MRCP negative diagnosis risk factors in ABP patients with choledocholithiasis for improved diagnostic selection.

Methods: This retrospective study included 2321 ABP patients. After exclusions, 337 ABP patients with negative MRCP results were analyzed, including 75 with positive EUS findings. Univariate and multivariate logistic regression identified MRCP negative diagnosis risk factors.

Results: Patients with positive EUS findings were older (62.0 vs 55.0) and had higher cholecystectomy rates (18.7% vs 7.3%). Univariate analysis showed cholecystectomy history, age, and sex as potential risk factors. Then, after adjusting the other potential risk factors (direct bilirubin, alanine transaminase, γ-glutamyl transpeptidase, and alkaline phosphatase), a history of cholecystectomy (odds ratio, 2.859; 95% confidence interval [CI], 1.312-6.23), older age (1.03; 95% CI, 1.009-1.052), and male (2.016; 95% CI, 1.152-3.528) were independent risk factors of negative diagnosis of MRCP in ABP patients with choledocholithiasis.

Conclusions: Cholecystectomy history, older age, and male sex increase MRCP negative diagnosis risk in ABP patients with choledocholithiasis. Patients with these risk factors should undergo EUS first for better diagnostic outcomes.

Abstract: Unusual symptoms, rapid progression, lack of reliable early diagnostic biomarkers, and lack of efficient treatment choices are the ongoing challenges of pancreatic cancer. Numerous research studies have demonstrated the correlation between exosomes and various aspects of pancreatic cancer. In light of these facts, exosomes possess the potential to play functional roles in the treatment, prognosis, and diagnosis of the pancreatic cancer. In the present study, we reviewed the most recent developments in approaches for exosome separation, modification, monitoring, and communication. Moreover, we discussed the clinical uses of exosomes as less invasive liquid biopsies and drug carriers and their contribution to the control of angiogenic activity of pancreatic cancer. Better investigation of exosome biology would help to effectively engineer therapeutic exosomes with certain nucleic acids, proteins, and even exogenous drugs as their cargo. Circulating exosomes have shown promise as reliable candidates for pancreatic cancer early diagnosis and monitoring in high-risk people without clinical cancer manifestation. Although we have tried to reflect the status of exosome applications in the treatment and detection of pancreatic cancer, it is evident that further studies and clinical trials are required before exosomes may be employed as a routine therapeutic and diagnostic tools for pancreatic cancer.

Abstract: Both the clinical management and study of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) is complicated by significant heterogeneity in the etiology, mechanisms, symptoms, and complications of pancreatitis. The National Institutes of Diabetes and Digestive and Kidney Disease (NIDDK) recently convened a workshop to address current knowledge and knowledge gaps in the field. Preclinical models that better replicate human disease are important for development of new therapies. Pain is often the most common and most difficult symptom to treat, as the causes are multifactorial and effective treatment may vary depending on whether pain is neuropathic or nociceptive in origin, and the placebo effect can complicate evaluation of the efficacy of medical and procedural interventions. Novel technologies like functional MRI and virtual reality may offer novel means for assessing and treating pain, respectively. Clinical trial designs will need to consider best approaches to addressing the heterogeneity of CP, including careful attention to designing eligibility criteria, and establishing accepted and validated core outcomes criteria for the field. The latter may be informed by consensus in pain research. Recruitment of participants into clinical trials has been challenging, often requiring multiple centers. Establishment of a clinical trials network would facilitate greater opportunities for therapeutic trials in pancreatitis.