Pancreas最新文献

Objectives: Abdominal pain affects nearly 80% of youth with acute recurrent or chronic pancreatitis (ARP/CP), yet its broader burden is poorly understood. We characterized direct (healthcare utilization) and indirect (school absenteeism, parental work loss) burden in youth with painful ARP/CP and examined associations with pain characteristics and health-related quality of life (HRQOL).

Methods: Youth with painful ARP/CP and caregivers were recruited from INSPPIRE sites and the community. Caregivers reported healthcare use and indirect burden via the Client Service Receipt Inventory. Youth completed validated measures of pain severity, pain interference, and HRQOL. Negative binomial and logistic regression assessed associations between pain, HRQOL, and disease burden.

Results: Ninety youth (mean age 14.9) were included. Over 9 months, youth had a median of 1 hospital admission (3-day stay), 1.5 ED visits, 4 outpatient visits, 1 non-physician visit, 18.5 missed school days, and 6.0 parental workdays lost; one in six parents provided additional weekly childcare. Higher pain severity was associated with higher ED (+33%) and outpatient visits (+20%), more medication use (+35%), complementary and alternative medicine (CAM) use (+136%), and more school days missed (+48%). Higher pain interference was linked to more hospital admissions (+38%) and longer stays (+103%), greater outpatient (+21%), non-physician (+20%), CAM (+120%), medication use (+41%; opioids +138%), as well as more school (+100%) and parental workday loss (+133%). Higher HRQOL was associated with lower burden.

Conclusions: Pediatric painful ARP/CP imposes substantial direct and indirect burden. Interventions targeting pain and disability may reduce healthcare use and improve functioning and family well-being.

Objectives: Smoking is a key risk factor for pancreatitis, contributing to pathogenesis and disease progression. Data regarding secondhand smoking, or passive smoking (PS) exposure, are lacking. We therefore aimed to assess the impact of PS exposure across the pancreatitis spectrum.

Methods: We analyzed baseline data from the PROCEED study, a multicenter study in the US including patients with acute (AP), recurrent acute (RAP), and chronic (CP) pancreatitis. Participants detailed their individual smoking history and PS exposure, which was compared between AP, RAP, and CP subgroups. Participant factors and clinical characteristics were compared by level of individual and PS exposure.

Results: Among 1369 participants (190 AP, 498 RAP, 681 CP), 346 (25.3%) were current and 409 (29.9%) were former smokers. The CP subgroup had the highest proportion of current smokers (36.7% CP vs. 15.1% RAP, 11.1% AP, P<0.001). PS exposure was also significantly higher in the CP subgroup (68.6% CP vs. 58.2% RAP, 55.3% AP, P<0.001). A minority (16.3%) with CP reported no smoking exposure (by self or passive) while nearly half smoked ≥20 pack-years. The mean PS duration was significantly higher in CP participants (21.8 y) compared to those with AP (17.8 y) or RAP (18.9 y) (P<0.0166).

Conclusions: In this multicenter study, we affirmed an association with smoking use and intensity with CP-related complications. For the first time we report a high prevalence of prior exposure to passive smoking in all pancreatitis subtypes, which require further study to understand the impact on disease outcomes.

Objectives: The Clinical Practice Guidelines for Pancreatic Cancer were first published in 2006 by the Japan Pancreas Society and have been revised in 2009, 2013, 2016, 2019, and 2022. In July 2025, a newly revised version was released in Japanese.

Methods: This latest revision was developed in accordance with the Minds Manual for Guideline Development 2020, which incorporates the principles of GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to improve clarity, transparency, and reliability of the recommendations. Patients and citizens were actively involved in both the development and implementation processes.

Results: The guideline provides updated algorithms for the diagnosis, treatment, drug therapy, and precision medicine of pancreatic cancer, comprising 8 domains: diagnosis, surgical therapy, adjuvant therapy, radiation therapy, drug therapy, stent therapy, supportive and palliative care, and patient and citizen involvement. It includes 63 clinical questions and 99 corresponding statements, each accompanied by an evidence level, strength of recommendation, and consensus rate.

Conclusions: These guidelines represent the most comprehensive and standardized resource currently available in Japan for the clinical management of pancreatic cancer. This English synopsis aims to disseminate the 2025 edition of the Japanese Clinical Practice Guidelines for Pancreatic Cancer to a global audience and highlight the Japanese approach to pancreatic cancer care.

Background: Adjuvant chemotherapy (AC) provides an improved long-term survival chance for those with R0/R1 resection, following limited survival improvement space, as well as intolerable side effects. There is currently a gap in the use of macromolecule-targeted drugs (nimotuzumab) added to AC, so we developed this study.

Materials and methods: Resectable pancreatic cancers (RPC) were treated with surgery and postoperative chemotherapy with or without nimotuzumab. Demographic and clinical data were collected from the electronic medical records of Ruijin Hospital from May 2016 to July 2022. The primary efficacy endpoint was OS. Additional endpoints included disease-free survival (DFS) and adverse reactions (safety).

Results: Thirty-six RPC patients who had received AC with nimotuzumab (study arm) or 55 patients who had conducted AC alone (control arm) treatment out of the 795 patients screened. The median age was 61 years. The Barthel score was 99. The study arm demonstrated a prolonged median overall survival (mOS) and median disease-free survival (mDFS) trend compared with the control arm (mOS, 45.1 mo vs. 28.1 mo; mDFS, 20.0 mo vs. 13.0 mo). In the further exploratory analyses of KRAS mutation and KRASG12D types, the study arm also showed a survival benefit trend (mOS, 44.6 mo vs. 25.0 mo, mDFS, 30.9 mo vs. 10.3 mo in KRAS mutation; mOS, 36.2 mo vs. 19.6 mo in KRASG12D type). R0 patients with KRASG12D, the survival benefit on DFS was significantly different (mDFS, 16.0 mo vs. 9.9 mo; P =0.022). For adverse events grade 3 or higher calculated, the highest incidence of adverse reactions was slightly hematologic abnormalities, such as anemia, leukopenia, etc., in both groups. No grade 4 or above adverse reactions were observed.

Conclusions: By adding nimotuzumab to existing gemcitabine-based AC regimens, RPC patients would show a survival benefit trend with a satisfactory safety profile.

Pancreatic surgery is complex and associated with a high morbidity, so its development was slow after an initial phase of anatomical studies from the 16th century and exploration of its physiology 3 centuries later. Pancreatic surgery began in the mid-19th century, with simple procedures like external and internal drainage. The first distal pancreatectomies were performed in the late 1800s, while the first cephalic resections, more complex and more risky than distal ones, were performed progressively with several steps from 1898 to 1935. However, the high morbidity and mortality associated with pancreatectomies, mainly related to postoperative pancreatic fistula, limited the development of pancreatic surgery for decades. From the 1980s, the concept of high-volume centers emerged, resulting in decreased mortality and thus enlargement of indications, particularly for benign or inflammatory diseases. The management of postoperative complications has improved with intensive care and interventional radiology. In parallel, surgery for pancreatic adenocarcinoma was completed since the 1990s by adjuvant chemotherapy, then by neodadjuvant treatments, allowing more resections with a more favorable prognosis. More recently, islet cell transplantation, an alternative to pancreatic transplantation, and minimally invasive surgery have expanded the possibilities of less aggressive pancreatic surgery.

Background: Acute pancreatitis (AP) is a common cause of acute abdominal pain, and about 25% of AP patients will develop severe acute pancreatitis (SAP), causing damage to multiple organ functions and eventually death. Ferroptosis has recently been identified as significantly contributing to SAP progression. Our study aims to elucidate a novel mechanism of ferroptosis that which O-GlcNAcylation of ATF3 regulates in the context of SAP.

Methods: AR42J cells were treated with L-Arginine to induce SAP cell model. Levels of GSH, MDA, LPO, Fe2+, and LDH were measured by their commercial kits. The Fura-3 AM probes and C11 BODIPY 581/591 probe were used to detect Ca2+ levels or lipid ROS. To demonstrate the regulatory relationship between ATF3 and ACSL1, ChIP and dual-luciferase reporter assays were applied. Co-IP and sWGA pull-down assays were conducted to verify the O-GlcNAcylation level. The co-localization of OGT and ATF3 was displayed by immunofluorescence. Male SD rats were intraperitoneally injected with L-Arginine to establish a SAP model. Pancreatic histopathological alterations were subsequently evaluated by HE staining.

Results: Ferroptosis and ATF3 increased by treating L-Arginine in AR42J cells. ATF3 knockdown suppressed MDA, LPO, Fe2+, and lipid ROS levels but improved GSH and cell viability. OGT was elevated in SAP, and it promoted the O-GlcNAcylation of ATF3, resulting in the aggravation of ferroptosis. Both OGT inhibitor and OGT knockdown limited O-GlcNAcylation, ATF3, and ACSL1 levels. ATF3 directly bound to the promoter region of ACSL1 to upregulate its expression. ACSL1 overexpression abolished the suppression of ferroptosis in AR42J cells caused by ATF3 reduction. Inhibiting the ATF3 O-GlcNAcylation suppresses ferroptosis and attenuates pancreatic tissue injury in SAP rat.

Conclusion: The OGT-mediated O-GlcNAcylation of ATF3 is significantly enhanced, thereby promoting the transcriptional activity of ASCL1 and exacerbating ferroptosis in SAP.

Background: Standardized admission order entry systems (OES) and clinical decision support (CDS) tools can facilitate implementation of evidence-based practice. We conducted a mixed-methods analysis incorporating quantitative analysis of OES/CDS usage as well as qualitative analysis to identify barriers and facilitators related to usage of acute pancreatitis (AP)-specific OES-CDS.

Methods: Quantitative analysis: A retrospective cohort study of hospitalized encounters for AP (defined by diagnosis codes and lipase or amylase >3x normal) was conducted across 12 hospitals within an integrated health system from September 2014 through October 2022 to evaluate adoption of the AP OES/CDS, relationship to length-of-stay (LOS≥7 d), and in-hospital mortality adjusted for patient clinical and demographic characteristics. Qualitative analysis: Semi-structured interviews of focus groups identified themes related to perceived benefits, barriers, and improvements to the OES/CDS.

Results: Among 16,874 AP hospitalizations during the study, annual use of the AP OES/CDS peaked in 2021 at 7.4%. Use of AP OES/CDS was associated with reduction in prolonged LOS (OR: 0.81, 95% CI: 0.69-0.94). This finding was consistent after adjusting age, sex, race/ethnicity, and comorbidity indices. No significant difference in mortality was associated with OES usage (OR: 0.89, 95% CI: 0.61-1.32). Barriers to OES adoption included lack of awareness, competition with other tools, and complexity of patient case-mix.

Conclusion: Although adoption was limited, usage of an AP OES/CDS tool was associated with a decrease in prolonged length-of-stay. Future efforts to expand the reach of such instruments through provider awareness and refinement of the instrument may facilitate broader impact for management of patients with acute pancreatitis.