Pancreas最新文献

Objective: To investigate the contributing factors for the development of systemic inflammatory response syndrome (SIRS) in acute pancreatitis (AP) patients and subsequently develop a novel nomogram prediction model.

Methods: A multivariate logistic regression analysis was conducted to determine independent predictors of SIRS, where the variables were chosen based on statistical significance from univariate analysis. Based on their presence, 238 AP patients were grouped into non-SIRS (n=170) and SIRS (n=68). Logistic regression analysis identified independent predictors of SIRS complications. We then developed a visual nomogram prediction model alongside a logistic regression model. The model's predictive power cut-off was determined by receiver operating characteristic (ROC) curve analysis, providing sensitivity, specificity, and predictive accuracy.

Results: The study found that in the cohort of acute pancreatitis (AP) patients, systemic inflammatory response syndrome (SIRS) incidence was 28.6%. From our analysis, we determined that red blood cell distribution width (RDW), fibrinogen (FIB), amylase (AMY), blood glucose (Glu), and lactate dehydrogenase (LDH) were independent risk factors for SIRS. In addition, we calculated the area under the ROC curve (AUC) for our prediction model of SIRS reached 0.816, which exceeded the AUCs of the individual risk indicators (RDW, FIB, AMY, Glu, and LDH) and the bedside index of severity in acute pancreatitis (BISAP) score. In addition, we conducted a correlation analysis to validate the relationships among the predictive factors and to eliminate possible multicollinearity. The calibration curve plot showed that the nomogram agreed well between the predicted SIRS and actual risks. Finally, the clinical decision curve for our model also indicated its clinical utility by guiding decision-making for timely interventions at a threshold probability range of 0.4-1.

Conclusion: The model predicted non-SIRS with a critical value ≥0.332, a sensitivity of 71.3% and specificity of 87.1%, and a kappa value of 0.56. These results indicate that this prediction model is based on admission data, with recommended additional validation assessments at multiple time points (eg, 24, 48, and 72 h) to fully characterize the progression of SIRS's risk. Overall, this nomogram prediction model provides an efficient and simple means to predict SIRS for patients with AP.

Objectives: Walled-off pancreatic necrosis (WOPN) management has shifted towards greater emphasis on endoscopic methods, although practice variation persists. Percutaneous drains are still widely utilized, with or without transmural endoscopic stents, although the clinical impact of either single or combined approach has not been clarified. We aimed to assess efficacy of first-line endoscopic drainage of WOPN, and define characteristics associated with need for step-up to additional percutaneous drain, that is, dual modality drainage (DMD).

Methods: A single-center retrospective review was performed among patients who received endoscopic ultrasound (EUS)-guided transmural drainage for WOPN as index therapy. Patient characteristics, WOPN morphology and clinical course were assessed. The primary outcome was need for step-up to DMD.

Results: Fifty-six patients (32.1% women; median 54.5 y) were included, all who received initial EUS-drainage, with similar rates of LAMS usage and disconnected tail between groups. Thirty-seven patients (66.1%) were managed by endoscopic approach only (EAO). DMD patients had larger collection(s): 16.4 versus 11. 5 cm ( P =0.013) and more frequent pericolic extension (42.1% vs. 13.5%, P =0.043). Despite additional route of drainage, DMD patients required more total endoscopy sessions (4.7 vs. 3.3, P =0.010).

Conclusions: In patients receiving initial EUS drainage, the rate of step-up to DMD was 33.9%, highlighting that 2/3 of those with WOPN can be successfully managed by endoscopic means alone. Large size and pericolic extension were identified as predictors for need for step-up, and such features may be useful in identifying patients who may benefit from early dual approach.

Pancreatic neuroendocrine neoplasms (pNENs) are among the most frequently occurring neuroendocrine neoplasms (NENs). In this study, we aimed to investigate the role and impact of LncRNA-n336928 (n336928) in pNENs. We evaluated changes in cell proliferation using CCK-8, colony formation, and EDU assays, and assessed the effects on cell migration and invasion through transwell assays. RNA-seq analysis was performed to explore the potential mechanisms underlying n336928-induced pNEN progression. Subcutaneous tumorigenesis models were constructed to verify the function of n336928 in vivo. Our findings indicate that overexpression of n336928 significantly accelerated the proliferation, migration, and invasion of pNEN cell lines, while concurrently suppressing apoptosis. Furthermore, transcriptome sequencing revealed that the NF-κB pathway was activated in pNEN cells following n336928 overexpression. We have established that the upregulation of n336928 promotes the progression of pNENs through the NF-κB signaling pathway, thereby implicating it in the occurrence and development of pNENs.

Background: Autoimmune pancreatitis (AIP) is a rare but important etiology of pancreatitis due its steroid-responsive nature and association with IgG4-Related Disease (IgG4-RD). This study evaluated the prevalence and clinical characteristics of AIP in an Australian cohort, where a paucity of data exists. Diagnostic yield of IgG4 testing in acute pancreatitis was also evaluated.

Methods: Retrospective cohort study of patients aged above 18 years admitted with acute pancreatitis to a quaternary referral center in Melbourne, Australia, between August 2018 and August 2022. The International Consensus Diagnostic Criteria (ICDC) for AIP was applied to identify and classify patients with AIP. Frequency of IgG4 testing was recorded.

Results: Overall, 1468 patients were admitted with acute pancreatitis. Of these, 5 (0.3%) patients with AIP were identified: 3 (60%) were classified as type 1 AIP and 2 (40%) as type 2 AIP. All 3 patients with type 1 AIP had either pre-existing or new diagnosis of IgG4-RD. The median age of AIP diagnosis was 44 years and 4 (80%) were male. Three cases underwent further evaluation by endoscopic ultrasound with fine needle aspiration. All except 1 patient (lost to follow up, previously steroid responsive) were treated with oral corticosteroids with clinical and radiological improvement in all cases. Three patients had disease recurrence requiring steroid sparing agents. The cost of one IgG4 test was AUD $99.28. In total, 741 serum IgG4 tests were ordered across 642 (44%) patients, resulting in an average cost of AUD $18,391 per year and a pathology cost of AUD $14,713 per AIP diagnosis.

Conclusion: This study supports that AIP is a rare etiology of acute pancreatitis in a large Australian cohort of patients. IgG4 testing, while useful in certain circumstances, has a low diagnostic yield in patients presenting with acute pancreatitis, is expensive and should not be routinely tested in these patients.

Background: Animal models have been valuable tools for studying pathophysiology and testing novel therapeutic interventions for various pancreatic disorders. A comprehensive understanding of the anatomy of the pancreas in different animal species is essential for appropriate model selection for research applications. However, there is a scarcity of literature that systematically compares pancreatic anatomy across different animal species.

Methods: A comprehensive search of Embase, PubMed, and Biosis Preview databases was conducted from inception to March 2024 to identify full-text manuscripts that described the anatomy of the pancreas in various vertebrate animal classes. Established systematic review methods were followed for screening and data extraction.

Results: Seventy-two eligible studies were found in the literature search. The extracted data was organized into sections delineating the gross anatomy of the pancreas, pancreatic ducts, and histologic characteristics. An evolutionary trend in the organization of the pancreatic exocrine tissue was noted with a transition from a diffuse or dispersed form in primitive fish to a more compact configuration in higher vertebrate taxonomic levels. Similar trends were noted in the development of pancreatic ducts. The organization of the endocrine tissue of the pancreas varies significantly from species to species.

Conclusion: This comparative review highlights the structural and histologic organization of the pancreatic tissue across animal species. This review offers a key resource for translational researchers seeking to develop animal models to recapitulate the spectrum of pancreatic disorders observed in human patients.

Objectives: Smoking increases the risk of the first episode of acute pancreatitis (AP), its recurrence, and progression to chronic pancreatitis. Co-use of cigarettes with marijuana may exacerbate health risks, complicating pancreatitis management. Our study aims to investigate the lifetime smoking history and co-use of cigarettes and marijuana in AP patients.

Materials and methods: We analyzed smoking history and marijuana use data from a multicenter case-crossover study of alcohol-associated AP patients (n = 145) recruited from June 2020 to June 2024. Lifetime cigarette use was categorized as: history of smoking <1 pack per day (PPD), ≥1 PPD, and nonsmokers. Age-based smoking prevalence was estimated across 2 birth cohorts (1956-1979 and 1980-1998). Risk factors for co-use were also assessed.

Results: Of the 143 participants enrolled and who completed smoking history interview, 76% were current smokers and 24% were former smokers. Median cumulative pack-years of smoking until enrollment was 20.4 years in ≥1 PPD smokers versus 4.2 years in <1 PPD smokers ( P < 0.001). Peak smoking prevalence was higher in females born in 1980-1998 than females born in 1956-1979 (100% vs 67%), while males showed an opposite trend (61% for 1956-1979 vs 52% for 1980-1998). Of all participants, 20% reported co-use of cigarettes and marijuana, 22% cigarette-only use, and 14% marijuana-only use. Trauma and stressor-related disorders were associated with a lower likelihood of co-use than cigarette-only use (AOR: 0.19, 95% CI: 0.05-0.63, P = 0.010).

Conclusions: Smoking is highly prevalent in patients with alcohol-associated AP, many of whom also use marijuana. Tailored smoking cessation interventions are needed for AP patients.

Background: Oleoyl-ACP hydrolase (OLAH), a fatty acid metabolism-related gene, is abnormally expressed in many diseases. Using the GEO database, we found that OLAH was highly expressed in acute pancreatitis (AP) patients. However, whether it mediates hyperlipidemic AP (HAP) progression remains unclear.

Materials and methods: Mouse pancreatic acinar cells (MPC-83) were treated with palmitic acid (PA) and cerulein (CER) to mimic HAP cell models, and HAP mice models were constructed by injecting with P-407 and CER. The mRNA and protein levels of OLAH and Salmonella pathogenicity island 1 (SPI1) were determined by qRT-PCR and western blot. The oxidative stress and inflammation in MPC-83 cells and the pancreatic tissues of HAP mice models were assessed by measuring the levels of MDA, SOD, ROS, IL-1β, TNF-α and IL-6. Cell apoptosis was examined using flow cytometry. The interaction between SPI1 and OLAH promoter was evaluated using ChIP assay and dual-luciferase reporter assay.

Results: OLAH was upregulated in PA+CER-induced MPC-83 cells, and its silencing suppressed pancreatic acinar cell oxidative stress, inflammation and apoptosis. Transcription factor SPI1 bound to OLAH promoter region to enhance its expression. SPI1 knockdown inhibited PA+CER-induced MPC-83 cell oxidative stress, inflammation and apoptosis, as well as alleviated HAP process in mice models, while these effects were reversed by OLAH overexpression.

Conclusion: SPI1-mediated transcriptional activation of OLAH promoted pancreatic acinar cell oxidative stress, inflammation and apoptosis to accelerate HAP progression.