Pub Date : 2023-02-08DOI: 10.1097/JP9.0000000000000120
Yongzheng Li, Jian Yang, Z. Fan, Peng Dong, Jing-Xi Hu, Shujie Liu, Yue Meng, Changhao Gao, Xin Gao, C. Pang, H. Zhan
Background and objective: The incidence of pancreatic neuroendocrine neoplasms (pNENs) has been increasing year by year, and pancreatic steatosis has been paid more and more attention to by clinicians. Our study aims to reveal the correlation between pancreatic steatosis, clinicopathological parameters, and the prognosis of patients with pNENs. Methods: The clinicopathological data of patients with pNENs who underwent surgical resections in our institution from January 2013 to May 2022 were retrospectively analyzed. The mean computed tomography (CT) values of the pancreas and spleen were used to assess the severity of the pancreatic steatosis. Pearson Chi-square test, T test, Mann Whitney U test, Univariate Cox regression, and Multivariate Cox regression were used to explore the relationship between pancreatic steatosis and age, sex, body mass index, tumor type, tumor location, tumor stage, blood lipid, prognosis, and other factors. Results: A total of 122 patients were included in our study, and 19.67% have pancreatic steatosis. The incidence of pancreatic steatosis was significantly higher in patients with fatty liver than in patients without fatty liver (36.8% vs 16.5%, P = .04). In insulinoma, the incidence of pancreatic steatosis in elderly patients was significantly higher than in young and middle-aged patients (41.7% vs 9.3%, P = .025). There was no significant difference in lipid levels between the pancreatic steatosis group and the non-pancreatic steatosis group (P > .05). Kaplan-Meier curves show that the prognosis of stage III/IV patients was significantly worse than that of stage I/II patients (P < .001). However, there was no significant difference in prognosis between patients with and without pancreatic steatosis (P = .404). Conclusion: The incidence of pancreatic steatosis was significantly higher in those with fatty liver than those without fatty liver. There is a high incidence of pancreatic steatosis in elderly patients with insulinoma. American Joint Committee on Cancer (AJCC) stage, but not pancreatic steatosis, significantly affected the prognosis of patients with pNENs.
背景与目的:胰腺神经内分泌肿瘤(pNENs)的发病率逐年上升，胰腺脂肪变性越来越受到临床医生的重视。我们的研究旨在揭示胰腺脂肪变性、临床病理参数和pNENs患者预后之间的关系。方法:回顾性分析我院2013年1月至2022年5月行手术切除的pNENs患者的临床病理资料。胰腺和脾脏的CT平均值被用来评估胰腺脂肪变性的严重程度。采用Pearson卡方检验、T检验、Mann Whitney U检验、单因素Cox回归和多因素Cox回归探讨胰腺脂肪变性与年龄、性别、体重指数、肿瘤类型、肿瘤部位、肿瘤分期、血脂、预后等因素的关系。结果:122例患者纳入本研究，其中19.67%为胰腺脂肪变性。脂肪肝患者胰腺脂肪变性的发生率明显高于非脂肪肝患者(36.8% vs 16.5%， P = 0.04)。在胰岛素瘤中，老年患者的胰腺脂肪变性发生率明显高于中青年患者(41.7% vs 9.3%， P = 0.025)。胰腺脂肪变性组与非胰腺脂肪变性组血脂水平差异无统计学意义(P < 0.05)。Kaplan-Meier曲线显示，III/IV期患者的预后明显差于I/II期患者(P < 0.001)。然而，胰腺脂肪变性患者与非胰腺脂肪变性患者的预后无显著差异(P = .404)。结论:脂肪肝患者胰腺脂肪变性的发生率明显高于非脂肪肝患者。老年胰岛素瘤患者胰腺脂肪变性的发生率较高。美国癌症联合委员会(AJCC)分期，而非胰腺脂肪变性，显著影响pNENs患者的预后。
{"title":"Pancreatic steatosis and its correlation with clinicopathological features in patients with pancreatic neuroendocrine neoplasms","authors":"Yongzheng Li, Jian Yang, Z. Fan, Peng Dong, Jing-Xi Hu, Shujie Liu, Yue Meng, Changhao Gao, Xin Gao, C. Pang, H. Zhan","doi":"10.1097/JP9.0000000000000120","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000120","url":null,"abstract":"Background and objective: The incidence of pancreatic neuroendocrine neoplasms (pNENs) has been increasing year by year, and pancreatic steatosis has been paid more and more attention to by clinicians. Our study aims to reveal the correlation between pancreatic steatosis, clinicopathological parameters, and the prognosis of patients with pNENs. Methods: The clinicopathological data of patients with pNENs who underwent surgical resections in our institution from January 2013 to May 2022 were retrospectively analyzed. The mean computed tomography (CT) values of the pancreas and spleen were used to assess the severity of the pancreatic steatosis. Pearson Chi-square test, T test, Mann Whitney U test, Univariate Cox regression, and Multivariate Cox regression were used to explore the relationship between pancreatic steatosis and age, sex, body mass index, tumor type, tumor location, tumor stage, blood lipid, prognosis, and other factors. Results: A total of 122 patients were included in our study, and 19.67% have pancreatic steatosis. The incidence of pancreatic steatosis was significantly higher in patients with fatty liver than in patients without fatty liver (36.8% vs 16.5%, P = .04). In insulinoma, the incidence of pancreatic steatosis in elderly patients was significantly higher than in young and middle-aged patients (41.7% vs 9.3%, P = .025). There was no significant difference in lipid levels between the pancreatic steatosis group and the non-pancreatic steatosis group (P > .05). Kaplan-Meier curves show that the prognosis of stage III/IV patients was significantly worse than that of stage I/II patients (P < .001). However, there was no significant difference in prognosis between patients with and without pancreatic steatosis (P = .404). Conclusion: The incidence of pancreatic steatosis was significantly higher in those with fatty liver than those without fatty liver. There is a high incidence of pancreatic steatosis in elderly patients with insulinoma. American Joint Committee on Cancer (AJCC) stage, but not pancreatic steatosis, significantly affected the prognosis of patients with pNENs.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"6 1","pages":"48 - 54"},"PeriodicalIF":0.0,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44820560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-07DOI: 10.1097/JP9.0000000000000116
Chunlu Tan, Zhiqing Yang, Jiang Li, Fengming Ji, S. Gou
Background: Pancreatic solid pseudopapillary neoplasms (SPNs) are low-grade malignant tumors of the pancreas. Organ-preserving surgery is being increasingly performed for these tumors, although there is little evidence to support its use. This retrospective multicenter study aimed to determine the clinicopathologic characteristics of pancreatic SPNs in Central and Western China and to determine the efficacy of organ-preserving surgery. Methods: The clinicopathologic, treatment and follow-up data of 227 pancreatic SPN patients treated between July 2003 and December 2016 at 5 tertiary care centers were retrospectively reviewed. Results: Among the 227 patients (38 males, 189 females; mean age 33.30 ± 12.70 years), only 72 (31.7%) had symptoms. The mean tumor size was 55.08 ± 29.56 mm. Adjacent organ/lymphovascular invasion was present in 16 (7.1%) patients and distant metastasis in 3 (1.3%) patients; no patient had spread to distant lymph nodes. Surgery included organ-preserving surgery in 108 (47.6%) patients, classic surgery in 115 (50.7%) patients, and palliative surgery in 4 (1.8%) patients. Tumor recurrence was seen in 8 (3.6%) patients. Cox regression analysis showed positive surgical margin (P < .01) and metastasis (P = .03) to be independent predictors of recurrence. Tumor characteristics were comparable between patients receiving organ-preserving surgery and classic surgery. The risk of recurrence was also similar in both groups (P = .72). Conclusions: Organ-preserving surgery appears to be an effective procedure for the treatment of pancreatic SPNs. Resection surgery should aim for negative surgical margins.
{"title":"Organ-preserving surgery and classic surgery for pancreatic solid pseudopapillary neoplasms: a multicenter analysis from Central and Western China","authors":"Chunlu Tan, Zhiqing Yang, Jiang Li, Fengming Ji, S. Gou","doi":"10.1097/JP9.0000000000000116","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000116","url":null,"abstract":"Background: Pancreatic solid pseudopapillary neoplasms (SPNs) are low-grade malignant tumors of the pancreas. Organ-preserving surgery is being increasingly performed for these tumors, although there is little evidence to support its use. This retrospective multicenter study aimed to determine the clinicopathologic characteristics of pancreatic SPNs in Central and Western China and to determine the efficacy of organ-preserving surgery. Methods: The clinicopathologic, treatment and follow-up data of 227 pancreatic SPN patients treated between July 2003 and December 2016 at 5 tertiary care centers were retrospectively reviewed. Results: Among the 227 patients (38 males, 189 females; mean age 33.30 ± 12.70 years), only 72 (31.7%) had symptoms. The mean tumor size was 55.08 ± 29.56 mm. Adjacent organ/lymphovascular invasion was present in 16 (7.1%) patients and distant metastasis in 3 (1.3%) patients; no patient had spread to distant lymph nodes. Surgery included organ-preserving surgery in 108 (47.6%) patients, classic surgery in 115 (50.7%) patients, and palliative surgery in 4 (1.8%) patients. Tumor recurrence was seen in 8 (3.6%) patients. Cox regression analysis showed positive surgical margin (P < .01) and metastasis (P = .03) to be independent predictors of recurrence. Tumor characteristics were comparable between patients receiving organ-preserving surgery and classic surgery. The risk of recurrence was also similar in both groups (P = .72). Conclusions: Organ-preserving surgery appears to be an effective procedure for the treatment of pancreatic SPNs. Resection surgery should aim for negative surgical margins.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"6 1","pages":"55 - 60"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42395006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pancreatic cancer with ovarian metastases is rare and easily misdiagnosed. Patients with ovarian metastases are first diagnosed with ovarian cancer and may miss the opportunity to receive surgical operation. We report 7 rare cases of ovarian metastases secondary to pancreatic adenocarcinoma and review the literature to analyze clinical characteristics, diagnostic methods, and potential therapeutic strategies for the rare malignancy. Cases Summary: We retrospectively analyzed the clinical data of 7 female patients with ovarian metastases of primary pancreatic cancer who were admitted to our hospital from January 01, 1985, to April 1, 2020. These 7 patients were diagnosed with ovarian metastasis at an average age of 52.28 (38–69) years. The reason for the patient’s visit was generally a mass in the lower abdomen and/or abdominal pain. Six of them had significantly higher serum Carbohydrate antigen19-9 (CA19-9) levels, 6 patients had pancreatic tumors located in the body or tail, and 1 patient had one in the head of the pancreas. All patients underwent excision of ovarian tumors and resection or biopsy of pancreatic tumors. Five patients had pancreatic ductal adenocarcinoma (PDAC), and 2 had pancreatic cystadenocarcinoma (PCC), all of which were revealed by the pathological results. Ovarian tumors were assessed by pathology and were consistent with pancreatic metastasis. Currently, all 7 patients have died (follow-up to January 2, 2021). The median survival time for all patients was 13.7 months (2.9–27 months). Conclusions: For this rare tumor, elevated serum CA19-9 may indicate that the primary lesion is in the pancreas. Enhanced pancreatic Computed Tomography (CT) can facilitate diagnostic localization. In addition, if the pancreatic tumor cannot be removed, the ovarian tumor should still be resected to reduce the tumor load and improve the quality of life.
{"title":"Pancreatic cancer with ovarian metastasis: cases report and literature review","authors":"Zeru Li, Xingtong Zhou, Bangbo Zhao, Zhibo Zheng, Cheng Qin, Xudong Liu, Huadan Xue, Weibin Wang","doi":"10.1097/JP9.0000000000000114","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000114","url":null,"abstract":"Background: Pancreatic cancer with ovarian metastases is rare and easily misdiagnosed. Patients with ovarian metastases are first diagnosed with ovarian cancer and may miss the opportunity to receive surgical operation. We report 7 rare cases of ovarian metastases secondary to pancreatic adenocarcinoma and review the literature to analyze clinical characteristics, diagnostic methods, and potential therapeutic strategies for the rare malignancy. Cases Summary: We retrospectively analyzed the clinical data of 7 female patients with ovarian metastases of primary pancreatic cancer who were admitted to our hospital from January 01, 1985, to April 1, 2020. These 7 patients were diagnosed with ovarian metastasis at an average age of 52.28 (38–69) years. The reason for the patient’s visit was generally a mass in the lower abdomen and/or abdominal pain. Six of them had significantly higher serum Carbohydrate antigen19-9 (CA19-9) levels, 6 patients had pancreatic tumors located in the body or tail, and 1 patient had one in the head of the pancreas. All patients underwent excision of ovarian tumors and resection or biopsy of pancreatic tumors. Five patients had pancreatic ductal adenocarcinoma (PDAC), and 2 had pancreatic cystadenocarcinoma (PCC), all of which were revealed by the pathological results. Ovarian tumors were assessed by pathology and were consistent with pancreatic metastasis. Currently, all 7 patients have died (follow-up to January 2, 2021). The median survival time for all patients was 13.7 months (2.9–27 months). Conclusions: For this rare tumor, elevated serum CA19-9 may indicate that the primary lesion is in the pancreas. Enhanced pancreatic Computed Tomography (CT) can facilitate diagnostic localization. In addition, if the pancreatic tumor cannot be removed, the ovarian tumor should still be resected to reduce the tumor load and improve the quality of life.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"6 1","pages":"34 - 39"},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45395831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-30DOI: 10.1097/JP9.0000000000000113
Yueyue Chen, Ningning Niu, J. Xue
Interferon-gamma (IFNγ) is a pleiotropic cytokine implicated in tumor immune surveillance, with its antiproliferative, pro-apoptotic, and immune-provoking effects. Regarding the antitumor effects of IFNγ, IFNγ-dependent therapies have been proposed and have undergone many clinical trials for various cancer types but the outcomes were not satisfactory. Recent studies have suggested that cancer cells develop immune evasion strategies to escape from IFNγ-dependent immunosurveillance by various mechanisms. In this review, we summarize recent advances in the effects and molecular mechanisms of IFNγ on target cells, as well as potential immune escape mechanisms of tumor cells. Furthermore, we discuss how to target IFNγ signaling and overcome immune evasion to provide promising therapeutic strategies for the treatment of patients with cancer.
{"title":"Double-edged roles of IFNγ in tumor elimination and immune escape","authors":"Yueyue Chen, Ningning Niu, J. Xue","doi":"10.1097/JP9.0000000000000113","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000113","url":null,"abstract":"Interferon-gamma (IFNγ) is a pleiotropic cytokine implicated in tumor immune surveillance, with its antiproliferative, pro-apoptotic, and immune-provoking effects. Regarding the antitumor effects of IFNγ, IFNγ-dependent therapies have been proposed and have undergone many clinical trials for various cancer types but the outcomes were not satisfactory. Recent studies have suggested that cancer cells develop immune evasion strategies to escape from IFNγ-dependent immunosurveillance by various mechanisms. In this review, we summarize recent advances in the effects and molecular mechanisms of IFNγ on target cells, as well as potential immune escape mechanisms of tumor cells. Furthermore, we discuss how to target IFNγ signaling and overcome immune evasion to provide promising therapeutic strategies for the treatment of patients with cancer.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"6 1","pages":"8 - 17"},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45684502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.1097/JP9.0000000000000115
Yuhui Chen, Zhiwei Liu, S. Cai
Background: Acute pancreatitis (AP) was a potentially fatal disease with a variation in severity. Infected pancreatic necrosis was a common complication in AP which needed surgical intervention. The present study was to study the correlative factors of death in patients with infected pancreatic necrosis after surgical intervention. Methods: From January 2016 to October 2019, a total of 186 patients with infected pancreatic necrosis after surgical intervention in the First Medical Center, Chinese PLA General Hospital were retrospectively enrolled in this study. Of the 186 patients, 22 who died in the hospital were defined as a mortality group and the others as a survival group. The clinical characteristic of the 2 groups was compared and the relative risk of mortality in patients with infected pancreatic necrosis after the surgical intervention was studied. Results: Acute fluid collection, acute kidney injury, acute lung injury, acute liver injury, multiple organ dysfunction syndromes, abdominal bleeding, abdominal Acinetobacter baumannii infection, pulmonary infection, pulmonary A baumannii infection, positive blood culture, A baumannii of blood culture, severe acute pancreatitis according to Atlanta 2012, the use of continuous renal replacement therapy, mechanical ventilation and minimally invasive retroperitoneal pancreatic necrosectomy was associated with death in hospital. Older age, longer acute kidney injury lasting time, longer acute lung injury lasting time, longer acute liver injury lasting time, and longer multiple organ dysfunction syndromes lasting time in predicting mortality in patients with infected pancreatic necrosis after surgical intervention were (0.635 [95% confidence interval (CI): 0.512–0.758], P = .040), (0.877 [95% CI: 0.788–0.965], P = .000], (0.932 [95% CI: 0.897–0.968], P = .000), (0.822 [95% CI: 0.708–0.935], P = .000), and (0.943 [95% CI: 0.887–0.998], P = .000). Due to the small number of death cases, the results of the multivariate analyses were not available. Conclusion: In this single-center retrospective study of 186 cases of infected pancreas necrosis, the correlative factors of death are identified. The results warranted further strategies are needed especially focusing on elder patients to prevent blood infection and to protect the functions of vital organs.
{"title":"Correlative factor of death in patients with infected pancreatic necrosis after surgical intervention","authors":"Yuhui Chen, Zhiwei Liu, S. Cai","doi":"10.1097/JP9.0000000000000115","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000115","url":null,"abstract":"Background: Acute pancreatitis (AP) was a potentially fatal disease with a variation in severity. Infected pancreatic necrosis was a common complication in AP which needed surgical intervention. The present study was to study the correlative factors of death in patients with infected pancreatic necrosis after surgical intervention. Methods: From January 2016 to October 2019, a total of 186 patients with infected pancreatic necrosis after surgical intervention in the First Medical Center, Chinese PLA General Hospital were retrospectively enrolled in this study. Of the 186 patients, 22 who died in the hospital were defined as a mortality group and the others as a survival group. The clinical characteristic of the 2 groups was compared and the relative risk of mortality in patients with infected pancreatic necrosis after the surgical intervention was studied. Results: Acute fluid collection, acute kidney injury, acute lung injury, acute liver injury, multiple organ dysfunction syndromes, abdominal bleeding, abdominal Acinetobacter baumannii infection, pulmonary infection, pulmonary A baumannii infection, positive blood culture, A baumannii of blood culture, severe acute pancreatitis according to Atlanta 2012, the use of continuous renal replacement therapy, mechanical ventilation and minimally invasive retroperitoneal pancreatic necrosectomy was associated with death in hospital. Older age, longer acute kidney injury lasting time, longer acute lung injury lasting time, longer acute liver injury lasting time, and longer multiple organ dysfunction syndromes lasting time in predicting mortality in patients with infected pancreatic necrosis after surgical intervention were (0.635 [95% confidence interval (CI): 0.512–0.758], P = .040), (0.877 [95% CI: 0.788–0.965], P = .000], (0.932 [95% CI: 0.897–0.968], P = .000), (0.822 [95% CI: 0.708–0.935], P = .000), and (0.943 [95% CI: 0.887–0.998], P = .000). Due to the small number of death cases, the results of the multivariate analyses were not available. Conclusion: In this single-center retrospective study of 186 cases of infected pancreas necrosis, the correlative factors of death are identified. The results warranted further strategies are needed especially focusing on elder patients to prevent blood infection and to protect the functions of vital organs.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 1","pages":"141 - 145"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47839340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.1097/JP9.0000000000000111
Jiaqi Cui, Di Wu, Huimin Zhou, Hai-yan Chen, Zhixia Dong, J. Yang
Acute pancreatitis (AP) is a disease characterized by local inflammation in the pancreas, followed by trypsin activation, and may result from multiple etiologies. Approximately 20% of AP can progress to severe acute pancreatitis (SAP), which can lead to systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndromes (MODS). SAP mortality rates have remained high in recent years, but there are currently no specific drugs designed to reduce these rates. Clinical studies have shown that patients can reduce the symptoms of the disease and slow down the development of the disease after taking the Chinese medicine decoction. Basic studies have shown that in AP or SAP disease models, the use of Chinese medicine monomers can improve the condition of rates. These natural Chinese herbal products can improve pancreatitis, given their ability to act on multiple targets. However, they have not been widely employed clinically and studied sufficiently and thoroughly. Therefore, this review aimed to summarize the pathophysiological mechanisms underlying pancreatitis and review the potential role of natural Chinese herbs (monomers and decoctions) in clinical and basic research.
{"title":"Natural Chinese herbs for the prevention and treatment of acute pancreatitis: a narrative review","authors":"Jiaqi Cui, Di Wu, Huimin Zhou, Hai-yan Chen, Zhixia Dong, J. Yang","doi":"10.1097/JP9.0000000000000111","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000111","url":null,"abstract":"Acute pancreatitis (AP) is a disease characterized by local inflammation in the pancreas, followed by trypsin activation, and may result from multiple etiologies. Approximately 20% of AP can progress to severe acute pancreatitis (SAP), which can lead to systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndromes (MODS). SAP mortality rates have remained high in recent years, but there are currently no specific drugs designed to reduce these rates. Clinical studies have shown that patients can reduce the symptoms of the disease and slow down the development of the disease after taking the Chinese medicine decoction. Basic studies have shown that in AP or SAP disease models, the use of Chinese medicine monomers can improve the condition of rates. These natural Chinese herbal products can improve pancreatitis, given their ability to act on multiple targets. However, they have not been widely employed clinically and studied sufficiently and thoroughly. Therefore, this review aimed to summarize the pathophysiological mechanisms underlying pancreatitis and review the potential role of natural Chinese herbs (monomers and decoctions) in clinical and basic research.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 1","pages":"186 - 197"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41355011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.1097/JP9.0000000000000110
Yuhui Chen, Mao-sheng Su, X. Xin, Zhiwei Liu, S. Cai
Background: Persistent external pancreatic fistula (EPF) in patients with pancreatic duct disruption or disconnection can result from minimal access to retroperitoneal pancreatic necrosectomy (MARPN) in severe acute pancreatitis patients, which is a difficult problem for clinicians and requires a long treatment duration. This study aimed to investigate the effectiveness and safety of trans-sinus gastric stent placement and drainage using interventional technology in the management of persistent EPF after MARPN in severe acute pancreatitis. Methods: From August 2018 to December 2020, the data of 9 patients with persistent EPF treated with trans-sinus gastric stent placement and drainage in our hospital were retrospectively collected. The main outcome measures were technical success rate, recurrence rate, new pancreatic fluid collection, morbidity, and mortality. All patients were followed up after the procedure through clinic visits and imaging modalities. Results: The median age of the patients was 46 years (30–61 years). The median persistent EPF duration was 5 months (2–12 months). The median follow-up time was 41 months (range, 20–47 months). The median operation time was 48 minutes (range, 40–54 minutes), and the technical success rate was 100%. Seven days after treatment, the percutaneous drainage tubes of all patients were removed. Six months after the procedure, 2 patients lost the stents, and one of those patients suffered from a pseudocyst, which gradually increased to a maximum diameter of 7 cm over 9 months. Therefore, a double pigtail drainage tube was placed under the guidance of an endoscope. The second of these 2 patients had no recurrence or pseudocyst. Twelve months after the procedure, another 3 patients lost the stents; 18 months after the procedure, another 2 patients lost the stents. These patients had no recurrence as well. No other adverse events or deaths occurred during the study period. Conclusion: Trans-sinus tract gastric stent placement and drainage are safe and effective in the treatment of persistent EPF after MARPN in severe acute pancreatitis patients. However, this study had a small sample size and did not include a comparative group.
{"title":"Clinical application of trans-sinus gastric stent placement and drainage in the management of persistent external pancreatic fistula after minimal access retroperitoneal pancreatic necrosectomy in severe acute pancreatitis patients","authors":"Yuhui Chen, Mao-sheng Su, X. Xin, Zhiwei Liu, S. Cai","doi":"10.1097/JP9.0000000000000110","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000110","url":null,"abstract":"Background: Persistent external pancreatic fistula (EPF) in patients with pancreatic duct disruption or disconnection can result from minimal access to retroperitoneal pancreatic necrosectomy (MARPN) in severe acute pancreatitis patients, which is a difficult problem for clinicians and requires a long treatment duration. This study aimed to investigate the effectiveness and safety of trans-sinus gastric stent placement and drainage using interventional technology in the management of persistent EPF after MARPN in severe acute pancreatitis. Methods: From August 2018 to December 2020, the data of 9 patients with persistent EPF treated with trans-sinus gastric stent placement and drainage in our hospital were retrospectively collected. The main outcome measures were technical success rate, recurrence rate, new pancreatic fluid collection, morbidity, and mortality. All patients were followed up after the procedure through clinic visits and imaging modalities. Results: The median age of the patients was 46 years (30–61 years). The median persistent EPF duration was 5 months (2–12 months). The median follow-up time was 41 months (range, 20–47 months). The median operation time was 48 minutes (range, 40–54 minutes), and the technical success rate was 100%. Seven days after treatment, the percutaneous drainage tubes of all patients were removed. Six months after the procedure, 2 patients lost the stents, and one of those patients suffered from a pseudocyst, which gradually increased to a maximum diameter of 7 cm over 9 months. Therefore, a double pigtail drainage tube was placed under the guidance of an endoscope. The second of these 2 patients had no recurrence or pseudocyst. Twelve months after the procedure, another 3 patients lost the stents; 18 months after the procedure, another 2 patients lost the stents. These patients had no recurrence as well. No other adverse events or deaths occurred during the study period. Conclusion: Trans-sinus tract gastric stent placement and drainage are safe and effective in the treatment of persistent EPF after MARPN in severe acute pancreatitis patients. However, this study had a small sample size and did not include a comparative group.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 1","pages":"146 - 150"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46075205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.1097/JP9.0000000000000112
Xin-Tian He, B. Sun, Y. Nie, Wen Zhang
Immunoglobulin G4 (IgG4)-related autoimmune pancreatitis (AIP), also known as “type 1 AIP,” is a rare, chronic, and fibroinflammatory disease manifested as obstructive jaundice and enlargement of the pancreas, usually accompanied by extra-pancreatic organ involvement. The understanding of IgG4-related AIP is gradually deepening. In this review, we summarized the basic concepts, common clinical manifestations, and new progress of the disease including diagnostic, therapeutic strategies, and prognosis mainly based on published case reports, cohort studies, meta-analyses, and guidelines in the past 5 years. Issues such as diagnostic markers, risk factors for relapse, and more effective treatment still need to be further studied.
{"title":"Recent advances in diagnosis, treatment, and prognosis of IgG4-related autoimmune pancreatitis: a narrative review","authors":"Xin-Tian He, B. Sun, Y. Nie, Wen Zhang","doi":"10.1097/JP9.0000000000000112","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000112","url":null,"abstract":"Immunoglobulin G4 (IgG4)-related autoimmune pancreatitis (AIP), also known as “type 1 AIP,” is a rare, chronic, and fibroinflammatory disease manifested as obstructive jaundice and enlargement of the pancreas, usually accompanied by extra-pancreatic organ involvement. The understanding of IgG4-related AIP is gradually deepening. In this review, we summarized the basic concepts, common clinical manifestations, and new progress of the disease including diagnostic, therapeutic strategies, and prognosis mainly based on published case reports, cohort studies, meta-analyses, and guidelines in the past 5 years. Issues such as diagnostic markers, risk factors for relapse, and more effective treatment still need to be further studied.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 1","pages":"202 - 209"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42966468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-24DOI: 10.1097/JP9.0000000000000109
Qiang Zhou, Dan Chen, Junfeng Zhang, Jifeng Xiang, Tao Zhang, Huaizhi Wang, Yanyan Zhang
Pancreatic ductal adenocarcinoma (PDAC) is the most common type and composes about 90% of pancreatic cancer featured with high intra-tumoral heterogeneity and poor prognosis, which has been considered the least immunogenic cancer for decades. However, this characterization might be over-simplistic, and more sophisticated approaches are needed to develop effective treatment strategies. In this review, we aim to summarize studies involving PDAC immunity in different aspects to provide a multidimensional recognition and comprehensively understanding of the mechanisms underlying the tumor microenvironment (TME) of PDAC. A database search of peer-reviewed articles published in English between 2003 and 2022 in PubMed and the Web of Science was performed. Original articles and review articles relevant to the topic were selected. We emphasized the importance of investigating tumor-infiltrating lymphocytes (TILs) in pancreatic cancer, especially focusing on CD8+ T cells, along with indicating potential therapeutic strategies to turn the immune-cold PDACs into the immune-hot ones.
胰腺导管腺癌（PDAC）是最常见的类型，约占癌症的90%，肿瘤内异质性高，预后差，几十年来一直被认为是免疫原性最低的癌症。然而，这种表征可能过于简单，需要更复杂的方法来制定有效的治疗策略。在这篇综述中，我们旨在总结不同方面涉及PDAC免疫的研究，以提供对PDAC肿瘤微环境（TME）潜在机制的多维认识和全面理解。对2003年至2022年间发表在PubMed和Web of Science上的英文同行评审文章进行了数据库搜索。选择了与该主题相关的原创文章和评论文章。我们强调了研究胰腺癌症中肿瘤浸润性淋巴细胞（TIL）的重要性，特别是关注CD8+T细胞，并指出了将免疫冷PDAC转化为免疫热PDAC的潜在治疗策略。
{"title":"Pancreatic ductal adenocarcinoma holds unique features to form an immunosuppressive microenvironment: a narrative review","authors":"Qiang Zhou, Dan Chen, Junfeng Zhang, Jifeng Xiang, Tao Zhang, Huaizhi Wang, Yanyan Zhang","doi":"10.1097/JP9.0000000000000109","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000109","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is the most common type and composes about 90% of pancreatic cancer featured with high intra-tumoral heterogeneity and poor prognosis, which has been considered the least immunogenic cancer for decades. However, this characterization might be over-simplistic, and more sophisticated approaches are needed to develop effective treatment strategies. In this review, we aim to summarize studies involving PDAC immunity in different aspects to provide a multidimensional recognition and comprehensively understanding of the mechanisms underlying the tumor microenvironment (TME) of PDAC. A database search of peer-reviewed articles published in English between 2003 and 2022 in PubMed and the Web of Science was performed. Original articles and review articles relevant to the topic were selected. We emphasized the importance of investigating tumor-infiltrating lymphocytes (TILs) in pancreatic cancer, especially focusing on CD8+ T cells, along with indicating potential therapeutic strategies to turn the immune-cold PDACs into the immune-hot ones.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 1","pages":"174 - 185"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43632606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-11DOI: 10.1097/jp9.0000000000000099
P. Müller, B. Müller-Stich, T. Hackert, F. Nickel
{"title":"Learning robotic distal pancreatectomy – The force awakens","authors":"P. Müller, B. Müller-Stich, T. Hackert, F. Nickel","doi":"10.1097/jp9.0000000000000099","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000099","url":null,"abstract":"","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45249645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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