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- Effect of Aging and Diffuse Chronic Pancreatitis on Pancreas Elasticity Evaluated using Semiquantitative EUS Elastography. [JOURNAL ARTICLE]
- Ultraschall Med 2013 Dec 10.
Purpose: Endosonographic elastography has been introduced as a method of estimating the stiffness of pancreatic tumors. This prospective single-center study was conducted to evaluate changes in the stiffness of the pancreas related to age and diffuse chronic pancreatitis. Patients and Methods: 46 individuals each up to age 60 (group 1) and over age 60 (group 2) with healthy pancreata and 26 patients with diffuse chronic pancreatitis (group 3) were included. Three elastograms were obtained in each case by endosonography in a defined section through the pancreatic body. Elastograms were further evaluated by histogram analysis. Mean strain values, based on a range from 0 (hardest) to 255 (softest), and their standard deviation were calculated from the histogram. The three groups were compared statistically with regard to pancreatic stiffness. A cut-off level for the diagnosis of chronic pancreatitis was defined by testing receiver operating characteristics curves. Results: The strain values (mean, SD) measured in the pancreatic body in groups 1 - 3 were 110.2 (23.9), 80.0 (16.4), and 32.4 (11.9), respectively. Pairwise comparison of the groups revealed highly significant differences (p < 0.001). At a cut-off value of 50, the area under the curve was 0.993 for distinguishing between chronic pancreatitis and healthy pancreata in people aged over 60. Conclusion: Semiquantitative elastography shows that pancreata become significantly harder during aging, but remain softer than in chronic pancreatitis. A cut-off value of 50 is suggested as a possible diagnostic criterion for diffuse chronic pancreatitis.
- Splenic vein thrombosis and pancreatic fistula after minimally invasive distal pancreatectomy. [JOURNAL ARTICLE]
- Br J Surg 2013 Dec 10.
This study aimed to investigate the clinical relevance of splenic vein thrombosis (SVT) in the splenic vein remnant following minimally invasive distal pancreatosplenectomy (DPS).Medical records of patients who underwent laparoscopic or robotic distal pancreatectomy (DP) with or without splenectomy between January 2006 and August 2012 were reviewed. Rates of SVT and clinically relevant postoperative pancreatic fistula (POPF) were compared in a group of patients undergoing DPS and a group having spleen-preserving DP.Seventy-nine patients had minimally invasive DP, of whom 38 (48 per cent) developed SVT in the splenic vein remnant. DPS was associated with POPF (P = 0·001) and SVT (P < 0·001). SVT length was closely related to the amount of peripancreatic fluid collection (P = 0·025) and POPF (P = 0·045). In a comparison of splenic vessel-sacrificing, spleen-preserving DP and DPS, postoperative platelet count was significantly higher in the DPS group (P < 0·001). In addition, grade of SVT (P = 0·092) and POPF (P = 0·065) tended to be associated with DPS, suggesting that SVT may be related to both splenectomy and POPF.Minimally invasive DPS is associated with SVT and POPF. Preservation of the spleen should be considered when treating patients with benign and borderline malignant tumours of the distal pancreas.
- Enhanced FGFR signalling predisposes pancreatic cancer to the effect of a potent FGFR inhibitor in preclinical models. [JOURNAL ARTICLE]
- Br J Cancer 2013 Dec 10.
Background:Fibroblast growth factor receptor (FGFR) signalling has been implicated in pancreas carcinogenesis. We investigated the effect of FGFR inhibition in pancreatic cancer in complementary cancer models derived from cell lines and patient-derived primary tumour explants.Methods:The effects of FGFR signalling inhibition in pancreatic cancer were evaluated using anti-FRS2 shRNA and dovitinib. Pancreatic cancers with varying sensitivity to dovitinib were evaluated to determine potential predictive biomarkers of efficacy. Primary pancreatic explants with opposite extreme of biomarker expression were selected from 13 tumours for in vivo dovitinib treatment.Results:Treatment with anti-FRS2 shRNA induced significant in vitro cell kill in pancreatic cancer cells. Dovitinib treatment achieved similar effects and was mediated by Akt/Mcl-1 signalling in sensitive cells. Dovitinib efficacy correlated with FRS2 phosphorylation status, FGFR2 mRNA level and FGFR2 IIIb expression but not phosphorylation status of VEGFR2 and PDGFRβ. Using FGFR2 mRNA level, a proof-of-concept study using primary pancreatic cancer explants correctly identified the tumours' sensitivity to dovitinib.Conclusion:Inhibiting FGFR signalling using shRNA and dovitinib achieved significant anti-cancer cancer effects in pancreatic cancer. The effect was more pronounced in FGFR2 IIIb overexpressing pancreatic cancer that may be dependent on aberrant stimulation by stromal-derived FGF ligands.British Journal of Cancer advance online publication, 10 December 2013; doi:10.1038/bjc.2013.754 www.bjcancer.com.
- Incidence, Risk Factors and Clinical Course of Pancreatic Fluid Collections in Acute Pancreatitis. [JOURNAL ARTICLE]
- Dig Dis Sci 2013 Dec 11.
Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems. Acute fluid collections and pseudocyst formation are the most frequent complications of acute pancreatitis.The aims of this study were to evaluate the incidence, risk factors, and clinical course of pancreatic fluid collections and pseudocyst formation following acute pancreatitis.A prospective multicenter study was conducted in five participating centers with 302 patients diagnosed with acute pancreatitis from January 2011 to July 2012.The incidence of pancreatic fluid collections and pseudocyst was 42.7 and 6.3 %, respectively. Patients with fluid collections were significantly younger, compared to those without fluid collections (51.5 ± 15.9 vs. 60.4 ± 16.5 years, P = 0.000). The proportion of alcoholic etiology (54.3 %) in patients with fluid collections was significantly higher compared to other etiologies (P = 0.000). C-reactive protein (CRP) (48 h) was significantly higher in patients with fluid collections, compared to patients without fluid collections (39.2 ± 77.4 vs. 15.1 ± 36.2 mg/dL, P = 0.016). LDH (48 h) was significantly higher in patients with pseudocyst formation, compared to patients with complete resolution (1,317.6 ± 706.4 vs. 478.7 ± 190.5 IU/L, P = 0.000). Pancreatic fluid collections showed spontaneous resolution in 69.8 % (90/129) and 84.2 % of the pseudocysts disappeared or decreased in size during follow up.Age, CRP (48 h), and alcohol etiology are risk factors for pancreatic fluid collections. LDH (48 h) appears to be a risk factor for pseudocyst formation. Most pseudocysts showed a decrease in size or spontaneous resolution with conservative management.
- Connexin 36 Mediates Blood Cell Flow in Mouse Pancreatic Islets. [JOURNAL ARTICLE]
- Am J Physiol Endocrinol Metab 2013 Dec 10.
The insulin-secreting β-cells are contained within islets of Langerhans, which are highly vascularized. Blood cell flow rates through islets are glucose-dependent, even though there are no changes in blood cell flow within in the surrounding exocrine pancreas. This suggests a specific mechanism of glucose-regulated blood flow in the islet. Pancreatic islets respond to elevated glucose with synchronous pulses of electrical activity and insulin secretion across all β-cells in the islet. Connexin 36 (Cx36) gap junctions between islet β-cells mediate this synchronization, which is lost in Cx36 knockout mice (Cx36(-/-)). This leads to glucose intolerance in these mice, despite normal plasma insulin levels and insulin sensitivity. Thus, we sought to investigate whether the glucose-dependent changes in intra-islet blood cell flow is also dependent on coordinated pulsatile electrical activity. We visualized and quantified blood cell flow using high speed in vivo fluorescence imaging of labeled red blood cells and plasma. Utilizing a live animal glucose clamp, blood cell flow was measured during either hypoglycemia (~50 mg/dl) or hyperglycemia (~300 mg/dl). In contrast to the large glucose-dependent islet blood velocity changes observed in wild type mice, only minimal differences are observed in both Cx36(+/-) and Cx36(-/-) mice. This observation supports a novel model where intra-islet blood cell flow is regulated by the coordinated electrical activity in the islet β-cells. Since Cx36 expression and function is reduced in type 2 diabetes, the resulting defect in intra-islet blood cell flow regulation may also play a significant role in diabetic pathology.
- Translational Research in Pancreatic Cancer: KRAS and Beyond. [Journal Article]
- Pancreas 2014 Jan; 43(1):150-2.
- A New Mouse Model of Chronic Pancreatitis in C57BL/6J Strain That Mimics the Human Pathology. [Journal Article]
- Pancreas 2014 Jan; 43(1):148-50.