The purpose of this study is to develop bioimpedance spectroscopy methods for diagnosing pancreatic diseases. We developed a descriptor approach using impedance spectroscopy results, generating four amplitude-phase-frequency responses from four quasi-orthogonal leads. They create the feature spaces required for our hybrid classifier for diagnosing pancreatic diseases, consisting of five macro levels, the first of which is based on probabilistic neural networks, and the remaining four are based on fuzzy inference. We also presented a device structure for generating informative feature spaces. The use of multi-frequency sensing in classifiers based on fully connected neural networks made it possible to develop a clinical decision support system for diagnosing pancreatic diseases. The results were confirmed in groups of patients aged from 25 to 80 years, male and female, at different stages of pancreatic disease. The training and testing samples were formed using various diagnostic methods, including medical history, physical examination, assessment of comorbidities, laboratory tests, ultrasound, laparoscopy, intraoperative revision, and computed tomography. An assessment of the diagnostic quality indicators of a hybrid neural network for three classes of diseases: "pancreatic cancer," "chronic pancreatitis" and "without pancreatic pathology" showed that their maximum value for differentiating these classes of diseases was 89%, the minimum -63%. Experimental software studies and clinical trials of our decision support system demonstrated diagnostic sensitivity and specificity comparable to existing methods, validating the practicality of our methods. This research opens new possibilities for accessible and objective diagnosis of pancreatic diseases, expanding the ability to make intelligent medical decisions.

Ectopic parathyroid adenoma within the spectrum of Multiple Endocrine Neoplasia Type 1 (MEN1) is an extremely rare clinical entity. We report a 27-year-old woman who presented with acute pancreatitis as the sentinel manifestation of MEN1, an atypical and intriguing clinical scenario. Initially, her serum calcium levels were deceptively normal, only to surge later, unmasking a deeper endocrine pathology. Subsequent biochemical evaluation established primary hyperparathyroidism (PHPT), and a methoxyisobutylisonitrile (MIBI) scan revealed an ectopic parathyroid adenoma as the culprit lesion. Further endocrine profiling disclosed Cushing's syndrome (CS), confirmed through a low-dose dexamethasone suppression test, while a positive family history of MEN1-related tumors in her sister solidified the syndromic diagnosis. She was treated with aggressive hydration, analgesia, antibiotics, and supportive therapy, followed by successful parathyroidectomy. This case illustrates a remarkable convergence of conditions including ectopic parathyroid adenoma, acute pancreatitis, and MEN1 with the additional complexity of initially normocalcemic presentation during the acute phase of pancreatitis. Although the pathophysiological link between hypercalcemia and pancreatitis remains debated, pancreatitis secondary to hypercalcemia from primary hyperparathyroidism is rare, and its presentation as the first clue to MEN1 is exceptionally uncommon. ACTH-secreting pituitary adenomas causing CS are also a rare manifestation of MEN1, and the concomitant presence of an empty sella on brain Magnetic resonance imaging (MRI) further underscores the uniqueness of this case. To the best of our knowledge, this represents the first documented instance in which acute pancreatitis with normocalcemia concealed an underlying ectopic parathyroid adenoma in MEN1, accompanied by CS and an empty sella, making this a noteworthy clinical and diagnostic rarity.

Blood purification plays an important role in the treatment of severe acute pancreatitis. Extracorporeal blood anticoagulation is an important strategy to achieve smooth circulation in blood purification circuits. We aimed to investigate the efficacy, safety, and impact on circulating cytokines of using heparin or nafamostat mesylate anticoagulation in patients with severe acute pancreatitis during continuous renal replacement therapy.

Post-pancreatitis diabetes mellitus after acute pancreatitis (PPDM-A) is increasingly recognized as a distinct metabolic complication rather than a simple subtype of type 2 diabetes. This narrative review summarizes current evidence on PPDM-A, with emphasis on terminology, diagnostic timing, epidemiology, pathophysiology, risk factors, clinical phenotypes, screening, prevention, and long-term follow-up. A structured literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar to identify relevant studies. PPDM-A may develop after mild, moderately severe, or severe acute pancreatitis, although the risk is greatest in patients with pancreatic necrosis, recurrent attacks, exocrine pancreatic dysfunction, obesity, dyslipidemia, fatty liver disease, metabolic comorbidities, and marked in-hospital glycemic variability. A major diagnostic challenge is distinguishing transient stress hyperglycemia and previously unrecognized diabetes from incident PPDM-A. Formal diagnosis should generally be established no earlier than 90 days after the index episode of acute pancreatitis to minimize misclassification due to transient stress-related dysglycemia. Follow-up assessment should combine fasting plasma glucose and HbA1c, whereas a 75-g oral glucose tolerance test (OGTT) may provide greater sensitivity during early recovery, particularly when HbA1c is unreliable, results are borderline or discordant, or isolated postprandial dysglycemia is suspected. Current evidence indicates that PPDM-A develops through interacting pathogenic domains, including pancreatic endocrine injury with impaired β-cell reserve, metabolic dysregulation characterized by insulin resistance and persistent inflammation, exocrine pancreatic dysfunction with nutritional consequences, and emerging mechanisms involving gut microbiome alterations, bile acid-FGF19 signaling, and extracellular vesicle-mediated communication. Available data support a trajectory-based model in which some patients recover normal glucose metabolism, some develop persistent intermediate dysglycemia, and others progress to overt diabetes over months or years. Structured post-discharge surveillance, risk-stratified follow-up, assessment of exocrine dysfunction, and prevention of recurrent pancreatic injury are essential for improving early detection, reducing diagnostic misclassification, and optimizing long-term clinical outcomes.

Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced stage, highlighting the need for minimally invasive biomarkers capable of distinguishing it from related risk conditions. This study evaluated relative leukocyte telomere length (LTL) and gut microbiome profiles as potential biomarkers for PDAC. The study included 244 participants with PDAC (n = 37), chronic pancreatitis (CP; n = 56), type 2 diabetes mellitus (T2DM; n = 99), or no related risk conditions (controls; n = 52). LTL was measured by monochrome multiplex quantitative polymerase chain reaction (qPCR), while gut microbiome composition was assessed by 16S ribosomal RNA (rRNA) gene sequencing in a subset of participants with PDAC (n = 12), CP (n = 13), and controls (n = 7). LTL varied with age, sex, and smoking status. After adjustment for these factors, patients with PDAC had significantly longer LTL than controls (p = 0.029), whereas differences between PDAC and CP or T2DM were not significant. LTL showed limited ability to discriminate PDAC from controls (area under the receiver operating characteristic curve = 0.651) and was not associated with overall survival. Gut microbiome diversity and taxonomic composition did not differ significantly among the analyzed groups. These findings indicate that LTL has limited utility as a standalone diagnostic or prognostic biomarker for PDAC but may warrant further evaluation as a complementary marker in larger prospective studies. The exploratory microbiome findings also require validation in adequately powered cohorts.

Nephrocalcinosis refers to the deposition of calcium oxalate or calcium phosphate in the kidney, most commonly within the renal medulla, and is frequently linked with underlying metabolic abnormalities. Roux-en-Y gastric bypass (RYGB) is a well-established risk factor for enteric hyperoxaluria secondary to fat malabsorption, thereby increasing the risk of nephrolithiasis, oxalate nephropathy, and nephrocalcinosis. Despite this association, nephrocalcinosis following RYGB remains an uncommon and underrecognized clinical entity. A 36-year-old male with a history of complicated peptic ulcer disease, multiple prior abdominal surgeries, and previous RYGB presented with acute abdominal pain and distention. Laboratory evaluation revealed an elevated creatinine of 2.27 mg/dL, a suppressed parathyroid hormone level of 6.3 pg/mL, and hypocalcemia with serum calcium of 8.1 mg/dL. Imaging studies revealed bilateral renal medullary calcifications, consistent with nephrocalcinosis. Given the patient's history of RYGB, chronic pancreatitis, multiple GI surgeries, and evidence of chronic malnutrition, chronic malabsorptive physiology leading to enteric hyperoxaluria was hypothesized to be the most plausible explanation. However, measurements of 24-hour urinary oxalate, calcium, citrate, and vitamin D, as well as a renal biopsy, were not obtained, thereby precluding definitive confirmation of this proposed mechanism. This case highlights the importance of considering metabolic and renal complications in patients with complex GI disease following bariatric surgery and emphasizes the role of comprehensive metabolic evaluation and renal imaging in improving early recognition, diagnostic accuracy, and long-term kidney outcomes.

Objective: To investigate the clinical features of regional portal hypertension (RPH) in children whose primary presentation was isolated gastric fundal varices. Methods: This case series study reviewed clinical data from 8 children diagnosed with RPH complicated with isolated gastric fundal varices at Beijing Children's Hospital, Capital Medical University from June 2017 to January 2026. Data on demographics, clinical manifestations, laboratory findings, diagnosis, and treatment were extracted and analyzed for etiology, clinical characteristics, and outcomes. Results: Among 8 children there were 6 males and 2 females, with a diagnostic age of 2.2-11.5 years. The underlying etiologies were pancreatic in 6 children (5 with severe pancreatitis complicated by pancreatic pseudocyst, and 1 with pancreatic involvement secondary to acute leukemia), all involving pancreatic body and tail. One child was of splenic origin (disseminated tuberculosis with splenic involvement), and 1 child was retroperitoneal (secondary to retroperitoneal neuroblastoma). Presenting features included abdominal pain (7 children), vomiting (6 children), and gastrointestinal bleeding (2 children, 1 of whom with isolated hematemesis, another 1 with hematemesis and melena). Splenomegaly occurred in 7 children. Ascites observed in 5 children, was attributed to the primary disease rather than to RPH. All 8 children had normal platelets, 3 children presented with leukopenia and anemia, which were attributed to the primary disease and secondary lesions. All 8 children had normal liver function, and coagulation function, but all demonstrated splenic vein abnormalities. All 8 children received treatment targeting at the underlying etiology. Somatostatin was administered to 5 children, and hemostatic agents to the 2 children with gastrointestinal bleeding. No child underwent endoscopic intervention. The follow-up ranged from 2 months to 8 years; 1 child with tuberculosis was lost to follow-up. The remaining 7 children showed symptomatic relief and improvement or complete resolution of gastric fundal varices. Conclusions: Regional portal hypertension often manifests as isolated gastric fundus varices and splenomegaly, and may be accompanied by gastrointestinal bleeding. Pancreatic, splenic, and retroperitoneal etiologies should be vigilanted. Individualized treatment strategies focused on the primary disease are crucial for improving pediatric RPH outcomes.

An intraductal papillary mucinous neoplasm (IPMN) was incidentally detected in a 91-year-old woman 12 years before her current admission. The patient declined additional examinations and surgical intervention. Over the subsequent years, she experienced recurrent acute pancreatitis and ultimately developed a gastrointestinal perforation due to the rupture of the IPMN. Considering her age, general condition, and personal wishes, conservative management was selected, which allowed her to successfully resume oral intake until death from cancer. This rare clinical course provides valuable insights into the management of older adults with IPMN, a condition that is likely to be frequently encountered as the population ages.

Flavonoids exhibit a wide range of biological activities, including antioxidant, anti-inflammatory, antidiabetic, antitumor, antiproliferative, and hemorheological effects. This review discusses the hemorheological activity of flavonoids and the underlying mechanisms. The hemorheological activity of flavonoids and flavonoid complexes has been studied in both in vitro and in vivo models of myocardial infarction, arterial hypertension, atherosclerosis, cerebrovascular insufficiency, pancreatitis, hepatitis, and rheumatoid arthritis, as well as in aging animals. Flavonoids are known to decrease whole blood viscosity, reduce red blood cell (RBC) aggregation, improve RBC deformability, and even, in some cases, decrease fibrinogen levels and plasma viscosity. The key mechanisms underlying the hemorheological effects of flavonoids are the following: (1) antioxidant protection from oxidative stress and (2) stabilization of membrane fluidity. The antioxidant effect is mediated through neutralization of reactive oxygen species outside RBCs, within the RBC membrane, and in the cytoplasm, thereby protecting RBC membranes (both lipid and protein constituents) from oxidative damage. Flavonoids also contribute to the maintenance and enhancement of endogenous antioxidant defense systems in RBCs. Clinical trials of flavonoid-based agents have demonstrated both hemorheological activity and therapeutic efficacy in patients with diabetes mellitus, coronary heart disease, venous insufficiency, dyscirculatory encephalopathy, arterial hypertension, and other conditions. The introduction of effective and low-toxicity flavonoid preparations with hemorheological activity into treatment regimens for conditions associated with hyperviscosity syndrome may enable the development of new therapeutic strategies for many diseases and improve patient outcomes.

Retroperitoneal ectopic pregnancy (RPEP) is an exceedingly rare form of trophoblastic implantation within the retroperitoneal compartment, posterior to the parietal peritoneum and anatomically separate from the uterus, fallopian tubes, and ovaries. Proximity to major retroperitoneal vessels, including the abdominal aorta and inferior vena cava, creates potential for severe hemorrhage and complex operative management. Three mechanisms compound this risk by delaying diagnosis: transvaginal ultrasonography is physically limited to the true pelvis and cannot visualize supra-pelvic retroperitoneal implantations; persistent classification as pregnancy of unknown location defers extended imaging; and Zone I implantations may mimic acute pancreatitis, renal colic, or gastrointestinal illness, redirecting assessment away from obstetric consideration. This focused narrative review synthesizes published clinical experience of RPEP to identify recurring diagnostic pitfalls, anatomical patterns, and management themes, and to propose a practical framework for institutional use. The literature search encompassed PubMed/MEDLINE, Embase, Scopus, Google Scholar, and reference lists of relevant publications, from database inception to June 2026, using a structured set of RPEP-specific search terms. No meta-analysis was attempted because the evidence consists of case reports and small case series with heterogeneous reporting. Zone I para-aortic and interaortocaval implantation appears to be the most frequently reported anatomical pattern. Systemic methotrexate alone appears unsuitable as routine definitive therapy for high-risk phenotypes - characterized by elevated beta-hCG, embryonic cardiac activity, or major-vessel proximity. Multidisciplinary operative planning is essential in confirmed or probable cases. Based on this synthesis, we propose diagnostic categories for definite, probable, and possible RPEP; a five-zone surgical anatomical classification intended to support operative planning; and a seven-step institutional escalation framework. These proposals are derived exclusively from very low-certainty evidence consisting predominantly of case reports, small case series, and expert anatomical interpretation. They should be regarded as hypothesis-generating frameworks rather than evidence-based recommendations or validated clinical guidance and require prospective evaluation before clinical adoption.