The BTB and CNC homology (BACH) proteins BACH1 and BACH2 are highly conserved transcriptional repressors that exert their effects by forming heterodimers with small musculoaponeurotic fibrosarcoma (MAF) proteins. BACH1 is ubiquitously expressed and functions by competing with nuclear factor erythroid 2-like 2 (NRF2) for binding to MAF. By suppressing the transcription of heme oxygenase 1 (HO-1/HMOX1), BACH1 inhibits the expression of genes involved in cellular oxidative stress responses. Expression of BACH2 is largely restricted to immune cells in both innate and adaptive compartments, where it plays a central role in hematopoietic development and immune cell differentiation. By engaging stretch or super-enhancers, BACH2 targets gene networks that include cytokines and cytokine receptors. Both BACH proteins have been implicated in numerous chronic diseases, including cancer and immune-mediated chronic inflammatory diseases. Aberrant activation is a key driver of BACH1-related pathogenesis, whereas BACH2 is typically linked to loss-of-function alterations. This article reviews the role of BACH proteins in diseases of the endocrine and exocrine pancreas, with a focus on type 1 and 2 diabetes mellitus, pancreatitis, and pancreatic cancer. Mechanistic aspects, pathophysiological correlations, and potential avenues for targeted therapies are discussed.

Chronic pancreatitis (CP) is an inflammatory syndrome that causes irreversible damage and loss of pancreatic function. A late complication is pancreatolithiasis, which exacerbates pain due to intraductal hypertension. In this work, we demonstrate that given the availability of different non-surgical treatment methods, if we are in the presence of dilated ducts, longitudinal pancreaticojejunostomy (Puestow procedure) is the best surgical drainage option. The clinical study is presented through the case of a 56-year-old man with idiopathic CP and recurrent lithiasis. The diagnosis was confirmed by magnetic resonance cholangiopancreatography. A lateral pancreaticojejunostomy was performed according to Puestow with Roux-Y anastomosis for ductal decompression. The intervention resolved ductal hypertension by allowing the drainage of liths. The patient was discharged after 10 days with improvement in liver profile and pancreatic enzymes, remaining asymptomatic during six months of follow-up. The Puestow procedure is a current and highly effective technique for refractory lithiasis CP. It is feasible in patients with stones larger than 2 mm, allowing complete functional recovery and preventing secondary complications.

Pancreatic fibrosis results from chronic pancreatitis, a critical pathological hallmark of pancreatitis and pancreatic insufficiency. This research explore the potential of synthesised nitrogen-containing heterocyclic indoline derivative (IB) encapsulated in alginate-capped silver nanoparticle (AG + IB) therapeutic against L-arginine (LAG) induced pancreatic fibrosis in adult zebrafish. AG + IB nanoconjugate were synthesised and characterized by UV-Vis spectrophotometer, FTIR, XRD, zeta potential, Tyndall effect and SEM/TEM analyses, confirming successful drug loading, a uniform morphological structure, stable dispersion, and pH-responsive release. In-vitro analysis demonstrated enhanced nitric oxide scavenging and protease inhibition by AG + IB compared to IB alone. Developmental toxicity assays confirmed 20 μM as safe and effective dose for in-vivo studies. LAG exposure significantly increases inflammatory stress in zebrafish pancreatic tissue leading to severe damage and reduced pancreatic function. However, AG + IB treatment markedly restored pancreatic architecture by decreased collagen deposition, normalized blood glucose level, and reversed oxidative stress. Additionally, restoring pancreatic architecture and alleviating oxidative stress normalized exocrine enzyme levels. Molecular analyse showed AG + IB downregulated key inflammatory markers, fibrogenic and remodelling genes. Histopathological examination further confirmed substantial protection against acinar cell atrophy, insulitis and fibrosis. These results indicate AG + IB holds great promise as a biocompatible nanotherapeutic for targeting chronic pancreatitis by modulating inflammation and oxidative stress.

Celiac plexus block (CPB) is an established interventional technique for the management of severe upper abdominal pain, particularly in patients with chronic pancreatitis (CP) and pancreatic cancer (PC). Pain in these conditions is complex, involving visceral and neuropathic mechanisms and, in CP, additional contributions from neuropathic remodeling, central sensitization, and altered descending modulation play a role.

A 22-year-old intact female donkey was referred for acute recumbency and inappetence. Physical examination revealed hypothermia, tachycardia and dermal abrasions consistent with prolonged recumbency. Clinicopathological findings included metabolic acidosis, electrolyte derangements and evidence of systemic inflammation. Despite intensive supportive care, the donkey's condition deteriorated, and euthanasia was elected 72 h after presentation. Post-mortem examination identified multilobulated pancreatic enlargement and oedema along with pulmonary fibrosis. Histopathology confirmed severe, necrotizing pancreatitis and chronic interstitial pulmonary fibrosis. This case underscores the diagnostic challenge of acute pancreatitis in equids, which often presents with non-specific clinical signs such as recumbency, and highlights the critical role of post-mortem examination in obtaining a definitive diagnosis.

ObjectivesIt remains unclear whether pancreatic lipase immunoreactivity (PLI) and lipase activity similarly reflect clinical status and disease severity in cats with suspected pancreatitis. This retrospective cohort study aimed to directly compare their association with clinical disease severity over timeMethodsTwenty-one client-owned cats with suspicion of pancreatitis were followed up over a median of 6 weeks (range, 1-130). The median number of re-checks was 2 (range, 1-9). Lipase activity (LIPC Roche; RI, 8-26 U/L) and PLI (Spec fPL; RI, 0-4.4 µg/L) were measured at each examination and compared to clinical status of cats expressed as a clinical disease activity score (CDAS).ResultsNo significant correlation between CDAS and either lipase assay was detected at the initial evaluation. During 50 follow-up visits, both lipase assays showed moderate correlations of similar magnitude with CDAS (lipase activity, rₛ = 0.486, P = 0.0003; PLI, rₛ = 0.432, P = 0.0017). Median lipase activity (46 U/L, range 20-421) and PLI (23 µg/L, range, 1.3-50), as well as CDAS (5, range 1-9) at initial presentation were significantly higher compared to follow-up visits (lipase activity 33 U/L, range 9-357; PLI 7 µg/L, range 0.7-50; CDAS 2, range 0-10). Seventeen cats had concurrent chronic enteropathy. Immunomodulatory therapy was administered during 31/50 (62%) follow-up visits compared to 4 (19%) cats at initial presentation. Discordant results relative to RIs were rare (3/72 visits, 4%), with normal lipase activity and mildly increased PLI; CDAS was 0 (n=2) or 1 (n=1) because of minimal weight loss in these 3 cats.Conclusions and relevanceBoth lipase assays provide clinically equivalent information, however a moderate correlation with clinical status was only seen during follow-up visits. The lack of correlation with clinical status in sicker cats may reflect the limited spectrum of clinical signs in feline pancreatitis.

Background: Patients with severe acute pancreatitis (SAP) are at high risk for developing chronic critical illness (CCI) and persistent inflammation, immunosuppression, and catabolism syndrome (PICS). However, the specific risk factors and prognostic implications of these conditions remain unclear. Methods: This single-center retrospective cohort study enrolled adult patients with SAP requiring ICU stay > 14 days. Least absolute shrinkage and selection operator (LASSO) regression was used to select risk factors, followed by multivariable logistic regression to identify independent predictors for CCI and PICS. Discriminative ability of early severity scores was assessed using the area under the curve (AUC) and compared via the DeLong's test. Kaplan-Meier and Cox regression evaluated in-hospital and 90-day mortality differences. Results: Among 156 SAP patients, 60 (38.5%) developed CCI, 38 (24.4%) progressed to PICS, and 32 (20.5%) met both criteria. After multivariable adjustment and sensitivity analyses, the computed tomography severity index (CTSI) emerged as an independent risk factor for both CCI (odds ratio [OR]: 1.40, 95% confidence interval [CI] 1.18-1.66) and PICS (OR: 1.56, 95% CI 1.29-1.89), with AUC values of 0.747 and 0.804, respectively. Significant differences in both the in-hospital and 90-day mortality rates were observed among the three groups (p < 0.001). The patients meeting both CCI and PICS criteria exhibited markedly increased risks of in-hospital (hazard ratio [HR]: 7.80, 95% CI 1.53-39.77; p = 0.013) and 90-day mortality (HR: 3.11, 95% CI 1.08-8.95; p = 0.035) after the multivariable adjustment. Conclusions: CTSI is an independent risk factor for CCI and PICS in patients with SAP. Both CCI and PICS were associated with a heightened risk of adverse outcomes. Future studies are warranted to explore the clinical characteristics and targeted interventions for this high-risk subgroup.

Diabetes mellitus (DM) is a complex metabolic disorder associated with a heightened risk of cardiovascular events, largely driven by a hypercoagulable and hypofibrinolytic state. The pathophysiological interplay between chronic hyperglycemia, oxidative stress, insulin resistance, and systemic inflammation fosters profound alterations in the coagulation cascade, endothelial function, and platelet activity. This narrative review synthesizes evidence from studies published between 2008 and 2026, focusing on coagulation and platelet-related biomarkers selected based on their biological relevance to thrombosis, endothelial dysfunction, and inflammation, as well as the availability of clinical and interventional data across different forms of DM. Although there are numerous biomarkers involved in the pathogenesis of various forms of diabetes, this narrative review critically examines key coagulation biomarkers-including D-dimer, fibrinogen, prothrombin, tissue thromboplastin or tissue factor, P-selectin, soluble urokinase plasminogen activator receptor, thrombomodulin, plasminogen activator inhibitor-1, von Willebrand factor, and β-thromboglobulin-across distinct diabetes subtypes, including type 1, type 2, gestational, and secondary forms linked to endocrinopathies and pancreatic diseases. The literature reveals substantial subtype-specific heterogeneity in hemostatic alterations. For instance, Type 1 DM is characterized by early endothelial dysfunction and platelet activation, while Type 2 DM presents with elevated coagulation factors, impaired fibrinolysis, and a proinflammatory milieu. Gestational DM exhibits pregnancy-specific changes in coagulation, yet distinguishing them from obesity-related effects remains challenging. Secondary diabetes forms, such as those associated with Cushing's syndrome or pancreatitis, further underscore the diversity in thrombotic risk profiles. Among the coagulation and platelet activation biomarkers reviewed, fibrinogen, P-selectin, and plasminogen activator inhibitor-1 demonstrate the most consistent associations with glycemic control, vascular dysfunction, and therapeutic modulation, particularly in type 2 diabetes, suggesting greater potential for clinical translation. In contrast, evidence for markers such as D-dimer, tissue factor or tissue thromboplastin, and soluble urokinase plasminogen activator receptor remains heterogeneous and insufficient for routine clinical application. By synthesizing mechanistic insights and clinical data, this review highlights the urgent need for subtype-tailored coagulation assessment in diabetes management. A better understanding of the dynamic alterations in coagulation pathways may facilitate earlier detection of vascular complications and inform personalized antithrombotic strategies.