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Journal of Magnetic Resonance Imaging :... Dec 2022The feasibility and reproducibility of multifrequency MR elastography (MRE) for diagnosing pancreatic ductal adenocarcinoma (PDAC) have not been reported.
BACKGROUND
The feasibility and reproducibility of multifrequency MR elastography (MRE) for diagnosing pancreatic ductal adenocarcinoma (PDAC) have not been reported.
PURPOSE
To determine the feasibility and reproducibility of multifrequency MRE for assessing pancreatic stiffness in healthy and diseased pancreases.
STUDY TYPE
Prospective.
SUBJECTS
A total of 40 healthy volunteers and 10 patients with PDAC were prospectively recruited between March 2018 and October 2021.
FIELD STRENGTH/SEQUENCE
A 3.0-T pancreatic MRE at frequencies in the order of 30, 40, 60, 80, and 100 Hz.
ASSESSMENT
Body mass index (BMI) and wave distance of the healthy pancreas and PDAC were measured. Image quality was assessed using the image quality score (IQS: 1-4, ≥3 were considered diagnostic quality). Three readers independently performed the pancreatic stiffness and IQS assessments to evaluate reproducibility.
STATISTICAL TESTS
Logistic regression analyses were performed to determine variables that influenced IQS. Statistical significance was set at P <0.05. Levels of inter- and intrarater agreement were assessed using intraclass correlation coefficients (ICC) and Cohen's kappa coefficient (κ). Good reproducibility was set at ICC and κ ≥ 0.8.
RESULTS
In logistic regression analysis, a diagnostic IQS in healthy volunteers was independently associated with a lower BMI (odds ratio [OR] = 0.89 kg/m ), shorter wave distance (OR = 0.70 cm ), and lower frequency (30 and 40 Hz: OR = 170.01 and 96.02). In PDAC, frequency was the only independent factor for diagnostic IQS (30-60 Hz: OR = 46.18, 46.18, and 17.20, respectively) with 100 Hz as a reference. In healthy volunteers, good reproducibility was observed at 30 and 40 Hz. In PDAC, good reproducibility was observed at 30-60 Hz.
DATA CONCLUSION
MRE at 30 and 40 Hz provides diagnostic wave images and reliable measurements of pancreatic stiffness in healthy volunteers. MRE at 30-60 Hz is acceptable for PDACs (IQS ≥ 3, ICC and κ ≥ 0.80).
EVIDENCE LEVEL
1 TECHNICAL EFFICACY: Stage 2.
Topics: Humans; Elasticity Imaging Techniques; Pancrelipase; Reproducibility of Results; Prospective Studies; Feasibility Studies; Pancreas; Magnetic Resonance Imaging; Pancreatic Neoplasms
PubMed: 35332973
DOI: 10.1002/jmri.28158 -
Pancreatology : Official Journal of the... Apr 2022
Topics: Humans; Islets of Langerhans; Islets of Langerhans Transplantation; Pancrelipase; Tissue Donors
PubMed: 35279352
DOI: 10.1016/j.pan.2022.03.004 -
Gan To Kagaku Ryoho. Cancer &... Dec 2021A man in his 60s underwent pancreaticoduodenectomy(PD)for ampullary cancer(pT3, N1, M0, pStage ⅡB). One year after the operation, lymph node recurrence was observed,...
A man in his 60s underwent pancreaticoduodenectomy(PD)for ampullary cancer(pT3, N1, M0, pStage ⅡB). One year after the operation, lymph node recurrence was observed, and gemcitabine/cisplatin regimen was introduced. Once the disease was controlled, but the tolerability of chemotherapy deteriorated due to severe anorexia and general fatigue around the 6th course of the regimen, thus we stopped the chemotherapy. The performance status was remarkably dropped and the oral intake was notably decreased, and subsequently he got hospitalized. Blood examination on admission showed signs of liver failure(Alb 1.9 g/dL, T-Bil 2.0 mg/dL, PT 36.2%, NH3 159μg/dL). CT scan revealed marked deterioration of fatty liver and newly recognized retention of ascites. We diagnosed this clinical state as liver dysfunction caused by aggravation of nonalcoholic fatty liver disease(NAFLD)due to pancreatic exocrine insufficiency after PD. Immediately pancreatic enzyme replacement therapy(pancrelipase)was performed, and liver function gradually improved. He was discharged 17 days after admission. One month after discharge, CT scan showed that the fatty liver was markedly improved and the ascites disappeared. Around the same time, the chemotherapy was able to be resumed with the improvement of general condition.
Topics: Ampulla of Vater; Common Bile Duct Neoplasms; Humans; Male; Non-alcoholic Fatty Liver Disease; Pancreas; Pancreaticoduodenectomy
PubMed: 35046340
DOI: No ID Found -
Pediatric Allergy and Immunology :... Feb 2022Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there are conflicting data about true prevalence of drug hypersensitivity in... (Review)
Review
BACKGROUND
Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there are conflicting data about true prevalence of drug hypersensitivity in children with CF.
METHODS
The suspicious drug hypersensitivity reactions (DHRs) of children with CF were enquired by the European Network for Drug Allergy (ENDA) questionnaire, and skin tests and/or drug provocation tests were performed according to the established guidelines.
RESULTS
Two hundred and nineteen children (48.9% boys; median [IQR] age, 8.4 years [4.8-12.4 years]) with cystic fibrosis were included in the study, among which 22 patients with 24 suspected DHRs were evaluated. Most of the suspected DHRs were of non-immediate (n = 16, 66.6%) type, and the offending drugs were amoxicillin-clavulanic acid (n = 7), macrolides (n = 4), trimethoprim-sulfamethoxazole (TMP/SMX) (n = 2), piperacillin-tazobactam (n = 1), pancrelipase (n = 1), and ursodeoxycholic acid (n = 1). Eight (33.3%) of the DHRs were classified as immediate (ceftriaxone [n = 2], ceftazidime [n = 2], meropenem [n = 1], AmBisome [n = 2], and vancomycin [n = 1]). The main clinical presentations were maculopapular eruption (41.6%) and urticaria (37.5%), accompanied by angioedema (8.3%), flushing (12.5%), and vomiting (8.3%). Nine skin tests (with beta-lactam protocol in 6 patients) and 24 DPTs were performed, and none of the skin tests revealed a positive result; however, 2 DPTs with TMP/SMX were positive.
CONCLUSION
Actual drug hypersensitivity was demonstrated in 2 of 219 patients (0.9%) with non-beta-lactam antibiotics. These results conflict with previous researches that showed higher drug hypersensitivity rates but are consistent with some recent studies. Allergological diagnostic workup is mandatory in patients with cystic fibrosis in case of a suspicious DHR.
Topics: Anti-Bacterial Agents; Child; Cystic Fibrosis; Drug Hypersensitivity; Female; Humans; Male; Skin Tests; beta-Lactams
PubMed: 34907613
DOI: 10.1111/pai.13719 -
Journal of Hepato-biliary-pancreatic... Apr 2022In the present study we aimed to prospectively assess the current prevalence and risk factors of nonalcoholic fatty liver disease (NAFLD) after total pancreatectomy (TP).
BACKGROUND/PURPOSE
In the present study we aimed to prospectively assess the current prevalence and risk factors of nonalcoholic fatty liver disease (NAFLD) after total pancreatectomy (TP).
METHODS
Between August 2015 and December 2017, we prospectively collected data from 68 Japanese centers on 148 consecutive patients who underwent TP whose computed tomography (CT) attenuation values were evaluated for 12 months. We defined post-TP NAFLD as a liver parenchyma CT value of less than 40 Hounsfield units (HU). Data on perioperative variables were retrieved from all patients and evaluated using univariate and multivariate analyses to identify the perioperative risk factors of NAFLD.
RESULTS
In this prospective cohort study, supplementation of pancreatic exocrine enzymes was provided to all 148 patients, and 97% of them were treated with high-titer pancrelipase (median dosage: 1800 mg) postoperatively. Indeed, 29 patients (19.6%) developed NAFLD within a year after TP. Multivariate analysis revealed that female sex (P = .002), higher body mass index (BMI) (P = .001), and postoperative diarrhea (P = .038) were independent risk factors for post-TP NAFLD. However, post-TP NAFLD ameliorated in 11 patients (37.9%) at 12 months after surgery.
CONCLUSIONS
Among patients with risk factors such as female sex, higher BMI, and postoperative diarrhea, attention should be paid to the occurrence of NAFLD after TP.
Topics: Diarrhea; Female; Humans; Incidence; Japan; Non-alcoholic Fatty Liver Disease; Pancreatectomy; Pancreaticoduodenectomy; Prospective Studies; Risk Factors
PubMed: 34863034
DOI: 10.1002/jhbp.1093 -
Internal Medicine (Tokyo, Japan) Jul 2022An 89-year-old woman underwent examinations for leg edema. Blood tests indicated low nutrition and low pancreatic enzymes, and a stool examination indicated fatty stool....
An 89-year-old woman underwent examinations for leg edema. Blood tests indicated low nutrition and low pancreatic enzymes, and a stool examination indicated fatty stool. Computed tomography showed pleural effusion, ascites, and cystic lesions in the pancreatic head and mural nodules within the cysts. Pancreatic juice cytology revealed adenocarcinoma. The diagnosis was pancreatic exocrine insufficiency caused by intraductal papillary mucinous carcinoma. The patient did not wish to undergo surgery. Therefore, diuretics, component nutrients, and pancreatic exocrine replacement therapy using pancrelipase were initiated. After starting treatment, her leg edema, pleural effusion, and ascites disappeared, and her activities of daily living improved markedly.
Topics: Activities of Daily Living; Adenocarcinoma, Mucinous; Adenocarcinoma, Papillary; Aged, 80 and over; Ascites; Carcinoma, Pancreatic Ductal; Edema; Exocrine Pancreatic Insufficiency; Female; Humans; Leg; Pancreatic Neoplasms; Pleural Effusion
PubMed: 34840231
DOI: 10.2169/internalmedicine.8611-21 -
Fitoterapia Jan 2022Since glucolipid metabolism disorders is often the mono-target therapy fails in managing blood glucose and lipid levels and the other complications, it is urgent and...
Since glucolipid metabolism disorders is often the mono-target therapy fails in managing blood glucose and lipid levels and the other complications, it is urgent and necessary to seek for the new potential drugs or functional food acting on multi-targets. The hypoglycemic and hypolipidemic dual activities of the root, stems and leaves of Desmodium caudatum, which is used for traditional Chinese medicine, was evaluated. Twelve extracts with different extraction conditions were prepared and extract 9 was find to exhibit potential inhibitory activities of fructose-1, 6-bisphosphatase (FBPase), α-glucosidase, and pancrelipase, as well as promote cellular glucose consumption and reduce cellular content of lipid. Five flavonoids were isolated and identified from extract 9, among which 8-prenylquercetin exhibited potent α-glucosidase (IC = 4.38 μM) and FBPase (IC = 3.62 μM) dual inhibitory activity, which were 75-fold higher than acarbose (IC = 330.10 μM) and comparable with AMP (IC = 2.92 μM). In addition, 8-prenylquercetin was able to promote glucose consumption and reduce lipid content. Besides, an efficient synthesis of the most potent 8-prenylquercetin was developed from inexpensive and commercially available rutin in 21% overall yield by 6 steps, which lay the foundation of preparation sufficient amount for follow-up study.
Topics: Apigenin; Blotting, Western; Fabaceae; Flavanones; Flavonoids; Glucose; Glycoside Hydrolase Inhibitors; Hep G2 Cells; Humans; Hydrogen-Ion Concentration; Inhibitory Concentration 50; Lipase; Plant Extracts; Quercetin; alpha-Glucosidases
PubMed: 34785238
DOI: 10.1016/j.fitote.2021.105083 -
International Journal of Biological... Dec 2021Pancreatic lipase (PL) is a key enzyme related to the prevention and treatment of obesity. The aim of the study was to evaluate the inhibitory effects of mulberry leaf...
Pancreatic lipase (PL) is a key enzyme related to the prevention and treatment of obesity. The aim of the study was to evaluate the inhibitory effects of mulberry leaf polysaccharides (MLP) on PL and possible interaction mechanism, inhibition on lipid accumulation in vitro and in vivo. The results revealed that MLP had obvious inhibitory effects on PL (P < 0.05). The interaction of MLP-PL complexes was in a spontaneous way driven by enthalpy, and hydrogen bonds were the main factors in the binding. MLP could significantly inhibit the development of lipid accumulation in HepG2 cells (P < 0.05). Furthermore, consumption of high-fat diet containing MLP showed protective effects on liver and adipose tissue damages in mice, and inhibited the lipid absorption in digestive tract. MLP also significantly reduced the increased expression level of pancreatic digestive enzymes (P < 0.05). The study indicated that the anti-obesity effect of MLP might be caused by inhibition of lipid absorption via reducing PL activity.
Topics: Adipose Tissue; Animals; Diet, High-Fat; Enzyme Activation; Enzyme Inhibitors; Humans; Lipid Metabolism; Liver; Mice; Molecular Weight; Morus; Obesity; Pancrelipase; Plant Extracts; Plant Leaves; Polysaccharides; Spectrum Analysis
PubMed: 34634334
DOI: 10.1016/j.ijbiomac.2021.10.010 -
Transplant International : Official... Sep 2021Static cold storage (SCS) is the standard method for pancreas preservation prior to transplantation; however, it does not permit organ assessment. Normothermic...
Static cold storage (SCS) is the standard method for pancreas preservation prior to transplantation; however, it does not permit organ assessment. Normothermic reperfusion (NR) is utilized clinically for other organs to assess viability. Our aim was to develop NR using normothermic machine perfusion technique to simulate reperfusion at the time of transplantation, enabling evaluation of oxygenated hypothermic machine perfusion (HMPO2) as a newer strategy to optimize pancreas preservation. 13 porcine pancreases procured after circulatory death were divided into 3 groups: 4 pancreases preserved using SCS, and 2 groups preserved by HMPO2 (n = 4 and n = 5, differing by type of preservation solution). Duration of perfusion or cold storage was 6 hours before the 1-hour assessment using NR. Outcome measures were perfusion characteristics, biochemistry and change in tissue water mass as oedema assessment. During NR, the HMPO2 groups demonstrated better perfusion characteristics, normal macroscopic appearances, decreased water mass and one HMPO2 group demonstrated a response to glucose stimulation. Conversely, the SCS group showed an increased water mass and developed early macroscopic appearances of oedema, interstitial haemorrhage and minimal portal outflow. This study suggests that ex situ assessment of pancreases by NR is promising, and that HMPO2 may be better than SCS.
Topics: Animals; Organ Preservation; Pancreas; Pancrelipase; Perfusion; Reperfusion; Swine
PubMed: 34448276
DOI: 10.1111/tri.13990 -
Journal of Pharmacy Practice Apr 2023A previous retrospective study documented restored patency to 48.2% of occluded enteral feeding tubes using alkalinized Creon pancreatic enzyme capsules. In light of...
A previous retrospective study documented restored patency to 48.2% of occluded enteral feeding tubes using alkalinized Creon pancreatic enzyme capsules. In light of the low efficacy rate, the institutional enteral feeding tube clearance protocol was subsequently revised to incorporate a newly marketed non-enteric-coated Viokace pancreatic enzyme tablet, despite the lack of published data for this indication. This study aims to evaluate the effectiveness of a Viokace-based alkalinized pancreatic enzyme protocol to clear occluded enteral feeding tubes in a university health system. This retrospective, cohort quality assurance study included adult and pediatric patients receiving a Viokace-based pancreatic enzyme protocol for enteral feeding tube occlusions in a university health system during a 12-month period. The primary outcome was effectiveness in enteral tube clearance as documented in the electronic medical record. Efficacy of the new protocol was also compared with a Creon-based alkalinized solution using historical data. The Viokace protocol successfully cleared 176 of the 277 (63.5%) occluded enteral feeding tubes occurring in 205 patients included in the analysis. The revised protocol was significantly more effective at clearing occluded enteral feeding tubes ( = 0.0056) than a protocol using Creon pancreatic enzyme capsules. According to this retrospective evaluation, an alkalinized Viokace pancreatic enzyme protocol was effective in clearing 63.5% of occluded enteral feeding tubes. This significantly higher success rate than previously documented with a Creon-based protocol supports the change in pancreatic enzyme formulations in the institutional protocol.
Topics: Adult; Humans; Child; Pancrelipase; Enteral Nutrition; Retrospective Studies; Drug Compounding
PubMed: 34340577
DOI: 10.1177/08971900211036590