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Medical Oncology (Northwood, London,... Apr 2022To evaluate omega-3 fatty acid-rich enteral nutrient effects in patients with unresectable or recurrent biliary tract or pancreatic cancers during chemotherapy. Enteric...
Effects of an enteral nutrient-rich therapy with omega-3 fatty acids in patients with unresectable or recurrent biliary tract cancer or pancreatic cancer during chemotherapy: a case-control study.
To evaluate omega-3 fatty acid-rich enteral nutrient effects in patients with unresectable or recurrent biliary tract or pancreatic cancers during chemotherapy. Enteric nutritional supplements containing omega-3 fatty acids (Racol) was administered to aforementioned patients with cancers during chemotherapy. The skeletal muscle mass and blood test data were obtained pre-administration and 28 and 56 days after. Patients with pancreatic cancer were administered the digestive enzyme supplement pancrelipase (LipaCreon) 28 days after the start of Racol administration. The number of chemotherapies skipped due to neutropenia was recorded for 2 months before and after enteral nutrient initiation. In all 39 patients, the skeletal muscle mass increased on day 56 versus baseline (median 17.3 kg vs. 14.8 kg, p < 0.01), number of chemotherapies skipped decreased (mean: 0.65 times/month vs. 1.3 times/month, p = 0.03), and retinol-binding protein (mean: 2.56 mg/dL vs. 2.42 mg/dL, p = 0.05) increased. Patients with pancreatic cancer showed increased blood eicosapentaenoic acid concentration on day 56 versus baseline (median: 48.1 μg/mL vs. 37.0 μg/mL, p = 0.04) and increased skeletal muscle mass (median 16.8 kg vs. 14.4 kg, p = 0.006). Baseline median neutrophil count increased significantly from 2200/μL at baseline to 2500/μL (p = 0.04). Patients with biliary tract cancer during chemotherapy also exhibited increased skeletal muscle mass following omega-3 supplementation (median 17.3 kg vs. 15.8 kg, p = 0.01). In patients undergoing chemotherapy for unresectable or post-recurrence pancreatic and biliary tract cancers, high-omega-3 fatty acid nutrition therapy use improved skeletal muscle maintenance and chemotherapy dosing intensity.
Topics: Biliary Tract Neoplasms; Case-Control Studies; Fatty Acids, Omega-3; Gastrointestinal Neoplasms; Humans; Nutrients; Pancreatic Neoplasms
PubMed: 35478069
DOI: 10.1007/s12032-021-01625-4 -
Surgical Case Reports Apr 2022Solid pseudopapillary neoplasms of the pancreas are rare. Moreover, pancreatoduodenectomy (PD) and postoperative care are not common in pediatric surgery. Herein, we...
BACKGROUND
Solid pseudopapillary neoplasms of the pancreas are rare. Moreover, pancreatoduodenectomy (PD) and postoperative care are not common in pediatric surgery. Herein, we report a case of PD and nonalcoholic fatty liver disease (NAFLD) after PD and present a literature review.
CASE PRESENTATION
A 10-year-old girl with a suspected liver tumor was referred to our hospital. Echography, enhanced computed tomography and magnetic resonance imaging showed that the tumor coexisted with the solid and cystic parts of the pancreatic head. Since the patient was a young woman and the imaging findings were consistent with that of pancreatic solid pseudopapillary neoplasms (SPNs), we diagnosed her with pancreatic SPN. Thereafter, PD was performed, and she was discharged 10 days after the operation. Although her postoperative course was mostly uneventful, she experienced few episodes of abdominal pain and diarrhea before hospital discharge. These symptoms subsequently became more frequent and severe. The patient was urgently readmitted to the hospital for watery steatorrhea and lower abdominal colic pain. Her serum aspartate aminotransferase and alanine aminotransferase levels were elevated, and a fatty liver was detected on echography. The patient was diagnosed with steatorrhea, peristaltic pain, and NAFLD after PD. Pancrelipase (containing pancreatic digestive enzymes), antidiarrheal agents, and probiotics were started. Dosage increase of these drugs reduced the defecation frequency and abdominal pain and switched diarrhea to loose stools. However, more lipids in meals or more meals caused diarrhea and abdominal pain. Therefore, the doses of these drugs were further increased, and another antidiarrheal agent, loperamide hydrochloride, was added. Exocrine pancreatic enzymes supplementation and careful follow-up should prevent NAFLD progression after PD. At present, the patient has occasional abdominal pain, but has tangible soft stools once or twice a day. Although echography still shows a mottled fatty liver, her hepatic enzymes are only mildly elevated.
CONCLUSIONS
Pediatric PD is rare, and residual pancreatic function is usually sufficient, unlike in adult cases. However, we experienced a case of NAFLD after PD for a pediatric pancreatic SPN, in which pancreatic enzyme supplementation effectively improved this condition. Further attention must be paid to worsening of NAFLD that can develop nonalcoholic steatohepatitis.
PubMed: 35381910
DOI: 10.1186/s40792-022-01414-9 -
Physiological Reports Apr 2022Viral infections are linked to the progression of inflammatory reactions and oxidative stress that play pivotal roles in systemic diseases. To confirm this phenomenon,...
Viral infections are linked to the progression of inflammatory reactions and oxidative stress that play pivotal roles in systemic diseases. To confirm this phenomenon, in the present study, TNF-α level and oxidative stress markers were examined in the liver, kidney, and pancreas of HTLV1-infected male BALB/c mice. To this end, twenty BALB/c mice were divided into HTLV1-infected mice that were inoculated with 1-million HTLV1-infected cells (MT-2), and the control groups. Two months after inoculation, the peripheral blood, mesenteric lymph nodes, liver, kidney, and pancreas were collected after deep anesthetization of mice (ketamine, 30 mg/kg). The extracted DNA of mesenteric lymph nodes was obtained to quantify proviral load (PVL) using quantitative real-time polymerase chain reaction (qRT-PCR). The levels of lipid peroxidation, total thiol (SH), nitric oxide (NO), TNF-α, catalase (CAT), and superoxide dismutase (SOD) activities were examined in the liver, kidney, and pancreases. Furthermore, histopathological changes in the liver and kidney were evaluated. In liver tissue, the levels of MDA, TNF-α, and blood cell infiltration were significantly increased, and the levels of CAT and SOD were significantly decreased. In the kidney, a reduction in SOD, CAT, and total SH and an increase in MDA and NO were observed. In the pancreas, CAT activity, total SH, and SOD were decreased, and the levels of MDA and NO were enhanced. In terms of TNF-α production, it has been shown that the level of this inflammatory cytokine was increased in the liver, kidney, and pancreas. The HTLV1 may have a role in inducing inflammatory reactions and oxidative stress pathways in the tissues.
Topics: Animals; Kidney; Liver; Male; Mice; Mice, Inbred BALB C; Oxidative Stress; Pancreas; Pancrelipase; Superoxide Dismutase
PubMed: 35373925
DOI: 10.14814/phy2.15243 -
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 -
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 -
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 -
BioMed Research International 2021Pancreatic enzyme replacement therapy (PERT) and fat predigestion are key in ensuring the optimal growth of patients with cystic fibrosis. Our study attempted to...
Pancreatic enzyme replacement therapy (PERT) and fat predigestion are key in ensuring the optimal growth of patients with cystic fibrosis. Our study attempted to highlight differences between fat predigestion and conventional PERT on body composition of young pigs with exocrine pancreatic insufficiency (EPI). EPI and healthy pigs were fed with high-fat diet for six weeks. During the last two weeks of the study, all pigs received additional nocturnal alimentation with Peptamen AF (PAF) and were divided into three groups: H-healthy pigs receiving PAF; P-EPI pigs receiving PAF+PERT; and L-EPI pigs receiving PAF predigested with an immobilized microbial lipase. Additional nocturnal alimentation increased the body weight gain of EPI pigs with better efficacy in P pigs. Humerus length and area in pigs in groups L and P were lower than that observed in pigs in group H ( value 0.005-0.088). However, bone mineral density and strength were significantly higher in P and L as compared to that of H pigs ( value 0.0026-0.0739). The gut structure was improved in P pigs. The levels of neurospecific proteins measured in the brain were mainly affected in P and less in L pigs as compared to H pigs. The beneficial effects of the nocturnal feeding with the semielemental diet in the prevention of EPI pigs' growth/development retardation are differently modified by PERT or fat predigestion in terms of growth, bone properties, neurospecific protein distribution, and gut structure.
Topics: Animals; Astrocytes; Body Composition; Bone and Bones; Diet; Enzyme Replacement Therapy; Exocrine Pancreatic Insufficiency; Feeding Behavior; Gastrointestinal Tract; Lipase; Nerve Tissue Proteins; Neurons; Pancrelipase; Swine; Weight Gain
PubMed: 34307664
DOI: 10.1155/2021/6647734 -
Animal Nutrition (Zhongguo Xu Mu Shou... Jun 2021The objective of this study was to investigate the effects of natural capsicum extract (NCE, containing 2% natural capsaicin, the rest is carrier) replacing...
Natural capsicum extract replacing chlortetracycline enhances performance via improving digestive enzyme activities, antioxidant capacity, anti-inflammatory function, and gut health in weaned pigs.
The objective of this study was to investigate the effects of natural capsicum extract (NCE, containing 2% natural capsaicin, the rest is carrier) replacing chlortetracycline (CTC) on performance, digestive enzyme activities, antioxidant capacity, inflammatory cytokines, and gut health in weaned pigs. A total of 108 weaned pigs (Duroc × [Landrace × Yorkshire], initial body weight = 8.68 ± 1.34 kg; weaned on d 28) were randomly allotted into 3 treatments with 6 replicate pens per treatment (3 barrows and 3 gilts per pen). The treatments include a corn-soybean meal basal diet as a control group (CON), a CTC group (basal diet + CTC at 75 mg/kg), and a NCE group (basal diet + NEC at 80 mg/kg). Compared with CON and CTC, NCE had increased ( < 0.05) average daily gain in phase 2 (d 15 to 28) and overall (d 1 to 28), and higher ( < 0.05) apparent total tract digestibility of gross energy, dry matter, crude protein, and organic matter in phase 1 (d 1 to 14). These pigs also had increased ( < 0.05) pancrelipase activity in pancreas, α-amylase, lipase and protease activities in the jejunal mucosa, and lipase activity in the ileal mucosa on d 28. Moreover, NCE had increased ( < 0.05) the contents of growth hormone, β-endorphin, 5-hydroxytryptamine, total antioxidant capacity, total superoxide dismutase, catalase, and IL-10, as well as decreased ( < 0.05) contents of malondialdehyde, tumor nuclear factor-α, interferon-γ, and interleukin-6 in serum on d 28 compared with CON and CTC. NCE showed higher ( < 0.05) propionic acid, butyric acid and total volatile fatty acids (VFA) contents, and increased ( < 0.05) relative abundance of in colon, as well as higher ( < 0.05) propionic acid and total volatile fatty acids in cecum on d 28 compared with CON. In conclusion, NCE replacing CTC could enhance performance via improving digestive enzyme activities, antioxidant capacity, anti-inflammatory function, gut VFA composition and microbiota community in weaned pigs, and it could be used as a potential target for the development of feed additives.
PubMed: 34258418
DOI: 10.1016/j.aninu.2020.12.004 -
BMJ Case Reports Mar 2021A 61-year-old man was transferred to our facility from an outside hospital due to refractory neutropaenia of unknown aetiology. The patient presented to the referring...
A 61-year-old man was transferred to our facility from an outside hospital due to refractory neutropaenia of unknown aetiology. The patient presented to the referring hospital with a 5-day history of worsening diarrhoea and abdominal pain. Initial lab results at presentation showed severe neutropaenia with an absolute neutrophil count of 0. Investigations included a bone marrow biopsy which showed slightly hypocellular marrow with near absence of granulocytic precursors. A CT without contrast showed evidence of chronic pancreatitis and acute colitis. The patient's neutropaenia persisted despite granulocyte colony-stimulating factor therapy. The patient was, thus, transferred to our facility for a higher level of care. At our facility, the patient had rapid correction of neutropaenia after discontinuation of pancrelipase therapy. The patient's abdominal pain and diarrhoea also improved while off pancrelipase. Neutropaenia has completely resolved 6 weeks after discharge without any further therapy.
Topics: Granulocyte Colony-Stimulating Factor; Granulocytes; Humans; Leukocyte Count; Male; Middle Aged; Neutropenia; Pancrelipase
PubMed: 33753395
DOI: 10.1136/bcr-2021-241799 -
Journal of Human Nutrition and... Apr 2020Little is known about adults' experience of living with cystic fibrosis (CF) specifically in relation to the gut. However, their unique perspectives may be meaningful to...
BACKGROUND
Little is known about adults' experience of living with cystic fibrosis (CF) specifically in relation to the gut. However, their unique perspectives may be meaningful to children with CF and inform the understanding and practice of dietitians. The present study aimed to explore adults' lived experience of the CF gut and how they learnt to manage the gut as they were growing up.
METHODS
Semi-structured interviews were conducted with adult inpatients (n = 10). Interviews were audio-recorded, transcribed verbatim and accounts analysed using interpretative phenomenological analysis.
RESULTS
Three super-ordinate themes were identified: taking Creon, the learning process and this much I (now) know. Participants accounts of how CF affects the gut predominantly focused on taking Creon (pancreatin, Mylan). Various strategies were employed for coping with peer responses to taking Creon at school. Several participants reached adulthood before they understood and/or accepted that taking Creon consistently needed to be normal for them. Knowledge and understanding developed over time, with 'CF experience' and was shaped by family, CF care teams and other children with CF. All had unmet information needs when growing up. Having key explanations earlier, to make connections between eating, taking Creon, gaining weight and growth, did or would have helped most participants. Participants urged children to be assertive, ask questions and not only be involved in managing their diet and gut, but also begin to take control of this aspect of their CF.
CONCLUSIONS
Supporting development of knowledge, skills and confidence to manage diet and the gut needs to be integral to care throughout childhood.
Topics: Adult; Cystic Fibrosis; Diet; Female; Gastrointestinal Agents; Gastrointestinal Diseases; Health Knowledge, Attitudes, Practice; Humans; Inpatients; Male; Pancrelipase; Qualitative Research
PubMed: 31763740
DOI: 10.1111/jhn.12703