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IUBMB Life Jan 2020There is an urgent need for the development of novel therapeutics options for diabetic patients given the high prevalence of diabetes worldwide and that, currently,... (Review)
Review
There is an urgent need for the development of novel therapeutics options for diabetic patients given the high prevalence of diabetes worldwide and that, currently, there is no cure for this disease. The transplantation of pancreatic islets that contain insulin-producing cells is a promising therapeutic alternative, particularly for type 1 diabetes. However, the shortage of organ donors constitutes a major limitation for this approach; thus, developing alternative sources of insulin-producing cells is of critical importance. In the last decade, our knowledge of the molecular mechanisms controlling embryonic pancreas development has significantly advanced. More importantly, this knowledge has provided the basis for the in vitro generation of insulin-producing cells from stem cells. Recent studies have revealed that GATA transcription factors are involved in various stages of pancreas formation and in the adult ß cell function. Here, we review the fundamental role of GATA transcription factors in pancreas morphogenesis and their association with congenital diseases associated with pancreas.
Topics: Animals; GATA Transcription Factors; Gene Expression Regulation, Developmental; Humans; Pancreas; Pancreatic Diseases; Signal Transduction
PubMed: 31580534
DOI: 10.1002/iub.2170 -
Journal of Gastroenterology Jan 2019Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide... (Review)
Review
Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide high-resolution images of the pancreas with a quality regarded as far surpassing that achieved on transabdominal ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). EUS is particularly useful for the detection of small pancreatic lesions, while EUS and its related techniques such as contrast-enhanced EUS (CE-EUS), EUS elastography, and EUS-guided fine needle aspiration (EUS-FNA) are also useful in the differential diagnosis of solid or cystic pancreatic lesions and the staging (T-staging, N-staging, and M-staging) of pancreatic cancers. In the diagnosis of pancreatic lesions, CE-EUS and EUS elastography play a complementary role to conventional EUS. When sampling is performed using EUS-FNA, CE-EUS and EUS elastography provide information on the target lesions. Thus, conventional EUS, CE-EUS, EUS elastography, and EUS-FNA are essential in the clinical investigation of pancreatic cancer.
Topics: Diagnosis, Differential; Elasticity Imaging Techniques; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Pancreatic Diseases; Pancreatic Neoplasms; Tomography, X-Ray Computed
PubMed: 30406288
DOI: 10.1007/s00535-018-1519-2 -
World Journal of Gastroenterology Mar 2022Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it is available in most endoscopic ultrasound machines, using either... (Review)
Review
Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it is available in most endoscopic ultrasound machines, using either qualitative or quantitative techniques. Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases, together with other imaging tests and clinical data. Elastography can be informative, especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions. However, further studies are necessary to standardize the method, increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses. Moreover, even if promising, elastography still provides little information in the evaluation of benign conditions.
Topics: Elasticity Imaging Techniques; Endosonography; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Reproducibility of Results
PubMed: 35317053
DOI: 10.3748/wjg.v28.i9.909 -
World Journal of Gastroenterology Jun 2021Acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer are three distinct pancreatic diseases with different prognoses and treatment options. However,... (Review)
Review
Acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer are three distinct pancreatic diseases with different prognoses and treatment options. However, it may be difficult to differentiate between benign and malignant disease. AP may be a first symptom of pancreatic cancer, particularly in patients between the ages of 56 and 75 with presumed idiopathic AP who had a concomitant diagnosis of new-onset diabetes mellitus or patients who present with CP at diagnosis of AP. In these patients, additional imaging is warranted, preferably by endoscopic ultrasonography. CP may lead to pancreatic cancer through oncogenic mutations, mostly in patients with hereditary CP, and in patients in whom risk factors for pancreatic cancer (, nicotine and alcohol abuse) are also present. Patients with -mediated CP and patients with a history of autosomal dominant hereditary CP without known genetic mutations may be considered for surveillance for pancreatic cancer. Pancreatic inflammation may mimic pancreatic cancer by appearing as a focal mass-forming lesion on imaging. Differentiation between the above mentioned benign and malignant disease may be facilitated by specific features like the duct-penetrating sign and the duct-to-parenchyma ratio. Research efforts are aimed towards developing a superior discriminant between pancreatitis and pancreatic cancer in the form of imaging modalities or biomarkers. This may aid clinicians in timely diagnosing pancreatic cancer in a potentially curable stage.
Topics: Acute Disease; Aged; Humans; Middle Aged; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis, Chronic
PubMed: 34163103
DOI: 10.3748/wjg.v27.i23.3148 -
Internal Medicine (Tokyo, Japan) Mar 2020Objectives To clarify the significance of ultrasonographically recorded pancreatic duct dilatation. Methods Various parameters predicting pancreatic disease were...
Objectives To clarify the significance of ultrasonographically recorded pancreatic duct dilatation. Methods Various parameters predicting pancreatic disease were evaluated in relation to pancreatic duct dilatation using data from medical checkups of healthy examinees. Results Records of 281,384 subjects were analyzed. Pancreatic duct dilatation (≥3 mm) was determined ultrasonographically in 524 patients (0.19%). Subsequent detailed examinations revealed the presence of pancreatic disease in 24.8% of these patients, including pancreatic cysts (15.6%) and chronic pancreatitis (4.9%). Pancreatic cancer was found in 6 cases (1.3%). Predictive factors of pancreatic diseases in examinees with pancreatic duct dilatation were investigated, and the diameter of the pancreatic duct (p<0.001) and HbA1c (p=0.003) were identified by a multivariate analysis. The diameter of the pancreatic duct (p<0.013), HbA1c (p=0.009), and body mass index (p=0.032) were identified as predictive factors in pancreatic cancer. The diameter of the pancreatic duct (p<0.001), age (p=0.006), and bilirubin (p=0.020) in pancreatic cyst as well as the diameter of the pancreatic duct (p<0.001), white blood cells (p=0.022), HbA1c (p=0.033), and alkaline phosphatase (p=0.043) in chronic pancreatitis were also identified. In patients with pancreatic duct dilatation, the optimal cut-off values were 3.5 mm and 6.1% for the pancreatic duct diameter and age, respectively, based on a receiver operating characteristic analysis. Conclusion In cases with ultrasonography-determined pancreatic duct dilatation, subsequent detailed examinations of the pancreas were necessary because of the high-prevalence rate of 24.8%. In particular, marked pancreatic duct dilatation (≥3.5 mm) and elevated HbA1c (≥6.1%) strongly suggest the presence of pancreatic diseases.
Topics: Adult; Aged; Body Mass Index; Cross-Sectional Studies; Diagnosis, Differential; Female; Glycated Hemoglobin; Humans; Japan; Male; Middle Aged; Pancreas; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatitis, Chronic; Prevalence; ROC Curve; Retrospective Studies; Ultrasonography
PubMed: 31813913
DOI: 10.2169/internalmedicine.3702-19 -
Pediatric Radiology Jan 2011Imaging plays a major role in the diagnostic work-up of children with hepatobiliary or pancreatic diseases. It consists mainly of US, CT and MRI, with US and MRI being... (Review)
Review
Imaging plays a major role in the diagnostic work-up of children with hepatobiliary or pancreatic diseases. It consists mainly of US, CT and MRI, with US and MRI being the preferred imaging modalities because of the lack of ionizing radiation. In this review the technique of US, CT and MRI in children will be addressed, followed by a comprehensive overview of the imaging characteristics of several hepatobiliary and pancreatic disease entities most common in the paediatric age group.
Topics: Child; Diagnostic Imaging; Humans; Liver Diseases; Magnetic Resonance Imaging; Pancreatic Diseases; Tomography, X-Ray Computed; Ultrasonography
PubMed: 20967540
DOI: 10.1007/s00247-010-1858-5 -
Diabetologia Oct 2020The islets of Langerhans are well embedded within the exocrine pancreas (the latter comprised of ducts and acini), but the nature of interactions between these... (Review)
Review
The islets of Langerhans are well embedded within the exocrine pancreas (the latter comprised of ducts and acini), but the nature of interactions between these pancreatic compartments and their role in determining normal islet function and survival are poorly understood. However, these interactions appear to be critical, as when pancreatic exocrine disease occurs, islet function and insulin secretion frequently decline to the point that diabetes ensues, termed pancreatogenic diabetes. The most common forms of pancreatogenic diabetes involve sustained exocrine disease leading to ductal obstruction, acinar inflammation, and fibro-fatty replacement of the exocrine pancreas that predates the development of dysfunction of the endocrine pancreas, as seen in chronic pancreatitis-associated diabetes and cystic fibrosis-related diabetes and, more rarely, MODY type 8. Intriguingly, a form of tumour-induced diabetes has been described that is associated with pancreatic ductal adenocarcinoma. Here, we review the similarities and differences among these forms of pancreatogenic diabetes, with the goal of highlighting the importance of exocrine/ductal homeostasis for the maintenance of pancreatic islet function and survival and to highlight the need for a better understanding of the mechanisms underlying these diverse conditions. Graphical abstract.
Topics: Animals; Carcinoma, Pancreatic Ductal; Cystic Fibrosis; Diabetes Mellitus; Humans; Islets of Langerhans; Pancreas, Exocrine; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis, Chronic
PubMed: 32894313
DOI: 10.1007/s00125-020-05210-8 -
Revista Espanola de Enfermedades... Dec 2018Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for the diagnosis and treatment of biliopancreatic disorders, and over one million ERCP...
Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for the diagnosis and treatment of biliopancreatic disorders, and over one million ERCP procedures are performed each year worldwide. ERCP has always been performed by a group of courageous endoscopists who on a daily basis managed to develop its full diagnostic and therapeutic potential over the technique's 50 years of lifespan, always making the most of radiographic images, ever secretly dreaming of directly viewing the banned, consigned-to-oblivion territory.
Topics: Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreatic Diseases
PubMed: 30466291
DOI: 10.17235/reed.2018.5991/2018 -
Gastroenterology Jun 2013A combination of genetic, environmental, and metabolic factors contribute to the development and recurrence of acute and chronic pancreatitis; information on all of... (Review)
Review
A combination of genetic, environmental, and metabolic factors contribute to the development and recurrence of acute and chronic pancreatitis; information on all of these is required to manage patients effectively. For example, variants that affect regulation of the protease, serine (PRSS)1-PRSS2, and claudin (CLDN)2 loci, rather than their coding sequences, interact with other genetic and environmental factors to affect disease development. New strategies are needed to use these data and determine their contribution to pathogenesis, because these variants differ from previously studied, rare variants in exons (coding regions) of genes such as PRSS1, SPINK1, cystic fibrosis transmembrane conductance regulator (CFTR), chymotrypsin (CTR)C, and calcium-sensing receptor (CASR). Learning how various genetic factors affect pancreatic cells and systems could lead to etiology-based therapies rather than treatment of symptoms.
Topics: Acute Disease; Disease Progression; Genetic Predisposition to Disease; Humans; Pancreatic Diseases; Pancreatitis, Chronic; Phenotype; Prognosis; Risk Factors; Time Factors
PubMed: 23622139
DOI: 10.1053/j.gastro.2013.01.069 -
Pancreatology : Official Journal of the... 2006During the last 15 years, endoscopic ultrasound (EUS) has become an important imaging procedure for diagnosis and management of pancreatic diseases. The clinical... (Review)
Review
During the last 15 years, endoscopic ultrasound (EUS) has become an important imaging procedure for diagnosis and management of pancreatic diseases. The clinical interest of EUS is now enhanced by interventional procedures. Noteworthy, fine-needle aspiration biopsy is one of the most important contributions of EUS, in particular for the investigation of patients with pancreatic cancer and cystic tumors. EUS-guided fine-needle aspiration appears to be a safe and reliable technique to obtain tissue from pancreatic masses with a low risk of complications. EUS became also a therapeutic procedure, especially applied for celiac plexus neurolysis, pseudocyst drainage, and pancreaticogastrostomy. Further developments are expected by improvement of needle devices such as pancreatic pseudocyst drainage kits. In the future, EUS might be also a support for local application of new treatments of pancreatic tumors, such as gene or cellular therapy products. In this review, we discuss the current clinical applications of interventional EUS and the future development for diagnosis and management of pancreatic diseases.
Topics: Animals; Biopsy, Needle; Endosonography; Humans; Neoplasms, Cystic, Mucinous, and Serous; Pancreatic Diseases; Pancreatic Neoplasms
PubMed: 16327280
DOI: 10.1159/000090022