Objective To summarize current research advances of mechanism and treatment of pancreatic endocrine and exocrine insufficiency in chronic pancreatitis. Method The related literatures about the research progress of the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis in recent years were retrieved and reviewed. Results In recent years, it had many new studies and discoveries on the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis. The mechanism of the pancreatic exocrine dysfunction was mainly due to the decrease of the pancreatin secretion in the patients with chronic pancreatitis. The mechanism of the pancreatic endocrine insufficiency was mainly due to the damage of the pancreatic exocrine gland and islet tissue in the chronic pancreas, which leaded to the destruction of the pancreatic endocrine cells, the other endocrine cells, and the disturbance of the intestine-islet axis, followed by the disorder of the various hormones (insulin, glucagon, pancreatic polypeptide, etc.), and eventually manifested the glucose tolerance or dominant diabetes. Conclusions At present, although there is a certain degree understanding for pancreatic endocrine and exocrine insufficiency in chronic pancreatitis, there are no breakthroughs in its mechanism and treatment, and effect is lack of large sample and multicenter clinical control study. Exploring more optimized detection methods and establishing a perfect treatment system is goal of future development and research.
ObjectiveTo summarize the remodeling of cholesterol metabolism in the occurrence and progression of pancreatic ductal adenocarcinoma (PDAC), and to review the research progress on targeted cholesterol metabolism in the treatment of PDAC. MethodRelevant literatures on cholesterol metabolism in the occurrence, development, and diagnosis and treatment of PDAC in recent years were searched and reviewed. ResultsMetabolites of PDAC tumor cells affected the expression of oncogenes or tumor suppressor genes. Signaling regulation within tumor cells affects cholesterol metabolism, characterized by increased de novo cholesterol synthesis and esterification, and reduced efflux. Tumor cells also regulated tumor immune microenvironment or tumor stroma formation through cholesterol metabolism. Inhibiting cholesterol metabolism could suppress the proliferation, invasion and migration of PDAC tumor cells, and combination therapy targeting cholesterol metabolism had a synergistic anti-PDAC effect. ConclusionsRemodeling of cholesterol metabolism occurs in both PDAC tumor cells and the tumor microenvironment, and is closely related to the occurrence, development, invasion, metastasis, and treatment response of PDAC. Targeting cholesterol metabolism or combined application with chemotherapy drugs can have anticancer effects. However, more research is needed to support the translation of cholesterol metabolism regulation into clinical treatment applications.
Objective To investigate the effect of the position of pancreatic duct in pancreatic section on postoperative pancreatic fistula. Methods The clinical data of patients undergoing pancreaticoduodenectomy admitted to the pancreatic surgery department of our hospital from September 2018 to August 2020 were retrospectively collected. The consistency between intraoperative pancreatic section data and preoperative CT cross-sectional images of pancreatic duct was compared, and the occurrence of postoperative pancreatic fistula was analyzed by univariate analysis and multivariate logistic regression model analysis, to determine whether the position of pancreatic duct on pancreatic section during pancreaticojejunostomy had an impact on the occurrence of postoperative pancreatic fistula. Results A total of 373 patients were included in this study. In 44 cases, the ratio of the thickness of the short distance from the center of the pancreatic duct to the edge of the pancreas at the pancreatic section was 0.41±0.09, and the imaging measurement value was 0.40±0.10. The interclass correlation coefficient detection value of the two measurement methods was 0.916 (>0.75), P<0.001, this had high consistency. Patients had a high BMI [OR=1.276, 95%CI (1.154, 1.411), P<0.000 1] and soft pancreatic texture [OR=2.771, 95%CI (1.558, 4.927), P=0.001] were independent risk factors for postoperative pancreatic fistula, while the risk of postoperative pancreatic fistula decreased with the increased proportion of pancreatic duct thickness from center to edge [OR=0.875, 95%CI (0.840, 0.911), P<0.000 1]. Conclusions Patients with high BMI and soft pancreas are independent risk factors for postoperative pancreatic fistula, and the risk of postoperative pancreatic fistula is reduced when the center of pancreatic duct is far from the edge of pancreas. The ratio of short distance from the center of pancreatic duct to the edge of pancreas to the total thickness of pancreas measured by preoperative imaging can be used to evaluate the risk of postoperative pancreatic fistula.