Pancreas
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The objective of the study was to compare the accuracy of predictive methods for mortality in patients with severe acute pancreatitis (SAP) on admission and on the day when infection was confirmed. ⋯ The time when infection is confirmed is a better time point for the reassessment of the outcome in patients with SAP.
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The initial injury in acute pancreatitis is characteristically sterile and results in acinar cells necrosis. Intracellular contents released from damaged cells into the extracellular space serve as damage-associated molecular patterns (DAMPs) that trigger inflammation. There is increasing evidence that this sterile inflammatory response mediated through DAMPs released from necrotic acinar cells is a key determinant of further pancreatic injury, remote organ injury, and disease resolution in experimental models. ⋯ Genetic deletion and pharmacologic antagonism demonstrate that specific DAMP receptors, including Toll-like receptor (TLR) 4, TLR9, and P2X7, are also required for inflammation in experimental acute pancreatitis. Downstream DAMP-sensing components include nod-like receptor protein 3, caspase 1, interleukin-1β (IL-1), IL-18, and IL-1 receptor, and also are required for full experimental pancreatitis. These DAMP-mediated pathways provide novel therapeutic targets using antagonists of TLRs and other receptors.
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The objective of the study was to delineate surgical outcomes of pancreatoduodenectomy following neoadjuvant concurrent chemoradiation therapy (CCRT) in uncinate process pancreatic cancer (UPC). ⋯ Although UPCs are found in relatively advanced clinical stages, favorable oncologic outcomes may be obtained by pancreatectomy following preoperative CCRT.