Tropical calcific pancreatitis.........An overview

Tropical calcific pancreatitis is a nonalcoholic type of chronic pancreatitis affecting the childrens and young adults characterized clinically by recurrent abdominal pain in childhood, diabetes in adolescent and death in early childhood. Although the exact etiology is not known, malnutrition and chronic cassava toxicity either singly or in combination are presumed to be the prime factor in pancreatic injury unopposed by detoxification of free radical. Moreover micronutrients deficiency, oxidant stress and antioxidant deficiency might play substantial role. Diabetes secondary to tropical calcific pancreatitis is a distinctive and frequent problem, being named by W.H.O. study group as 'fibrocalculous pancreatic diabetes (FCPD) and classified as one of the variant of the so-called malnutrition related diabetes mellitus (MRDM).熱帯地方の貧困層の小児や若干成人にみられる非アルコール性の慢性膵炎で,小児期に反復する腹痛で発症し,10～20歳で膵性糖尿病になり,20～ 30歳で死亡する類似の病像を示す症例をTropical calcific pancreatitis(熱帯性石灰化慢性膵炎)という｡高率に膵石を伴う｡成因は乳幼児期からの熱量,蛋白貰,micronutrients(亜鉛,銅,セレニウム)の摂取不足に加えて食事中シアン産生物質や環境中oxidantsなど複合因子によると推測されている｡病理像は世界各国にみられる慢性膵炎典型例に類似する｡最近は,生活環境や医療事情の改善により,全身栄養障害の減少や生存期間 の延長など病像が変貌しっつある｡糖尿病を重視する立場からはFibrocalculous pancreatic diabetesと呼ばれ,同一地域にみられるProtein-deficient pancreatic diabetesと合わせてMalnutrition-related diabetes mellitus(MRDM)と総称し,糖尿病の一亜型に分類されている

Experimental model of chronic pancreatitis, a review - Does it really exist?

Experimental model of pancreatitis is mandatory for elucidating the pathobiology of the disease and also to see the response of a novel treatment. In addition, the need for an animal model of chronic pancreatitis is further strengthened by the relative inaccessibility and paucity of the human pancreatitis tissue. Whereas various models of acute pancreatitis and also of exocrine pancreatic tumor have been described, chronic pancr-eatitis has not been consistently reproduced in experimental animals. Many researchers attempted to establish an experimental model of chronic pancreatitis either by partially obstructing the drainage of pancreatic secretion in dogs and cats or by feeding alcohol to dogs and rats with and without temporary occlusion of the biliopancreatic duct or by surgically inducing ischaemia in the pancreas of the dogs. But, none of these models is identical with human disease. A consistently reproducible model of human chronic pancr-eatitis probably does not exist. In this expanding era of molecular biology which promises us to enhance greatly our understanding of this disease, a right experimental model of chronic pancreatitis is still in progress.疾患の実験モデルの作成は,その疾患の病因,病態の解明,さらに治療法の開発のために重要である｡筆者らの一人は厚生省難治性膵疾患調査研究班の班員として,慢性膵炎の病態の解明や治療法の開発に関する研究を行っており,その研究の一環として,慢性膵炎の実験モデルの作成を現在行っている｡そこで,これまで報告されている慢性膵炎の実験モデルについて概要を報告した｡種々の動物や方法でヒト慢性膵炎に病因,病態,組織像が類似するモデルの作成が試みられてきたが,そのすべてが合致するような慢性膵炎モデルは確 立されてはいない｡近年の分子生物学的研究の進歩は著しく,実験モデルへの応用が種々なされている現在,より簡便で再現性のある慢性膵炎モデルの作成が望まれるところである

Insights from the 19th Student Council Symposium (SCS2023), the first hybrid ISCB Student Council global event

The 19th ISCB Student Council Symposium (SCS2023) organized by ISCB-SC adopted a hybrid format for the first time, allowing participants to engage in-person in Lyon, France, and virtually via an interactive online platform. The symposium prioritized inclusivity, featuring on-site sessions, poster presentations, and social activities for in-person attendees, while virtual participants accessed live sessions, interactive Q&A, and a virtual exhibit hall. Attendee statistics revealed a global reach, with Europe as the major contributor. SCS2023’s success in bridging in-person and virtual experiences sets a precedent for future events in Computational Biology and Bioinformatics. Availability and Implementation: The details of the symposium, speaker information, schedules, and accepted abstracts, are available in the program booklet (https://doi.org/10.5281/zenodo.8173977). For organizers interested in adopting a similar hybrid model, it would be beneficial to have access to details regarding the online platform used, the types of sessions offered, and the challenges faced. Future iterations of SCS can address these aspects to further enhance accessibility and inclusivity.publishersversionpublishe

Study of the preparation with sodium picosulfate and PEG intestinal lavage solution for total colonoscopy.

Total colonoscopyの前処置における被検者の負担軽減と良好な腸管洗浄を得る目的で,50例の大腸内視鏡検査において,前日の食事制限せず, sodium picosulfate 20mℓ前夜服用,検査当日PEG腸管洗浄液1ℓ以上服用する前処置法の有用性について検討した。本前処置法によってPEG腸管洗浄液平均1230mℓの服用により,50例中48例で観察可能な腸管洗浄が得られ,PEG腸管洗浄液の服用量の減量が可能であった｡腹痛,嘔気,腹鳴などの症状出現例は認めたが,重篤な副作用は認めなかった｡腸管洗浄度の点で,高齢者の大腸内視鏡検査の前処置として有用である｡以上よりSodium Picosulfate 20mℓをPEG腸管洗浄液と併用することにより,優れた腸管洗浄度を得られると同時にPEG腸管洗浄液服用量の減量か可能であり,total colonoscopyの前処置として有用であることが示された。The following results were obtained from a total colonoscopic study of 50 patients who received preparation with 20mℓ of sodium picosulfate (Laxoberon®) and PEG intestinal lavage solution (Niflec®) prior to the examination. (l) The present method in combination with a mean of 1230mℓ of PEG intestinal lavage solution allowed colonic cleaning for which observation was available in 48 of 50 patients. (2) With this method. no adverse reactions were observed except for mild abdominal pain, nausea, and rugitus in a few patients. (3) This method was particularly as a preparation for colonoscopic examination in elderly patients. Thus, we conclude that preparation with 20mℓ of sodium picosulfate and PEG intestinal lavage solution is useful for colonoscopic examination

Clinical opplication of a newly developed radiographic system including a fluoroscope equiped with CCD and digital image processor

画像の入力部に世界初100万画素の多画素･高精細のCCD(電荷結合素子)を用いたテレビカメラを搭載したX線テレビ装置とDigital・Radiography装置を導入し,主に消化管検査を中心に多目的に任用した｡このシステムは従来のscreen/filmシステムの持つ膨大な情報量を確保しながらCCDカメラのメリットを最大限に生かしており,DRシステムの特長であるリアルタイムのCRT撮影画像表示,透視像のFREEZE確認,動態解析,画像処理等を導入することにより診断能の向上がはかれた｡更に,従来X線フィルム･撮像管に比較して被曝量の大幅な低減が期待できた｡また,デジタルであるため撮影像をHDに保管すると共にMODにも記録･再生が可能である｡今後,PACSやフイルムレス電子媒体保管への展開の可能性についても確認できた｡We have clinically applied a newly developed radiographic system which was introduced into our institute in April 1994. This system consists of a fluoroscope, CCD (charge-coupled device) which had a million matrix, and digital image processor. This system has following advantages comparison with a conventional radiographic system ; (1) doses of x-ray exposuce during examination is less, (2) a sharp fluoroscopic image can be obtained by real-time image processing, (3) radiographic images can be kept in the recording device such as hard disc (HD) and magnetic optical disc (MOD) since this has a digital radiographic system. By connecting this system with main online system, it is expected to be able to see the various diagnostic images simulataneously as well as laboratory data at different spots of the hospital which is now available in other hospltal

A case of multiple pancreatic cysts with K-ras point mutation in pure pancreatic juice

膵癌の早期診断を行うために,最近の進歩の著しい遺伝子診断を用いて,膵液中のK-ras遺伝子の点突然変異の検討がなされている｡われわれは膵液の細胞診は陰性であるが,K-ras遺伝子の点突然変異を認め,膵全体に多発する膵嚢胞の1例を経験した｡本例は悪性であるとの確診が得られないことや切除するとなれば膵全摘となることなどのために,経過観察を行っているが,18カ月後の現在,嚢胞の増大など認めていない｡膵癌の遺伝子診断の文献的考察を含め,報告する｡Pancreatic cancer is the one of the leading causes of death among cancer deaths and the early diagnosis is one of the main topics of pancreatic research. Mutation of K-ras oncogene at codon 12 has been reported in pancreatic adenoma, hyperplasia of the pancreatic duct, and also in pancreatic cancer, Recently, detection of K-ras point mutation in pure pancreatic juice is underinvestigation as a potential tool of early diagnosis of pancreatic cancer by setting a certain cut-off value. We recently experienced a case of multiple pancreatic cysts without any malignant cells in pancreatic juice, but with a positve point mutation of K-ras oncogene. Operation was deferred after obtaining informed consent from the family, because the lesions were so multiple and extensive as to require total pancreatectomy. Eighteen months follow-up studies did not reveal any deterioration in imaging tests as well as clinical picture

Deep Learning Assisted Automated Assessment of Thalassaemia from Haemoglobin Electrophoresis Images

Haemoglobin (Hb) electrophoresis is a method of blood testing used to detect thalassaemia. However, the interpretation of the result of the electrophoresis test itself is a complex task. Expert haematologists, specifically in developing countries, are relatively few in number and are usually overburdened. To assist them with their workload, in this paper we present a novel method for the automated assessment of thalassaemia using Hb electrophoresis images. Moreover, in this study we compile a large Hb electrophoresis image dataset, consisting of 103 strips containing 524 electrophoresis images with a clear consensus on the quality of electrophoresis obtained from 824 subjects. The proposed methodology is split into two parts: (1) single-patient electrophoresis image segmentation by means of the lane extraction technique, and (2) binary classification (normal or abnormal) of the electrophoresis images using state-of-the-art deep convolutional neural networks (CNNs) and using the concept of transfer learning. Image processing techniques including filtering and morphological operations are applied for object detection and lane extraction to automatically separate the lanes and classify them using CNN models. Seven different CNN models (ResNet18, ResNet50, ResNet101, InceptionV3, DenseNet201, SqueezeNet and MobileNetV2) were investigated in this study. InceptionV3 outperformed the other CNNs in detecting thalassaemia using Hb electrophoresis images. The accuracy, precision, recall, f1-score, and specificity in the detection of thalassaemia obtained with the InceptionV3 model were 95.8%, 95.84%, 95.8%, 95.8% and 95.8%, respectively. MobileNetV2 demonstrated an accuracy, precision, recall, f1-score, and specificity of 95.72%, 95.73%, 95.72%, 95.7% and 95.72% respectively. Its performance was comparable with the best performing model, InceptionV3. Since it is a very shallow network, MobileNetV2 also provides the least latency in processing a single-patient image and it can be suitably used for mobile applications. The proposed approach, which has shown very high classification accuracy, will assist in the rapid and robust detection of thalassaemia using Hb electrophoresis images. 2022 by the authors.A part of the research was funded by the Higher Education Commission of Pakistan through its funded project of Artificial Intelligence in Healthcare, Intelligent Information Processing Lab, National Center of Artificial Intelligence.Scopu

Gastro-biliary motility in patients with non-ulcer dyspepsia

現在,上腹部不定愁訴の原因は特定されていない｡その原因を解明するため,上腹部不定愁訴患者8人と健常対照者10人に対して液体食の胃排出能と,食事負荷による胆嚢収縮能を測定した｡胃排出時間,胆嚢収縮能はいずれも両者に有意な差は認められなかった｡健常対照者では胃排出時間と胆嚢収縮時間に有意な相関関係が認められたが,上腹部不定愁訴群では相関関係は認められなかった｡上腹部不定愁訴の原因として胃･胆嚢協調運動障害の存在が示唆 された。Subjective symptoms are quite similar between cystic duct syndrome (CDS) and non-ulcer dyspepsia (NUD) : epigastralgia, hypochondralgia and vague complaints in the upper part of the abdomen. Recently, there has been several reports suggesting that the cause of these disorders is postprandial dysmotility in the gallbladder and stomach. However, there has been no report suggesting incoordination of postprandial gastrobilialy motility as the cause of tha above mentioned complaints in these disorders. The aim of this study was to define the difference of postprandial gastrobiliary motility between patients with NUD and controls. Eight patients with NUD and 10 controls were studied. Gastric emptying time of liquid meal and gallbladder contraction were measured, simultaneously. There was no significant difference between study patients and controls when gastric emptying time and gallbladder contraction rate were compared in isolation. However, when these two parameters were assessed in combination, gastric emptying time was linearly correlated with minimum ballbladder contraction time in controls but not in patients. We conclude that the incoordination between gastric emptying and minimal gallbladder contraction may be one of the major causes of the symptoms in NUD

Mechanisms of pancreatic fibrosis

膵の線維化は慢性膵炎に特徴的な病理組織所見の一つであるが,その発生機序については不明な点か多い｡慢性膵炎はいったん発症すれば,進行性かつ非可逆性であるとされるが,その非可逆性に膵の線維化が関与するとされる｡膵の線維化の発生機序を明らかにし,線維化に対する根本的な治療法の確立が望まれるところである｡そこで,本稿では今後の膵の線維化の研究課題を明らかにする目的で,現在までの膵臓線維化の発生機序に関する知見を整理した｡Pancreatic fibrosis is an outstanding morphological feature in chronic pancreatis although it is seen in pancreatic cancer and convalescent stage of acute pancreatitis. Progressive fibrosis in chronic pancreatitis leads to the destruction and contributes to irreversiblity of chronic pancreatitis. Exact mechanisms of pancreatic fibrosis is not yet unclear, although advances in molecular biology have revealed possible roles of cytokines and growth factors in it. We summarized our understanding of pancreatic fibrosis in the revIew

Collagen degradation and in the pathogenesis of dieseases

組織のコラーゲン沈着にはコラーゲン合成系と分解系の不均衡によって生ずる｡従来,主としてコラーゲン合成系が注目されていたが,最近の研究の進歩により,コラーゲン分解系が重要な役割を演ずることが明らかになってきた｡コラーゲンの分解系には細胞内と細胞外の二つの経路が存在する｡それぞれcollagenolytic cathepsinおよびmatrix metalloproteinases( MMP)がコラーゲン分解能を有する重要な酵素である｡その調節因子については細胞外の経路についての解明か進んでいる｡MMPの遺伝子の発現にはサイトカインや成長因子が関与し,IL-1やTNF-αは強力な誘導因子である｡一旦,遺伝子か発現すれば,MMPは合成され,細胞外に不活性型(latent form)で分泌される｡不活性型のMMPが活性化する過程にはplasminogen activator inhibitorやtissue inhibitors of metalloproteinases(TIMP)などの阻害因子が存在し,MMP活性を調節する｡TIMPの遺伝子の発現にもサイトカインや成長因子が関与する｡MMPがTIMPを上回るような病態では組織破壊が,逆にTIMPがMMPを上回るような病態では綿維化が生ずる｡コラーゲン分解能の障害が線維化の維持や不可逆性に関与することが推察される。Fibrosis is the result of net accumulation of collagen in the organ. This may occur as a consequence of alterations in the synthesis of collagen, their degradation, or both. Recent investigations revealed that a decrease in collagen degradation plays a crucial role in fibrogenesis. Two pathways exist in collagen degradation : extracellular and intracellular. Each pathway has an important enzyme; that is, matrix metalloproteinases (MMP) and collagenolytic cathepsin, respectively. Collagenolytic activity is regulated at several levels. Expression of MMP and tissue inhibitors of metalloproteinase (TIMP), which act as inhibitors of MMP, is regulated independently by a number of cytokines and growth factors. MMP, which is synthesized in the cell, is secreted in a latent form. Activation of the latent MMP is controlled by TIMP and plasminogen activator inhibitor. TIMP also inhibits activated MMP which can degrade connective tissue matrices including collagens. In the condition where TIMP is predominant over MMP, activity of collagen breakdown is reduced, and consequently collagen deposition occurrs