Association of Preoperative Risk Factors With Malignancy in Pancreatic Mucinous Cystic Neoplasms: A Multicenter Study

Pancreatic mucinous cystic neoplasms (MCNs) harbor malignant potential, and current guidelines recommend resection. However, data are limited on preoperative risk factors for malignancy (adenocarcinoma or high-grade dysplasia) occurring in the setting of an MCN

The diagnosis of pancreatic mucinous cystic neoplasm and associated adenocarcinoma in males: An eight‐institution study of 349 patients over 15 years

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137278/1/jso24582_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137278/2/jso24582.pd

Low Abdominal NIRS Values and Elevated Plasma Intestinal Fatty Acid-Binding Protein in a Premature Piglet Model of Necrotizing Enterocolitis

<div><p>To identify early markers of necrotizing enterocolitis (NEC), we hypothesized that continuous abdominal near-infrared spectroscopy (A-NIRS) measurement of splanchnic tissue oxygen saturation and intermittent plasma intestinal fatty-acid binding protein (<i>p</i>I-FABP) measured every 6 hours can detect NEC prior to onset of clinical symptoms. Premature piglets received parenteral nutrition for 48-hours after delivery, followed by enteral feeds every three hours until death or euthanasia at 96-hours. Continuous A-NIRS, systemic oxygen saturation (SpO₂), and heart rate were measured while monitoring for clinical signs of NEC. Blood samples obtained at 6-hour intervals were used to determine <i>p</i>I-FABP levels by ELISA. Piglets were classified as fulminant-NEC (f-NEC), non-fulminant-NEC (nf-NEC) and No-NEC according to severity of clinical and histologic features. Of 38 piglets, 37% (n=14) developed nf-NEC, 18% (n=7) developed f-NEC and 45% (n=17) had No-NEC. There were significant differences in baseline heart rate (p=0.008), SpO₂ (p<0.001) and A-NIRS (p<0.001) among the three groups. A-NIRS values of NEC piglets remained lower throughout the study with mean for f-NEC of 69±3.8%, 71.9±4.04% for nf-NEC, and 78.4±1.8% for No-NEC piglets (p<0.001). A-NIRS <75% predicted NEC with 97% sensitivity and 97% specificity. NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04). Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001). In f-NEC piglets, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL;p<0.001). <i>p</i>I-FABP levels increased in parallel with disease progression and a value >0.25ng/mL identified animals with NEC (68% sensitivity and 90% specificity). NIRS is a real-time, non-invasive tool that can serve as a diagnostic modality for NEC. In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels. These modalities may help identify neonates with NEC prior to clinical manifestations of disease.</p></div

Evaluation and management of incidental gallbladder cancer

Given the ubiquity of laparoscopic cholecystectomy in the modern era, the incidence of incidentally diagnosed gallbladder cancers (GBCs) is rising. This unique clinical scenario poses specific challenges regarding the role of staging, re-resection, and adjuvant treatment for patients with this disease. This review will address these controversies with the latest published data.</p

Premature Pig Model of NEC—Gross and Histological Examination.

<p>A, Gross examination of the abdominal viscera of healthy No-NEC piglet. B, Gross examination of piglet with non-fulminant NEC shows inflamed and congested small bowel with areas of focal necrosis. C, Gross examination of piglet with fulminant NEC shows diffuse necrosis throughout the entire bowel. D, Histologic examination of the normal small intestine of a No-NEC piglet. E, Histologic examination of the small intestine of a piglet with non-fulminant NEC demonstrating moderate mucosal injury, blunting of villi and separation of the basement membrane. F, Histologic examination of the small intestine of a piglet with fulminant NEC demonstrating severe mucosal injury and diffuse pneumatosis.</p

Continuous Heart Rate Measurements.

<p>Heart rate data stratified by NEC severity groups demonstrating an overall increasing trend in heart rates throughout the study period and that f-NEC and nf-NEC piglets were significantly more tachycardic during the first 24 hours of life than No-NEC piglets. <i>‡ = p<0</i>.<i>05</i>, <i>compared to Non-Fulminant NEC; * = p<0</i>.<i>05</i>, <i>compared to No-NEC</i>.</p

Proximal Jejunum Intestinal Fatty Acid Binding Protein (I-FABP) immunohistochemical staining.

<p>Immunohistochemistry fluorescent staining for I-FABP in proximal jejunum specimens. In these images I-FABP is represented in green. In the No-NEC piglets there is robust expression of I-FABP and in the NEC piglets the mucosa has been significantly denuded and I-FABP signal degraded.</p