Cyst Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Imaging and Pathology

Background: Intraductal papillary mucinous neoplasms (IPMNs) display diverse macroscopic, histological, and immunohistochemical characteristics with typical morphological appearance in magnetic resonance imaging. Depending on those, IPMNs may show progression into invasive carcinomas with variable frequency. Overall, IPMN-associated invasive carcinomas are found in about 30% of all IPMNs, revealing phenotpyes comparable with conventional ductal adenocarcinomas or mucinous (colloid) carcinomas of the pancreas. In Sendai-negative side-branch IPMNs, however, the annual risk of the development of invasive cancer is 2%; thus, risk stratification with regard to imaging and preoperative biomarkers and cytology is mandatory. Methods and Results: The present study addresses the radiological and interventional preoperative measures including histological features to determine the risk of malignancy and the prognosis of IPMNs. Conclusion: While preoperative imaging largely relies on the detection of macroscopic features of IPMNs, which are associated with a divergent risk of malignant behavior, in resected specimens the determination of the grade of dysplasia and the detection of an invasive component are the most important features to estimate the prognosis of IPMNs

The role of socioeconomic differences, migration background and parental lifestyle on arterial stiffness in children

Background: The socioeconomic status (SES), migration background and parental lifestyle are shown to be associated with several cardiovascular (CV) risk factors such as obesity, physical inactivity and passive smoking in children. The aim of the present study is to examine the influence of these social background factors on arterial stiffness in children. Methods: Pulse wave velocity (PWV) was recorded with the non-invasive oscillometric Mobil-O-Graph device in 983 children aged six to eight years (51% female). Additionally, the parents completed a questionnaire about the SES, migration background and parental lifestyle. Results: Children in the category of high household income had significantly lower PWV (4.30 Confidence interval (CI) [4.26; 4.34] m/s) compared to children in the lowest category (4.35 CI [4.32; 4.39] m/s; p=0.02). This correlation was not significant after adjusting to parental educational level. Further, children with smoking parents had significantly higher PWV (4.38 CI [4.35; 4.42] m/s) compared to children with non-smoking parents (4.31 CI [4.28; 4.34] m/s; p=<0.001). In parental educational level, migration background and parental physical activity (PA) trends were observed, favoring children with highly educated, native and physically active parents. These trends were not significant. Conclusion: Household income correlated negatively, and parental smoking correlated positively with arterial stiffness in children. In the remaining social background factors e.g. parental educational level, migration background and parental PA, no significant associations were found. To prevent CV diseases in adulthood, an elucidation about discrepancies in household income and parental smoking is necessary

Socioeconomic Status and Parental Lifestyle Are Associated With Vascular Phenotype in Children

Background/Aims:; Socioeconomic barriers and lifestyle conditions affect development of cardiovascular disease in adults, but little is known about the association of parental lifestyle and education with childhood health. We aimed to investigate the association of socioeconomic status (SES), migration background, parental physical activity (PA) and smoking status with micro-and macrovascular health in children.; Methods:; In 2016/2017, 833 school children (aged 7.2 ± 0.4 years) in Basel (Switzerland) were screened for retinal arteriolar-to-venular ratio (AVR), pulse wave velocity (PWV), SES, migration background and parental PA as well as smoking status.; Results:; High parental PA levels were associated with a favorable higher AVR (; p; = 0.020) and lower PWV (; p; = 0.035), but not independent of parental smoking status. Children with parents who smoked had a higher PWV [4.39 (4.35-4.42) m/s] compared to children with non-smoking parents [4.32 (4.29-4.34) m/s,; p; = 0.001]. Children of parents with a low household income had a higher PWV [4.36 (4.32-4.41) m/s] compared to children of parents with a high household income [4.30 (4.26-4.34) m/s,; p; = 0.033]. Low parental educational level was associated with a lower AVR [0.86 (0.85-0.88)] compared to children with highly educated parents [AVR:0.88 (0.87-0.88),; p; = 0.007; PWV: 4.33 (4.30-4.35) m/s,; p; = 0.041]. Children with a European background showed a higher AVR [0.88 (0.87-0.88)] compared to non-European children [AVR: (0.86 (0.85-0.87),; p; = 0.034].; Conclusion:; Parental PA is associated with better macro- and microvascular childhood health. However, the positive association is lost when parental smoking is considered in the analysis. Socioeconomic factors seem to associate with subclinical vascular alterations in children. Primary prevention programs should focus on including parental lifestyle interventions and educational programs to reduce the burden of lifestyle-associated barriers in order to improve cardiovascular health during lifespan.; Clinical Trial Registration:; ClinicalTrials.gov Exercise and Arterial Modulation in Youth, https://clinicaltrials.gov/ct2/show/NCT02853747, NCT02853747

European evidence-based guidelines on pancreatic cystic neoplasms

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring &lt; 40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter &gt;= 40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule &gt; 5 mm, and MPD diameter &gt; 10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN