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Wayne CD, Benbetka C, Besner GE, Narayanan S. Challenges of Managing Type 3c Diabetes in the Context of Pancreatic Resection, Cancer and Trauma. J Clin Med 2024; 13:2993. [PMID: 38792534 PMCID: PMC11122338 DOI: 10.3390/jcm13102993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Type 3c diabetes mellitus (T3cDM), also known as pancreatogenic or pancreoprivic diabetes, is a specific type of DM that often develops as a result of diseases affecting the exocrine pancreas, exhibiting an array of hormonal and metabolic characteristics. Several pancreatic exocrine diseases and surgical procedures may cause T3cDM. Diagnosing T3cDM remains difficult as the disease characteristics frequently overlap with clinical presentations of type 1 DM (T1DM) or type 2 DM (T2DM). Managing T3cDM is likewise challenging due to numerous confounding metabolic dysfunctions, including pancreatic endocrine and exocrine insufficiencies and poor nutritional status. Treatment of pancreatic exocrine insufficiency is of paramount importance when managing patients with T3cDM. This review aims to consolidate the latest information on surgical etiologies of T3cDM, focusing on partial pancreatic resections, total pancreatectomy, pancreatic cancer and trauma.
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Affiliation(s)
- Colton D. Wayne
- Department of Pediatric Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (C.D.W.); (G.E.B.)
- Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Department of Surgery, Baylor University Medical Center, 3600 Gaston Ave, Dallas, TX 75246, USA
| | | | - Gail E. Besner
- Department of Pediatric Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (C.D.W.); (G.E.B.)
- Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Siddharth Narayanan
- Department of Pediatric Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (C.D.W.); (G.E.B.)
- Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH 43205, USA
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Li KW, Chen WS, Wang K, Yang C, Deng YX, Wang XY, Hu YP, Liu YX, Li WQ, Ding WW. Open or Not Open the Retroperitoneum: A Pandora's Box for Blunt High-Grade Pancreatic Trauma? J Surg Res 2024; 293:79-88. [PMID: 37734295 DOI: 10.1016/j.jss.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/19/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The optimal management strategy for pancreatic trauma remains unclear. We aimed to determine whether the initial nonoperative management (NOM) strategy based on percutaneous drainage combined with endoscopic retrograde cholangiopancreatography guided stent placement would improve outcomes for blunt high-grade pancreatic trauma. METHODS Patients with blunt abdominal trauma who were hemodynamically stable without signs of diffuse peritonitis were consecutively enrolled at a high-volume center. The primary outcome was the occurrence of severe complications (Clavien‒Dindo classification ≥ Ⅲb) for patients who underwent initial laparotomy (LAP) versus NOM. Modified Poisson regression was used to model the primary outcome. Propensity score matching and weighting models were included into a regression-based sensitivity analysis. RESULTS Of 119 patients with grade III/IV pancreatic trauma, 29 patients underwent initial NOM, and 90 underwent initial LAP. The incidence of severe complications in the LAP group was higher than that in the NOM group (65/90 [72.2%] versus 9/29 [31.0%], P < 0.001). In the multivariable modified Poisson regression model, the relative risk for severe complications was decreased in the NOM group (relative risk, 0.52; 95% confidence interval, 0.30-0.90; P = 0.020). The results of the sensitivity analysis were consistent with those of the multivariable analysis. The mean number of reinterventions per patient was 1.8 in the NOM group and 2.6 in the LAP group (P = 0.067). CONCLUSIONS For blunt high-grade pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis, the NOM strategy was associated with a lower risk of severe complications (Clavien‒Dindo classification ≥ Ⅲb) and did not require more invasive reintervention procedures. In high-volume centers with sufficient expertise, percutaneous drainage combined with endoscopic retrograde cholangiopancreatography guided stent placement may serve as an initial reasonable option for selected patients.
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Affiliation(s)
- Kai-Wei Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Wen-Song Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Kai Wang
- Division of Trauma and Acute Care Surgery, Department of Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Chao Yang
- Division of Trauma and Acute Care Surgery, Department of Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Yun-Xuan Deng
- Division of Trauma and Acute Care Surgery, Department of Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Xin-Yu Wang
- Division of Trauma and Acute Care Surgery, Department of Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Yue-Peng Hu
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Yu-Xiu Liu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Division of Data and Statistics, Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China.
| | - Wei-Qin Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China.
| | - Wei-Wei Ding
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Division of Trauma and Acute Care Surgery, Department of Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China.
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Wang K, Li K, Deng Y, Wang X, Yang C, Chu C, Li W, Li J, Ding W. Postoperative hemorrhage following pancreatic injury: Risk factors and clinical outcomes. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 30:644-654. [PMID: 36270802 DOI: 10.1002/jhbp.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/23/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Kai Wang
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
| | - Kaiwei Li
- Division of Trauma and Surgical Intensive Care Unit, The First School of Clinical Medicine Southern Medical University Nanjing Jiangsu Province P. R. China
| | - Yunxuan Deng
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
| | - Xinyu Wang
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
| | - Chao Yang
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
| | - Chengnan Chu
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
| | - Weiqin Li
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
| | - Jieshou Li
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
| | - Weiwei Ding
- Division of Trauma and Surgical Intensive Care Unit, Affiliated Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu Province P. R. China
- Division of Trauma and Surgical Intensive Care Unit, The First School of Clinical Medicine Southern Medical University Nanjing Jiangsu Province P. R. China
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Mahapatra SJ, Garg PK. Navigating the Stormy Sea of Infected Necrotizing Pancreatitis: Are We There Yet? Well Almost! Gastroenterology 2022; 163:578-581. [PMID: 35793777 DOI: 10.1053/j.gastro.2022.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
Affiliation(s)
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India; Translational Health Science and Technology Institute, Faridabad, India.
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Han L, Zhao Z, Chen X, Yang K, Tan Z, Huang Z, Zhou L, Dai R. Human umbilical cord mesenchymal stem cells-derived exosomes for treating traumatic pancreatitis in rats. Stem Cell Res Ther 2022; 13:221. [PMID: 35619158 PMCID: PMC9137180 DOI: 10.1186/s13287-022-02893-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 01/30/2023] Open
Abstract
Background The therapeutic and protective effects of human umbilical cord mesenchymal stem cells-exosomes (hucMSC-Exs) on traumatic pancreatitis (TP) remain unknown. Here, we established a rat model of TP and evaluated and compared the therapeutic effects of hUC-MSCs and hucMSC-Exs. Methods HucMSC-Exs were obtained by ultracentrifugation and identified using transmission electron microscopy and western blot analysis. TP rats were treated by tail vein injection of hUC-MSCs and hucMSC-Exs. Their homing in rats was observed by performing fluorescence microscopy. The degree of pancreatic tissue damage was assessed by HE staining, the expression levels of amylase, lipase, and inflammatory cytokines were detected by ELISA, apoptosis was detected by TUNEL assay, and the expression levels of various apoptosis-related proteins were detected by western-blot. The expression levels of apoptosis-related molecular markers were detected by RT-qPCR. Results The colonization of exosomes was observed in pancreatic tissue. Compared to TP group, the histopathological score of pancreas was significantly decreased in the TP + hUC-MSCs group and TP + hucMSC-Exs group (P < 0.05). Compared to TP group, the activity of serum amylase and lipase was significantly decreased (P < 0.05). The expression levels of IL-6 and TNF-α were significantly decreased, while those of IL-10 and TGF-β were significantly increased (P < 0.05). The apoptosis index of the TP group was significantly increased (P < 0.05), whereas that of the TP + hUC-MSCs and TP + hucMSC-Exs groups was significantly decreased (P < 0.05). Compared to TP group, the expression levels of Bax, Bcl-2, and Caspase-3 were significantly decreased in the TP + hUC-MSCs group and TP + hucMSC-Exs group (P < 0.05). Conclusion HucMSC-Exs can colonize injured pancreatic tissue, inhibit the apoptosis of acinar cells, and control the systemic inflammatory response to facilitate the repair of pancreatic tissue.
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Affiliation(s)
- Li Han
- General Surgery Center, General Hospital of Western Theater Command, No. 270, Rongdu Rd, Jinniu District, Chengdu, 610083, Sichuan Province, China.,College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
| | - Zhirong Zhao
- College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
| | - Xingyun Chen
- Department of Hepatobiliary and Pancreatic Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Liangshan Yi Autonomous Prefecture, Xichang, 615000, Sichuan Province, China
| | - Ke Yang
- Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, 610083, Sichuan Province, China
| | - Zhen Tan
- General Surgery Center, General Hospital of Western Theater Command, No. 270, Rongdu Rd, Jinniu District, Chengdu, 610083, Sichuan Province, China
| | - Zhu Huang
- General Surgery Center, General Hospital of Western Theater Command, No. 270, Rongdu Rd, Jinniu District, Chengdu, 610083, Sichuan Province, China
| | - Lichen Zhou
- General Surgery Center, General Hospital of Western Theater Command, No. 270, Rongdu Rd, Jinniu District, Chengdu, 610083, Sichuan Province, China.,College of Clinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Ruiwu Dai
- General Surgery Center, General Hospital of Western Theater Command, No. 270, Rongdu Rd, Jinniu District, Chengdu, 610083, Sichuan Province, China. .,College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China. .,College of Clinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan Province, China.
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