Hiroki Suhara

Nomogram-based prediction of rebleeding in small bowel bleeding patients: the ‘PRSBB’ score

Small bowel capsule endoscopy (SBCE) and balloon-assisted endoscopy (BAE) have revolutionized the diagnosis and treatment of small bowel bleeding (SBB), allowing access to the small bowel and identification of specific bleeding lesions. However, some patients experience rebleeding after small bowel investigation, and there are no definitive algorithms for determining the most appropriate follow-up strategy in SBB patients. We developed and validated a nomogram that can predict rebleeding risk and be used to develop a risk-stratified follow-up strategy in SBB patients. A retrospective study was performed using data from 401 SBB patients who underwent SBCE at Nagoya University Hospital. We developed and internally validated a predictive model for rebleeding in the form of a nomogram using Cox regression models and a bootstrap resampling procedure. Optimal risk factors were selected according to the least absolute shrinkage and selection operator (LASSO). The LASSO method identified 8 independent predictors of rebleeding that could be assessed to obtain a ‘predicting rebleeding in SBB’, or ‘PRSBB’ score: age, sex, SBB type, transfusion requirement, cardiovascular disease, liver cirrhosis, SBCE findings, and treatment. The c-statistic for the predictive model was 0.681. In conclusion, our PRSBB score can help clinicians devise appropriate follow-up plans.

Neuroendocrine neoplasm of pancreas with cystic degeneration mimicking mucinous cystic neoplasm

Endoscopic ultrasound is increasingly being used for evaluation of pancreatic diseases and pancreatic tumors. Among various pancreatic cystic lesions, cystic degeneration of pancreatic neuroendocrine neoplasm is of the challenge in making diagnosis. Although unique characteristic of each type of pancreatic cystic lesions has been proposed abundantly, typical morphology of cystic degeneration of pancreatic neuroendocrine neoplasm is still unclear. We, herein, reported a case of 66-year-old woman who was incidentally found to have a cystic lesion in the tail of pancreas upon screening transabdominal ultrasonography. A well-defined cystic lesion with rim calcification was noted on subsequent abdominal computed tomography. Endoscopic ultrasound revealed a markedly thick-wall cystic lesion containing solid nodule inside which was not enhanced following contrast-enhanced study. A mucinous cystic neoplasm was suspected and the patient was proceeded with distal pancreatectomy. A definite diagnosis of neuroendocrine neoplasm was confirmed after staining with synaptophysin and chromogranin A. We performed a meticulous review on current literatures focusing on endoscopic characteristics of pancreatic neuroendocrine neoplasms with cystic degeneration.

Tu1891 Feasibility of Non-Invasive Method of Diagnosing Pancreatic Fibrosis Using Shear Wave Elastography

whether Hpa is involved in the pathogenesis of cerulein-induced AP in mice. Material and Methods: Heparanase over-expressing transgenic mice (hpa-TG) and their wild-type (WT) BALB/c mice, and Hpa knockout mice (hpa-KO) and their WT C57BL mice were intraperitoneally injected with either Cerulein (50 mg/kg, 5 times, at 1 hour apart) or vehicle. Pancreatic Hpa activity, edema, and inflammation along blood amylase and lipase levels, were determined 24 hours following pancreatitis induction. Results: Cerulein-induced pancreatitis in wild type mice was associated with significant rises in the serum levels of amylase and lipase. These increases were characterized by enhancement of Hpa activity and pancreatic inflammation. The elevation in amylase and lipase as well as pancreatic edema/inflammation responses to administration of cerulein were profoundly exaggerated in hpa-TG mice. In contrast, when cerulein was injected to hpa-KO mice, the severity of pancreatitis was attenuated as compared with their wild type controls. Importantly, pretreatment with Hpa inhibitor (PG545) reduced significantly the inflammatory response of acute pancreatitis by ameliorating pancreatic edema, amylase, and lipase serum levels. Conclusions: The hpa-TG mice are more susceptible to acute pancreatitis than their WT controls, indicating a role for Hpa in the pathogenesis of this disease state. The pancreatic-protective effects of Hpa inhibition provide a rational basis for therapeutic application of Hpa inhibitors.

Tu1950 Psychological Distress and Its Impact on the Survival in Patients With Pancreatic Cancer: A Prospective Analysis

Purpose : Porphyrin-based photosensitizers are most commonly used in photodynamic therapy (PDT). However, these drugs are exported extracellularly by a cell-mambrane transporter, the ATP-binding cassette subfamily G member 2 (ABCG2), which decreases the PDTinduced cytotoxicity in cancer treatment. Pegylation of a drug increases its molecular size. We hypothesized that intracellular level of a porphyrin can be increased by its pegylated form, which enhance the PDT-induced cytotoxicity. Our aim of study was to examine the escaping of ABCG2 function in the PDT using pegylated-Chlorin E6 (Che6) in the pancreatic cancer cells. Methods : We pegylated Che6 using a methoxy polyethylene glycol and branched polyethylenimine. AsPC-1 and MiaPaCa-2 cells were selected, which showed the low and high ABCG2 expression level, respectively. Intracellular level of Che6 and pegylatedChe6 was detected by Fluorescence meter, FACS and confocal microscope. Cells were incubated with 0.1 10 μM of Che6 and pegylated-Che6. They were exposed to a diode laser emitting at 670 nm wave length with total radiation dose of 6 J/cm2. Cell viability was determined by MTT assay. Production level of singlet oxygen was detected with photomultiplier-tube based singlet oxygen detection system. An antitumor PDT effects in AsPC-1 cellbearing BALC/nude mice of the Che6 and pegylated-Che6 were investigated. Results : The

Tu1489 Correlation Between Pancreatic Exocrine Function and Small-Intestinal Villus Form in Patients With Different Kind of Pancreatic Disorders

Baseline characteristics of the two study populations are shown in table 1. There was no difference in cold ischemia time in those with a greater than 50% drop in c-peptide compared with those without a 50% decrease (966 vs. 963 minutes, p=0.35). There was no difference between groups (> 50% decreased group vs. no > 50% decrease group) in terms of isolated islet equivalents per /kilogram body weight (5752 vs. 3687, p=0.16), 6 month insulin requirements (10 U vs. 5 U, p=0.33), or 6 month HgA1c levels (6.6 vs 6.1 mmol/L, p= 0.29). Odds ratios calculated for age, gender, body mass index, surgery type or the number of isolated islet equivalents were not significant for predicting islet cell function. CONCLUSION: Cold ischemia time is not a predictor of successful islet engraftment in patients undergoing pancreatectomy with remote islet isolation. These findings lend support to remote islet isolation as an acceptable technique for islet autotransplant. Baseline Characteristics of Patients Based on 6 Month C-peptide Level