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Pancreatic neuroendocrine neoplasms (PNENs) represent 10% of all pancreatic tumors by prevalence. Their incidence has reportedly increased over recent decades in parallel with that of pancreatic adenocarcinoma. PNENs are relatively rare, and of the few institutions that have published potential risk factors, findings have been heterogeneous. Our objective was to investigate the association between potential risk and protective factors for the occurrence of sporadic PNENs across a European population from several institutions. A multinational European case–control study was conducted to examine the association of selected environmental, family and medical exposure factors using a standardized questionnaire in face-to-face interviews. A ratio of 1:3 cases to controls were sex and age matched at each study site. Adjusted univariate and multivariate logistic regression analysis were performed for statistically significant factors. The following results were obtained: In 201 cases and 603 controls, non-recent onset diabetes (OR 2.09, CI 1.27–3.46) was associated with an increased occurrence of PNENs. The prevalence of non-recent onset diabetes was higher both in cases with metastatic disease (TNM stage III–IV) or advanced grade (G3) at the time of diagnosis. The use of metformin in combination with insulin was also associated with a more aggressive phenotype. Drinking coffee was more frequent in cases with localized disease at diagnosis. Our study concluded that non-recent onset diabetes was associated with an increased occurrence of PNENs and the combination of metformin and insulin was consistent with a more aggressive PNEN phenotype. In contrast to previous studies, smoking, alcohol and first-degree family history of cancer were not associated with PNEN occurrence.

Transcription factor NF-E2 p45-related factor 2 (Nrf2, also called Nfe2l2), a master regulator of redox homeostasis, and its dominant negative regulator, Kelch-like ECH-associated protein 1 (Keap1), together tightly control the expression of numerous detoxifying and antioxidant genes. Nrf2 and the 'antioxidant response element' (ARE)-driven genes it controls are frequently upregulated in pancreatic cancer and correlate with poor survival. Upregulation of Nrf2 is, at least in part, K-Ras oncogene-driven and contributes to pancreatic cancer proliferation and chemoresistance. In this review, we aim to provide an overview of Keap1-Nrf2 signalling as it relates to pancreatic cancer, discussing the effects of inhibiting Nrf2 or Nrf2/ARE effector proteins to increase chemosensitivity.

BackgroundThe effect of early organ dysfunction on long-term survival in acute pancreatitis (AP) patients is unknown.ObjectiveThe aim of this study was to ascertain whether early organ dysfunction impacts on long-term survival after an episode of AP.MethodsA retrospective analysis was performed using survival data sourced from a prospectively maintained database of patients with AP admitted to the Royal Infirmary of Edinburgh during a 5-year period commencing January 2000. A multiple organ dysfunction syndrome (MODS) score of ≥2 during the first week of admission was used to define early organ dysfunction. After accounting for in-hospital deaths, long-term survival probabilities were estimated using the Kaplan–Meier test. The prognostic significance of patient characteristics was assessed by univariate and multivariate analyses using Cox's proportional hazards methods.ResultsA total of 694 patients were studied (median follow-up: 8.8 years). Patients with early organ dysfunction (MODS group) were found to have died prematurely [mean survival: 10.0 years, 95% confidence interval (CI) 9.4–10.6 years] in comparison with the non-MODS group (mean survival: 11.6 years, 95% CI 11.2–11.9 years) (log-rank test, P=0.001) after the exclusion of in-hospital deaths. Multivariate analysis confirmed MODS as an independent predictor of long-term survival [hazard ratio (HR): 1.528, 95% CI 1.72–2.176; P=0.019] along with age (HR: 1.062; P

Inhibition of kynurenine 3-monooxygenase (KMO) protects against multiple organ dysfunction (MODS) in experimental acute pancreatitis (AP). We aimed to precisely define the kynurenine pathway activation in relation to AP and AP-MODS in humans, by carrying out a prospective observational study of all persons presenting with a potential diagnosis of AP for 90 days. We sampled peripheral venous blood at 0, 3, 6, 12, 24, 48, 72 and 168 hours post-recruitment. We measured tryptophan metabolite concentrations and analysed these in the context of clinical data and disease severity indices, cytokine profiles and C-reactive protein (CRP) concentrations. 79 individuals were recruited (median age: 59.6 years; 47 males, 59.5%). 57 met the revised Atlanta definition of AP: 25 had mild, 23 moderate, and 9 severe AP. Plasma 3-hydroxykynurenine concentrations correlated with contemporaneous APACHE II scores (R2 = 0.273; Spearman rho = 0.581; P 2 = 0.132; Spearman rho = 0.455, P

Purpose To explain an unusually severe presentation of concurrent sigmoid diverticulosis and endometriosis. Intestinal endometriosis can be complicated by colonic obstruction, perforation, fistula formation, and sepsis. Suppurative thrombosis of the portal system (pylephlebitis) complicating intestinal endometriosis has not been previously reported. Methods A previously fit and well 44-year-old woman presented with a two-day history of severe, intermittent left iliac fossa pain and loose, brown stools. CT scan revealed thickening of the sigmoid colon and inferior mesenteric and intra-hepatic vein thrombosis with patchy liver perfusion. Conservative management failed and an exploratory laparotomy showed a sigmoid inflammatory phlegmon. The inferior mesenteric vein containing pus and thrombus was excised together with the sigmoid mass. Results Histology revealed sigmoid colonic diverticulosis and endometriosis associated with extensive subserosal abscess formation. Widespread suppurative necrotizing venulitis with partial thrombosis of mesenteric veins was found. Literature review revealed that endometriotic cells produce a variety of pro-inflammatory mediators. Conclusions We postulate that endometriotic tissue within the diverticular sigmoid colon triggered an inflammatory cascade, leading to bacterial translocation and pylephlebitis.

Background and Aims: Risk factors for pancreatic neuroendocrine tumors (PNETs) are not well understood. The aim of this systematic review was to assess if diabetes mellitus, smoking, alcohol use, and family history of cancer are risk factors for PNETs. Methods: MEDLINE and abstracts from the European and North American Neuroendocrine Tumor Societies (ENETS and NANETS) were searched for studies published until October 2013. Eligible studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Five studies evaluating 4 individual populations were included (study accrual period 2000-2011) into the meta-analysis, involving 827 cases (range 160-309 per study) and 2,407 controls (range 233-924 per study). All studies had a case-control design and described regional series. The pooled adjusted odds ratio was 2.74 (95% CI: 1.63-4.62; p < 0.01; I2 = 60.4%) for history of diabetes, 1.21 (95% CI: 0.92-1.58; p = 0.18; I2 = 45.8%) for ever smoking, 1.37 (95% CI: 0.99-1.91; p = 0.06; I2 = 0.0%) for heavy smoking, 1.09 (95% CI: 0.64-1.85; p = 0.75; I2 = 85.2%) for ever alcohol use, 2.72 (95% CI: 1.25-5.91; p = 0.01; I2 = 57.8%) for heavy alcohol use, and 2.16 (95% CI: 1.64-2.85; p < 0.01; I2 = 0.0%) for first-degree family history of cancer. Conclusions: Diabetes mellitus and first-degree family history of cancer are associated with an increased risk of sporadic PNET. There was also a trend for diagnosis of sporadic PNET associated with heavy smoking. Alcohol use may be a risk factor for PNET, but there was considerable heterogeneity in the meta-analysis. These results suggest the need for a larger, homogeneous, international study for the clarification of risk factors for the occurrence of PNET.

Hitherto unknown abundance peaks of left coiling (l.c.) Neogloboquadrina pachyderma from a Gulf of Lions piston core indicate that abrupt cold spells associated with Atlantic Heinrich events affected the Mediterranean. N. pachyderma (l.c.) is typical of (sub) polar waters in the open ocean. The southern edge of its glacial North Atlantic bioprovince reached south Portugal. Only trace abundances of N. pachyderma (l.c.) are known from Quaternary Mediterranean sediments, suggesting that no significant “invasions” occured via the Strait of Gibraltar. The Gulf of Lions abundance peaks therefore seem to reflect area-specific thriving of a normally rare but indigenous taxon in the western Mediterranean through local favorable habitat development. The general planktonic foraminiferal record suggests that the basic hydrographic regime in the Gulf of Lions, with wintertime deep convective overturn, was relatively stable over the past 60 kyr. Under these conditions, high abundances of N. pachyderma (l.c.) would essentially imply temperature reductions of the order of 5°–8° relative to the present.

s / Pancreatology 14 (2014) S1eS129 S80 Conclusion: CSE inhibits pancreatic ductal fluid secretion and the activity of the CFTR which may play role in the smoke-induced pancreatic damage. This study was supported by OTKA, MTA and NFU/T AMOP.