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Background: Celiac plexus block has been commonly utilized for the treatment of chronic pancreatitis-associated abdominal pain. Prospective studies suggest efficacy in 30 to 50% of patients, although no randomized sham-controlled trials have been performed. The objective of this study is to assess the effect of endoscopic ultrasound (EUS)-guided celiac plexus block on abdominal pain in patients with documented chronic pancreatitis. Methods: This is a two-arm randomized sham-controlled trial with blinded evaluators. The study will be conducted at multiple academic sites in the United States who are members of the United States Pancreatic Disease Study Group (USPG). Patients referred for EUS to exclude chronic pancreatitis as a cause of abdominal pain as well as those with established painful chronic pancreatitis undergoing EUS for another indication will be eligible. At the time of EUS with confirmation of chronic pancreatitis by standard EUS diagnostic criteria, patients will be randomized to either celiac plexus block or sham whereby an anesthetic and steroid combination will be injected into the celiac plexus or saline will be injected into the gastric lumen with the same type of needle as used for celiac plexus block, respectively. The main outcome measure will be a 50% reduction in abdominal pain using the Brief Pain Inventory Short Form (BPI-SF) at 1 month post-intervention. A number of secondary outcomes will be measured including visual analog scale (VAS), Comprehensive Pain Assessment Tool Short Form (COMPAT-SF) pain scores, and quality of life using a pancreas-specific validated measure (PANQOLI). Discussion: In this study, the effect of celiac plexus block on abdominal pain in patients with chronic pancreatitis will be compared to a sham intervention. This randomized trial will offer a definitive assessment of the role of celiac plexus block for the treatment of abdominal pain in this setting. Trial registration {2}: ClinicalTrials.gov NCT 06178315. Registered on December 21, 2023 [ABSTRACT FROM AUTHOR]

The article discusses tips and tricks for performing endoscopic ultrasound guided celiac plexus interventions. Celiac plexus interventions are used to manage abdominal pain associated with pancreaticobiliary cancers and chronic pancreatitis. The article provides information on when to consider these interventions, patient preparation, technique optimization, alternative procedures, management of adverse events, and the efficacy of the interventions. It also mentions the potential use of endoscopic ultrasound guided radiofrequency ablation as an alternative to celiac plexus interventions. Overall, the article emphasizes the importance of these interventions as an adjunct to medical therapy for managing pain in a safe and effective manner. [Extracted from the article]

Over the years, the origin of ovarian Leydig cells has been, and still is, a topic subject to deep debate. Seven years ago, we proposed that this origin resided in intraneural elements that came from a possible reservoir of neural crest cells, a reservoir that may be located in the ganglia of the celiac plexus. We believe we have found the evidence necessary to prove this hypothesis. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions The objective of this study was to evaluate the effect of outpatient celiac plexus block on acute pain reduction in patients with suspected median arcuate ligament syndrome.This is an Institutional Review Board approved, retrospective chart review. Data were collected and analyzed from patients who received celiac plexus blocks from November 1, 2021 through April 6, 2023. The primary outcome was pain reduction, determined by the change in numerical pain rating scale (NPRS) from pre‐procedure to post‐procedure. Additional data collected include patient demographics, comorbidities, preoperative symptoms and duration of symptoms.There were 33 patients identified in this study. Thirty‐one patients were included in the data analysis. The median age of the cohort was 29 years, and the median BMI was 20.4. 94% of the cohort was female. These patients were referred as part of an evaluation for symptomatic vascular compression disorders. For many patients, positive response to celiac plexus block was used as an indication to proceed with surgical MALS resection. We provide a diagnostic algorithm for MALs. All patients endorsed preoperative symptoms. Patients experienced a median pain reduction of −4 from baseline to immediately post‐procedure.Celiac plexus blocks continue to be a tool for ruling out neurogenic median arcuate ligament syndrome in patients who have undergone extensive previous imaging and assessments for vascular compression disorders. Our data suggest that patients with suspected MALS may experience substantial immediate pain relief from temporary blocks of the celiac ganglion as guided by fluoroscopy in an outpatient setting. [ABSTRACT FROM AUTHOR]

Refractory upper abdominal pain or lower back pain (retroperitoneal pain syndrome) related to celiac plexus involvement characterises pancreatic and other upper gastrointestinal malignancies and is an unmet need. We hypothesised that ablative radiation delivered to the celiac plexus would decrease pain. This multicentre, single-arm, phase 2 study was done at eight hospitals in five countries (Israel, Poland, Canada, the USA, and Portugal). Eligible patients aged 18 years or older with an average pain level of 5–10 on the Brief Pain Inventory short form (BPI-SF), an Eastern Cooperative Oncology Group performance status score of 0–2, and either pancreatic cancer or other tumours involving the celiac axis, received a single fraction of 25 Gy of external-beam photons to the celiac plexus. The primary endpoint was complete or partial pain response based on a reduction of the BPI-SF average pain score of 2 points or more from baseline to 3 weeks after treatment. All evaluable patients with stable pain scores were included in response assessment. The trial is registered with ClinicalTrials.gov , NCT03323489 , and is complete. Between Jan 3, 2018, and Dec 28, 2021, 125 patients were treated, 90 of whom were evaluable. Patients were followed up until death. Median age was 65·5 years (IQR 58·3–71·8), 50 (56%) were female and 40 (44%) were male, 83 (92%) had pancreatic cancer, and 77 (86%) had metastatic disease. Median baseline BPI-SF average pain score was 6 (IQR 5–7). Of the 90 evaluable patients at 3 weeks, 48 (53%; 95% CI 42–64) had at least a partial pain response. The most common grade 3–4 adverse events, irrespective of attribution, were abdominal pain (35 [28%] of 125) and fatigue (23 [18%]). 11 serious adverse events of grade 3 or worse were recorded. Two grade 3 serious adverse events were probably attributed to treatment by the local investigators (abdominal pain [n=1] and nausea [n=1]), and nine were possibly attributed to treatment (seven were grade 3: blood bilirubin increased [n=1], duodenal haemorrhage [n=2], abdominal pain [n=2], and progressive disease [n=2]; and two were grade 5: gastrointestinal bleed from suspected varices 24 days after treatment [n=1] and progressive disease [advanced pancreatic cancer] 89 days after treatment [n=1]). Celiac plexus radiosurgery could potentially be a non-invasive palliative option for patients with retroperitoneal pain syndrome. Further investigation by means of a randomised comparison with conventional celiac block or neurolysis is warranted. Gateway for Cancer Research and the Israel Cancer Association. [ABSTRACT FROM AUTHOR]

Background: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery (CA) compression syndrome, is a rare condition characterized by persistent post-meal or post-exercise abdominal discomfort, often more pronounced during expiration. Additional symptoms include nausea, vomiting, and weight loss. Aims and Objectives: To document the clinical presentation, diagnostic process, and treatment outcomes of seven patients diagnosed with MALS and to evaluate the effectiveness of surgical release of the median arcuate ligament (MAL) over a follow-up period of at least six months. Materials and Methods: The study included seven patients diagnosed with MALS from 2019 to 2021. Diagnosis was based on the presence of chronic abdominal pain and associated symptoms, absence of alternative diagnoses after various clinical assessments, and angiographic evidence of CA compression. The primary treatment involved surgical decompression of the CA by releasing the MAL through either open or laparoscopic techniques. Results: All seven patients underwent successful surgical release of the MAL. The patients were followed up for at least six months post-surgery. The study evaluated the persistence of symptoms and the need for additional interventions such as revascularization techniques. Conclusion: Surgical release of the MAL is the primary treatment for MALS, providing relief for many patients. However, long-term follow-up is essential as some patients may continue to experience symptoms post-surgery, necessitating further interventions. [ABSTRACT FROM AUTHOR]

The fascia of the pancreatic head is referred to as the retropancreatic fascia of Treitz, and that of the body and tail of the pancreas is named the retropancreatic fascia of Toldt. However, the spatial relationship between the nerves, fascia, and the distribution of the fascia on the dorsal side of the pancreas remains unclear. Therefore, this study aimed to explore the distribution of these fasciae and elucidate the spatial relationship between the nerves and arteries connecting the retroperitoneal space and the peritoneal organs by studying eight cadavers using macroscopic anatomical examination, wide‐range serial sectioning, and three‐dimensional reconstruction. The fasciae of Treitz and Toldt converge caudally to the root of the superior mesenteric artery (SMA), forming a narrower gap around the roots of the celiac trunk and SMA than in the celiac plexus. The fasciae eventually get closer to each other, and the boundary between them becomes obscured, providing coverage to the anterior surface of the aorta between the SMA and the inferior mesenteric artery. The celiac plexus does not penetrate the fascia but converges before spreading into the pancreas. Similarly, the arteries pass through this gap in the fasciae. Our findings suggest that the retroperitoneal space and peritoneal organs are connected through a narrow no‐fascia area, with the distribution of the fascia relating to nervous and vascular pathways. Our findings reveal that the distribution of the avascular plane may provide a crucial anatomical foundation for abdominal digestive organ surgery by reducing bleeding volume and determining the dissection region. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 56-year-old male pancreatic adenocarcinoma patient experiencing severe pain, who underwent percutaneous cryoneurolysis of the splanchnic nerves using a hybrid approach with computed tomography (CT) and endoscopic guidance. The procedure resulted in significant pain reduction, with the patient reporting a pain score of 0/10 immediately after the treatment and maintaining this score after a 6-month follow-up. The use of endoscopic guidance within a minimally invasive approach shows promise for improving the accuracy and efficacy of treatments like cryoneurolysis, although further training for interventional radiologists may be necessary for widespread adoption of this technology. [Extracted from the article]

Simple Summary: The celiac plexus (CP) is a dense network of ganglia and sensitive fibres receiving nociceptive inputs from most abdominal viscera. In human medicine, the CP is a therapeutic target to control pain originating from pancreatic tumours and chronic pancreatitis. The fluoroscopic-guided block and neurolysis of the CP are commonly used in human analgesia but they have not been described in animals. We describe a fluoroscopically guided transcutaneous approach to the CP in swine cadavers to assess the feasibility of the technique in veterinary species. This technique is shown to be feasible, and its application in veterinary subjects suffering abdominal pain should be assessed. Celiac plexus block (CPB) and neurolysis (CPN) are used for pain management in people suffering from abdominal tumours or chronic pancreatitis. The fluoroscopically guided approach common in human medicine has not been described in veterinary settings. The aim of this study was to describe a fluoroscopic approach to the celiac plexus (CP) in fresh pig cadavers. Twelve animals were included in the procedure. Cadavers were positioned in sternal position and, under fluoroscopic guidance, a Chiba needle was inserted parasagittal at 6 cm from the spinal midline at the level of the last thoracic vertebra. From the left side, the needle was directed medio-ventrally with a 45° angle towards the T15 vertebral body; once the vertebral body was contacted, the needle was advanced 1 cm ventrally towards the midline. Iodinated contrast was injected to confirm the location. Following this, 2 mL of dye (China ink) was injected. A laparotomy was performed, and dyed tissue was dissected and prepared for both histochemical and immunohistochemical techniques. In 10 out of 12 samples submitted for histological evaluation, nervous tissue belonging to CP was observed. Fluoroscopy guidance allows for feasible access to the CP in swine cadavers in this study. Further studies are warranted to determine the efficacy of this technique in swine and other veterinary species. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Treatment with corticosteroids can lead to iatrogenic Cushing's syndrome when used for longer intervals and in high doses. Less common administration routes may conceal the exposure, raising the possibility of misdiagnosis and mismanagement. [ABSTRACT FROM AUTHOR]

Depression is a common non-motor symptom in Parkinson's disease (PD) that includes anhedonia and impacts quality of life but is not effectively treated with conventional antidepressants clinically. Vagus nerve stimulation improves treatment-resistant depression in the general population, but research about its antidepressant efficacy in PD is limited. Here, we administered peripheral non-invasive focused ultrasound to hemiparkinsonian ('PD') and non-parkinsonian (sham) rats to mimic vagus nerve stimulation and assessed its antidepressant-like efficacy. Following 6-hydroxydopamine (6-OHDA) lesion, akinesia-like immobility was assessed in the limb-use asymmetry test, and despair- and anhedonic-like behaviors were evaluated in the forced swim test and sucrose preference test, respectively. After, tyrosine hydroxylase immuno-staining was employed to visualize and quantify dopaminergic degeneration in the substantia nigra pars compacta, ventral tegmental area, and striatum. We found that PD rats exhibited akinesia-like immobility and > 90% reduction in tyrosine hydroxylase immuno-staining ipsilateral to the lesioned side. PD rats also demonstrated anhedonic-like behavior in the sucrose preference test compared to sham rats. No 6-OHDA lesion effect on immobility in the forced swim test limited conclusions about the efficacy of ultrasound on despair-like behavior. However, ultrasound improved anhedonic-like behavior in PD rats and this efficacy was sustained through the end of the 1-week recovery period. The greatest number of animals demonstrating increased sucrose preference was in the PD group receiving ultrasound. Our findings here are the first to posit that peripheral non-invasive focused ultrasound to the celiac plexus may improve anhedonia in PD with further investigation needed to reveal its potential for clinical applicability. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patients now live longer thanks to advanced cancer treatments and early cancer identification. In this study, the efficacy of celiac plexus and splanchnic nerve blocks for pain management and quality of life in patients with upper abdominal malignancies at three months is compared. Material and Methods: This prospective, randomized trial compared the efficaciousness of a splanchnic nerve block vs a celiac plexus block for managing excruciating pain, as well as the side effects associated with both neurolytic blocks. This study was carried out at the Department of Anaesthesiology, Kurnool Medical College, Andhra Pradesh, India. From the patients who are part of this investigation, informed permission was acquired. Using data from the pilot study conducted between August 2022 to July 2023, a sample size of 20 was chosen. Results: Out of 60, a total of 20 patients that were evaluated for eligibility, 10 individuals were found to not meet the necessary inclusion criteria, while an additional 10 patients chose not to partake in the study. A total of sixty patients were randomly assigned to groups over the course of the trial. Group SNB consisted of 10 patients, while Group CPB also included 10 patients. In order to elucidate the descriptive data statistics, the frequency analysis method was employed for categorical variables, while the mean and standard deviation were utilized for continuous variables. Conclusion: The statistical data and findings of this study demonstrate that a splanchnic nerve block exhibits clinical comparability to a celiac plexus block, but with statistically significant discrepancies that hold little clinical significance. [ABSTRACT FROM AUTHOR]

Background and Objectives : Endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) for pain relief in chronic pancreatitis (CP) has wide variation in results as reported in the literature. The objective was to find out the efficacy of EUS-CPB in painful CP from our region where phenotype of CP is different from West and to find out factors favoring response to EUS-CPB. Methods and Results : Patients with known CP who underwent EUS-CPB were assessed for response to CPB. Response to EUS-CPB was recorded as more than 50% reduction in visual analogue scale (VAS) score for pain severity at 1 week, 4 weeks, 12 weeks and 24 weeks after procedure. Factors between responders and nonresponders were analyzed. Among 29 patients who underwent EUS-CPB during the study period, response was seen in 72.4% patients after the procedure. The mean time to response to EUS-CPB was 1.22 (± 0.43) days. Mean duration of response was 8 months (± 4.73). Short duration of painful CP (≤2 years) was seen in 15 patients (51.72%) and long duration (>2 years) was seen in 14 (48.27%). Among responders (21/29), those patients who had short duration of disease had significantly lower median VAS score at 12 weeks, (1 versus 3, p- value= 0.026) and at 24 weeks, (1.5 versus 2.5, p -value= 0.049), as compared to those with longer duration of disease. Overall, 83.3% males responded as compared to 54.54% females (p = 0.04). Significant proportion of subjects who responded either stopped or used analgesics occasionally (p < 0.0001). There was no statistically significant difference in response to EUS-CPB with respect to age, prior history of endoscopic retrograde cholangiopancreatography (ERCP), etiology of CP, prior history of surgery, or whether only EUS-CBP was done (p > 0.05 for all). Conclusion : EUS-CPB can be effective when used in select group of painful CP patient who are not immediate candidates for surgery especially in early course of disease. It can be offered to patients with persistent pain despite optimum medical therapy. When effective, it can reduce need for analgesic medication at least in short to medium term. [ABSTRACT FROM AUTHOR]

Copyright of Creative Arts in Education & Therapy is the property of Inspirees International B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Journal of Digestive Endoscopy published a variety of articles in 2023. Some notable findings include the effectiveness of endoscopic ultrasound-guided celiac plexus block for relieving pain in patients with chronic pancreatitis, the importance of patient education to prevent pill esophagitis in developing countries, and the use of rotational thromboelastometry to reduce fresh frozen plasma requirement in patients undergoing therapeutic endoscopic procedures. Other articles discussed topics such as endoscopic biliary drainage, capsule endoscopy, and the management of various gastrointestinal conditions. The journal also featured endoscopy images and case reports, as well as review articles on topics such as endo-hepatology and the impact of artificial intelligence on colorectal polyp detection. The journal aims to continue publishing high-quality articles and increasing its citations in the future. [Extracted from the article]

Introduction: Abdominal and back pain is the most frequent symptom in patients with pancreatic cancer, with pain management being extremely challenging. This study aimed to evaluate pain control, opioid consumption, pain-interfered quality of life, and survival after early and delayed computed tomography (CT)-guided celiac plexus neurolysis (CPN). Methods: A retrospective analysis of pancreatic cancer patients receiving CPN for pain (n = 56) between June 2018 and June 2021 was done. The patients were grouped as early group (n = 22) and delayed group (n = 34) on the basis of the presence of persistent refractory pain according to expert consensus on refractory cancer pain. Results: Both groups were comparable in demographic characteristics and baseline pain conditions measured using the numeric rating scale (5.77 ± 1.23 vs. 6.27 ± 1.21; p = 0.141). The pain scores were significantly reduced in both groups; early CPN resulted in significantly lower scores from 3 to 5 months. The opioid consumption gradually decreased to a minimum at 2 weeks but increased at 1 month (35.56 ± 30.14 mg and 50.48 ± 47.90 mg, respectively); significantly larger consumption from 2 to 4 months was seen in the delayed group. The total pain interference was lower than baseline in all patients, with significant improvement after early CPN in sleep, appetite, enjoyment of life, and mood. The average survival time of the two groups was comparable. Conclusion: Early application of CT-guided CPN for patients with advanced pancreatic cancer may help reduce pain exacerbation and opioids consumption, without influencing the survival. [ABSTRACT FROM AUTHOR]

The concept of Chakras, or Force Centers, is central to Lok Purusha Samya's theory of the infinite universe. These centers are considered loci of life energy or Prana, and are linked to the cycle, circle, and wheel within all humans. The Vedas, particularly the Yoga Upanishad, have significant references to Chakras, which are considered vast pools of energy in human bodies. According to Ayurveda, Chakras are psychic centers present in the subtle body, acting as a bridge between physical existence and the limitless potential of pure consciousness. The subtle body contains energy channels called Nadis, which carry Prana, which flows through these channels and collects in Chakras. Shatchakra Nirupana is a system of six Chakras in the subtle human body, including Muladhara, Swadhisthana, Manipura, Anahat, Vishuddha, and Ajna Chakra. These Chakras are located at regular intervals in various portions of the spinal cord, with the Sahasrara Chakra being the most important. Sthana of Muladhara Chakra and Swadhishthana Chakra is Ling and Gud which can be correlate with inferior hypogastric and sacral plexus. Sthana of Manipura Chakra is Nabhi and is represented by solar plexus. Hrudiya is the Sthana of Anahat Chakra and it is represented by cardiac plexus. Sthana of Visuddha Chakra is Kantha and is represented by cervical plexus. Sthana of Ajna chakra is between eyebrow and it is Avyakta (union of Prakriti and Purush) hence not related to any plexus. These are directly related to physiological as well as physic centers so it is very necessary to explore this yogic knowledge for our physical, mental and spiritual well-being.. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Gastroenterología del Perú is the property of Sociedad de Gastroenterologia del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pancreatic cancer is a devastating disease with less than 5% 5-year survival. Inoperable patients often present with pain. Randomized controlled trial have shown that endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) improves pain control. It is usually performed by injecting bupivacaine followed by absolute alcohol around the celiac axis. Study design: Single center, randomized, double blind controlled trial of EUS-CPN with and without bupivacaine in patients with inoperable malignancy (pancreatic or other) involving the celiac plexus. The study was approved by research ethics board with approval number of 2022-9969, 21.151 and registered on ClinicalTrials.gov (NCT04951804). Discussion: We hypothesize that bupivacaine is superfluous and may actually reduce pain control by diluting the neurolytic effect of alcohol. Bupivacaine is also potentially dangerous in that it may produce serious adverse events such as arrythmias and cardiac arrest if inadvertently injected intravascularly. Conclusion: This randomized trial is designed to assess whether bupivacaine is of any value during EUS-CPN. [ABSTRACT FROM AUTHOR]

Background: Inflammation is a fundamental biological response to injury and infection, which if unregulated can contribute to the pathophysiology of many diseases. The vagus nerve, which primarily originates from the dorsal motor nucleus (DMN), plays an important role in rapidly dampening inflammation by regulating splenic function. However, direct vagal innervation of the spleen, which houses the majority of immune and inflammatory cells, has not been established. As an alternative to direct innervation, an anti-inflammatory reflex pathway has been proposed which involves the vagus nerve, the sympathetic celiac ganglion, and the neurotransmitter norepinephrine. Although sympathetic regulation of inflammation has been shown, the interaction of the vagus nerve and the celiac ganglia requires a unique interaction of parasympathetic and sympathetic inputs, making this putative mechanism of brain–spleen interaction controversial. Body: As neuropeptides can be expressed at relatively high levels in neurons, we reasoned that DMN neuropeptide immunoreactivity could be used to determine their target innervation. Employing immunohistochemistry, subdiaphragmatic vagotomy, viral tract tracing, CRISPR-mediated knock-down, and functional assays, we show that cocaine and amphetamine-regulated transcript (CART) peptide-expressing projection neurons in the caudal DMN directly innervate the spleen. In response to lipopolysaccharide (LPS) stimulation, CART acts to reduce inflammation, an effect that can be augmented by intrasplenic administration of a synthetic CART peptide. These in vivo effects could be recapitulated in cultured splenocytes, suggesting that these cells express the as yet unidentified CART receptor(s). Conclusion: Our results provide evidence for direct connections between the caudal DMN and spleen. In addition to acetylcholine, these neurons express the neuropeptide CART that, once released, acts to suppress inflammation by acting directly upon splenocytes. [ABSTRACT FROM AUTHOR]

Communication between the ovaries and the central nervous system occurs by peripheral innervation through the celiac plexus, superior ovarian nerve, and ovarian plexus nerve. The vagus nerve is involved in regulating the ovaries, but the neuroanatomical pathway that links them is not clear. Adult female rats were used for gross anatomy, acetylcholinesterase histochemistry, and the immunofluorescence analysis of tyrosine hydroxylase (TH), choline acetyltransferase (ChAT), and tryptophan hydroxylase 2 (TPH). The results obtained indicate that the right vagus nerve (RVN) travels parallel and caudal to the esophagus, where three nerve branches were identified. Also, a right vagal plexus (RVP) formed by microganglia was described, establishing communication with the celiac plexus, and was mainly reactive to tyrosine hydroxylase (TH); some serotoninergic and cholinergic neurons were also found. The left vagus nerve (LVN) travels over the esophagus, bifurcates before its insertion into the stomach and enters the RCG. This neuroanatomical and biochemical description of the RVN and LVN in the rat suggests the RVP is formed by presynaptic catecholaminergic terminals and cholinergic neurons. This information could support detailed studies of communication between the vagus nerve and the ovaries and identify the type of neural signaling involved in abdominal control of the vagus nerve. [ABSTRACT FROM AUTHOR]

The aberrant arteries of the lung are very rare abnormalities. It is included in the type 1 sequestration group when it is a single finding without other sequestration features. Sequestrations account for <1% of all lung malformations. Type 1 is the least common form in this group. In 75% of these cases, the aberrant artery (AA) originates from the thoracic aorta. AA originating from the celiac plexus is very rare. Moreover, even if it originates from an abdominal vascular, AA is extended left lower lobe of the lung or the right middle lobe. Our case is atypical with its azygoesophageal recess (AOR) localization. The AOR is a special region that forms the mediobasal segment of the right lung. After the pandemic, this region has been expressed as one of the areas where COVID-19 infection shows affinity. The reason for this condition has not been definitively clarified yet. Therefore, the anatomical details of this segment need to be more probed. Furthermore, the radiological multidetector computed tomography (MDCT) appearance of our case is in the differential diagnosis, with Scimitar syndrome and, as far as we know, this differential diagnosis detail has not been mentioned so far. MDCT plays an important role in the diagnosis and planning of definitive treatment by determining the origin and course of the AA. Definitive treatment may be surgery (lobectomy or segmentectomy) or endovascular. The case of a 62-year-old patient with a lung AA is presented accompanied by radiological and clinical findings. [ABSTRACT FROM AUTHOR]

Introduction: Conventionally, we rely on transurethral resection of bladder tumour (TURBT) for local staging of muscle-invasive bladder cancer (MIBC). However, the procedure is limited by its staging inaccuracy which may delay the definitive treatment of MIBC. Methods: We conducted a proof-of concept study on endoscopic ultrasound (EUS)-guided biopsy of detrusor muscle in porcine bladders. Five porcine bladders were used in this experiment. Upon EUS, four layers of tissue including the mucosa (hypoechoic), submucosa (hyperechoic), detrusor muscle (hypoechoic) and serosa (hyperechoic) could be identified. Results: A total of 37 EUS-guided biopsies were taken from 15 sites (three sites per bladder), and the mean number of biopsies taken from each site was 2.47 ±0.64. Among the 37 biopsies, 30 of them (81.1%) obtained detrusor muscle in the biopsy specimen. For the per biopsy site analysis, detrusor muscle was obtained in 73.3% if only one biopsy was taken, and 100% if two or more biopsies were taken from the same biopsy site. Overall, detrusor muscle was successfully obtained from all 15 biopsy sites (100%). No bladder perforation was observed throughout all biopsy processes. Conclusion: EUS-guided biopsy of the detrusor muscle could be performed during the initial cystoscopy session, thus expediting the histological diagnosis and subsequent treatment of MIBC. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical efficacy of celiac plexus block (CPB) combined with 125I seeds implantation (ISI) for refractory epigastric pain from abdominal malignancies. Methods: The data of 81 patients with refractory epigastric pain [visual analog scale (VAS) score ≥ 4] from abdominal malignancies were collected in this retrospective case–control study. Group A (n = 40) was treated with CPB alone, while Group B (n = 41) underwent CPB combined with ISI. The primary study endpoints were the VAS score, quality of life (QoL), and local tumor control (LTC) rate. The secondary endpoints were complications, progression-free survival (PFS), and overall survival (OS). Results: The VAS scores at week 2 (T2), week 4 (T4), week 8 (T8), and week 12 (T12) in both groups were significantly lower compared with the pretreatment values (all P < 0.01). VAS scores in Group B showed a sustained decrease, especially for "mild pain" and "moderate pain," while the VAS scores in Group A rebounded at T8 and T12 (both P < 0.01). The QoL in Group B improved significantly from T4 until T12, which better than that at T12 in Group A (all P < 0.01). The LTC rates at T8 were 35.0% and 92.7% in Groups A and B, respectively, with a significant difference (P < 0.01). Group B had a slightly lower complication rate and a slightly longer median PFS/OS than group A, but neither was statistically different (P = 0.09 and P = 0.99, respectively). Conclusion: CPB combined with ISI performs more sustained pain relief (up to 12 weeks) compared to CPB alone, and ultimately improves the patients' QoL. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Persistent hypotension is a rare complication of celiac plexus neurolysis. It is important to know what are the main and rare complications and how to treat these in patients who undergo CPN. Celiac plexus neurolysis is an effective treatment for visceral abdominal pain in oncological patients. Although it rarely has complications, some side effects may occur. A patient with visceral abdominal pain who developed long‐lasting orthostatic hypotension and was treated with the use of corticosteroids after a neurolytic celiac plexus block for intractable pain. We describe a rare complication and its treatment and we emphasize the importance of having a guide for the management and treatment of rare complications. We also suggest that every patient be informed about complications, from the most common to the rarest. [ABSTRACT FROM AUTHOR]

Introduction: The celiac plexus block is effective for treating intractable cancer pain and has been the focus of many studies. At our affiliated institution, fluoroscopy-guided splanchnic nerve block with a single needle via the transintervertebral disc approach was the first choice of treatment. The short-term efficacy of this technique has been reported, but the long-term efficacy is not clear. In the present study, we investigated the long-term analgesic efficacy of this technique. Methods: This multicenter, retrospective, observational study reviewed the medical records of patients who underwent neurolytic splanchnic nerve block (NSNB) via the transintervertebral disc approach for intractable cancer pain at five tertiary hospitals in Japan from April 2005 to October 2020. The primary outcome was the long-term analgesic efficacy of a one-time NSNB via the transintervertebral disc approach. Results: In total, 76 patients were included in the analysis. The median lowest numerical rating scale (NRS) score was 1 within 14 days. At 1, 2, 3, and 6 months after the nerve block, the median NRS score was also ≤ 2, while the median equivalent oral morphine dose did not show any clinically noticeable increase at those times. Conclusion: The long-term analgesic efficacy of NSNB via the transintervertebral disc approach in patients with intractable cancer pain has been demonstrated. Plain Language Summary: The celiac plexus block is effective for treating intractable cancer pain and has been the focus of many studies. The celiac plexus nerve block relieves intractable cancer pain arising from the pancreas or other organs in close proximity, and the splanchnic nerve block is considered clinically equivalent to the celiac plexus block for analgesia. At our affiliated institution, fluoroscopy-guided neurolytic splanchnic nerve block with a single needle via the transintervertebral disc approach is the first choice of treatment because it is technically simpler and less invasive than other approaches. While the short-term efficacy of this technique is known, its long-term efficacy remains unclear. Thus, this multicenter, retrospective, observational study aimed to investigate the long-term analgesic efficacy of a neurolytic splanchnic nerve block via the transintervertebral disc approach. The medical records of patients in whom intractable cancer pain was managed using this technique at five tertiary hospitals in Japan were analyzed. The primary outcome was the long-term analgesic efficacy of a one-time neurolytic splanchnic nerve block via the transintervertebral disc approach. The median lowest numerical rating scale score was 1 within 14 days. At 1, 2, 3, and 6 months after the nerve block, the median numerical rating scale score was also ≤ 2, while the median equivalent oral morphine dose did not show any clinically noticeable increase at those times. This technique may reduce opioid dose and associated side effects compared with long-term conventional pharmacotherapy alone. [ABSTRACT FROM AUTHOR]

Considering the prioritization of life-threatening injuries in trauma care, secondary dysfunctions such as ventilator-induced diaphragmatic dysfunction (VIDD) are often overlooked. VIDD is an entity induced by muscle inactivity during invasive mechanical ventilation, associated with a profound loss of diaphragm muscle mass. In order to assess the incidence of VIDD in polytrauma patients, we performed an observational, retrospective, longitudinal study that included 24 polytraumatized patients. All included patients were mechanically ventilated for at least 48 h and underwent two chest CT scans during their ICU stay. Diaphragmatic thickness was measured by two independent radiologists on coronal and axial images at the level of celiac plexus. The thickness of the diaphragm was significantly decreased on both the left and right sides (left side: −0.82 mm axial p = 0.034; −0.79 mm coronal p = 0.05; right side: −0.94 mm axial p = 0.016; −0.91 coronal p = 0.013). In addition, we obtained a positive correlation between the number of days of mechanical ventilation and the difference between the two measurements of the diaphragm thickness on both sides (r =0.5; p = 0.02). There was no statistically significant correlation between the body mass indexes on admission, the use of vitamin C or N-acetyl cysteine, and the differences in diaphragmatic thickness. [ABSTRACT FROM AUTHOR]

Background and objective: Chronic pancreatitis is a chronic, fibro-inflammatory condition that damages the pancreas' structural integrity permanently and impairs exocrine and endocrine function. Alcohol is a major part in the multifactorial pathogenesis. Pain in the form of recurrent attacks of pancreatitis or constant and disabling pain is usually the main symptom. Pain management is mainly empirical and involves treatment with potential potent analgesics, and duct drainage by endoscopic or surgical means. Methods: An observational study was conducted at Dr. D.Y. Patil Medical College for a period of two years, from 2020 to 2022. Cases of chronic pancreatitis were chosen for the study after taking informed consent of the patients concerned. This study aims at achieving comprehensive pain management, and seeks to assess the response to different modalities of treatment. Accordingly, a total of 36 patients were studied by commencing a medical line of management, and their responses were documented using the visual analog scale (VAS) on Day 1, Day 3, and Day 5. Pain medications were stepped up in unresponsive cases based on the World Health Organization (WHO) pain relief ladder. Celiac plexus block and surgical intervention (lateral pancreaticojejunostomy) were conducted where the pain could not be subsided by using the medical line of management. Results: Out of 36 cases with chronic pancreatitis, a majority of the cases had moderate pain (VAS score 4-7) at the time of admission, whereas severe pain (VAS > 7) was reported in 11.1% of the cases. Medical management was commenced in all cases by administering a paracetamol injection (1g IV, 8 hourly); however, pain was relieved in only 25% of the cases. In the remainder of cases, the line of treatment had to be stepped up by using a tramadol injection (1 ampule in 100ml NS IV, 8 hourly) in 61.1% (22 out of 27) of the cases, and by using a morphine injection (30mg IV, 8 hourly) in 13.9% (five) of the cases. Furthermore, celiac plexus block was required for managing pain in a total of 9 cases, and recurrence of pain after celiac plexus block was observed in 55% (5 out of 9 cases); these cases underwent lateral pancreaticojejunostomy. Cases that underwent surgical intervention showed satisfactory results with no recurrence of pain in the follow-up period. Conclusion: A majority of the patients responded to various levels of medical analgesia. Only a few required surgical intervention for pain management. Hence, a multidisciplinary approach is required for adequate management of pain to improve the quality of life. [ABSTRACT FROM AUTHOR]

This article, published in Equine Veterinary Education, examines the effect of celiac plexus block on intestinal motility and pain score in horses with experimentally induced endotoxemia. The study involved twelve horses, with six receiving an anaesthetic celiac plexus block and the other six receiving a sham injection. The results showed that the group receiving the anaesthetic block had a faster decrease in pain score and higher motility of the jejunum compared to the control group. The authors conclude that ultrasound-guided celiac plexus anaesthetic block has beneficial effects on endotoxin-induced discomfort and intestinal ileus in horses. [Extracted from the article]

Background: In the rat, studies have shown that ovary innervation arrives via the superior ovarian nerve (SON) and the ovarian plexus nerve, which originates from the celiac plexus (CP). In the present study, we performed a neuroanatomical technique to investigate the anatomy of the SON between the ovary and the CP. Results: We found that the SON fibers were concentrated on the lateral border of the suprarenal ganglion and projected towards, then inserted into the suspensory ligament. Then, it ran parallel to the long axis of the ligament to reach and innervate the ovaries. At this level, the SON was composed of two coiled nerve fibers, each between 10 and 15 µm in diameter. The SON was linked to three different ganglia: the suprarenal ganglia, the celiac ganglia, and the superior mesenteric ganglion. Conclusions: The postganglionic fibers that project to the ovary via the SON emerge from the suprarenal ganglia. The trajectories on the right and left sides to each ovary are similar. The somas of ipsilateral and contralateral SON neurons are located in the prevertebral ganglia, mostly in the celiac ganglia. [ABSTRACT FROM AUTHOR]

Pancreatic cancer (PC) is a fatal malignancy in the human abdominal cavity that prefers to invade the surrounding nerve/nerve plexus and even the spine, causing devastating and unbearable pain. The limitation of available in vitro models restricts revealing the molecular mechanism of pain and screening pain-relieving strategies to improve the quality of life of end-stage PC patients. Here, we report a PC nerve invasion model that merged human brain organoids (hBrO) with mouse PC organoids (mPCO). After merging hBrOs with mPCOs, we monitored the structural crosstalk, growth patterns, and mutual interaction dynamics of hBrO with mPCOs for 7 days. After 7 days, we also analyzed the pathophysiological statuses, including proliferation, apoptosis and inflammation. The results showed that mPCOs tend to approximate and intrude into the hBrOs, merge entirely into the hBrOs, and induce the retraction/shrinking of neuronal projections that protrude from the margin of the hBrOs. The approximating of mPCOs to hBrOs accelerated the proliferation of neuronal progenitor cells, intensified the apoptosis of neurons in the hBrOs, and increased the expression of inflammatory molecules in hBrOs, including NLRP3, IL-8, and IL-1β. Our system pathophysiologically replicated the nerve invasions in mouse GEMM (genetically engineered mouse model) primary and human PCs and might have the potential to be applied to reveal the molecular mechanism of nerve invasion and screen therapeutic strategies in PCs. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience. Methods: This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated. Results: Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and 5 cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively. Conclusions: EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries. [ABSTRACT FROM AUTHOR]

Context • Patients with pancreatic cancer (PC) at a late stage often suffer from severe abdominal pain due to the invasion of celiac plexus, and the analgesics they receive often have intolerable side effects. Endoscopic, ultrasoundguided, celiac plexus neurolysis (EUS-guided CPN) can have a good therapeutic effect. Objective • The study intended to evaluate the ability of two nursing cooperation patterns to reduce patients’ pain, decrease operation times, increase operational efficiency, and increase nurses’ satisfaction, for patients with advanced PC and abdominal pain who received EUS-guided CPN. Design • The research team designed a retrospective controlled study. Setting • The study took place at the Shenzhen People’s Hospital of the Second Clinical Medical College of Jinan University in Shenzhen, China, and at the Changhai Hospital of the Second Military Medical University in Shanghai, China. Participants • Participants were 40 patients with advanced PC who received EUS-guided CPN at one of the two hospitals between January 2019 and January 2020. Intervention • Twenty participants at Changhai Hospital received the traditional nursing cooperation pattern and became the control group, and 20 participants at the Shenzhen People’s Hospital received the new nursing cooperation pattern and became the intervention group. Outcome Measures • The study measured clinical data, nursing measures, diagnostic significance, and key points for the two patterns as well as compared the effects of the new nursing cooperation method to that of traditional nursing. If the measurement data met the requirements for normality, the team used the two independent sample t-test for the intergroup comparisons. If normality wasn’t satisfied, the team used medians and interquartile ranges (IQRs) for expression and the rank sum test for the intergroup comparisons. Counting data were expressed using the constituent ratio, and team used the chi-square test for comparisons between groups. P < .05 was considered to be statistically significant. Results • The operations were successful, and no complications occurred. No significant difference existed in the pain scores between the control group and the intervention group (P>.05), while a significant difference occurred in the nurses’ operation times and satisfaction. Not only were the scores for operation times for the control group (97) and the intervention group (59) significantly different, but also the nurses’ satisfaction was significantly higher for the intervention group postintervention, at 83.35 ± 5.25, than for the control group, at 62.25 ± 8.18 (P < .001). Such a new nursing cooperation method could assist in patient’s rehabilitation and increase nurses’ satisfaction. Conclusions • The new nursing cooperation method for patients with advanced PC and abdominal pain undergoing EUS-guided CPN can reduce operation time and improve nurses’ satisfaction. [ABSTRACT FROM AUTHOR]

Background Perforators are typically found in rows in the deep inferior epigastric perforator (DIEP) flap. As methods to assess flap perfusion continue to improve, surgeons may be more likely to select perforators traditionally avoided. The purpose of this article is to describe clinical outcomes based on row and number of perforators to reevaluate flap and abdominal donor site morbidity. Methods A retrospective analysis was performed on patients who underwent breast reconstruction with DIEP flaps by four microsurgeons from 2013 to 2020. The row and number of perforators were determined from operative reports. Chi-square and t -test or nonparametric Fisher's exact test and Wilcoxon two-sample test were used for discrete and continuous variable, respectively, as applicable. Logistic regression was used for multivariable analyses. Results Of 628 flaps, 305 were medial row (58.7%), 159 were lateral row (30.6%), and 55 had both rows (10.6%). Partial flap loss was higher in both rows (p = 0.003). Fat necrosis was higher with medial (p = 0.03) and both rows (p = 0.01) when compared with lateral using multivariable analysis. Hernia or bulge was higher in lateral row flaps (lateral: 8/157, 5.1%; medial, 5/299, 1.7%; both, 0/55; p = 0.05); however, mesh was more commonly used in both row flaps (p = 0.05). There was no difference in fat necrosis or abdominal morbidity between single and multiple perforators. Conclusion There was no difference in fat necrosis based on the number or row of perforators. The lateral row provides adequate perfusion but may be associated with an elevated risk of hernia or bulge. Patients may benefit from mesh, especially when both rows are dissected. [ABSTRACT FROM AUTHOR]

Background: Microglia regulate the response to injury and disease in the brain and spinal cord. In white matter diseases microglia may cause demyelination. However, how microglia respond and regulate demyelination is not fully understood. Methods: To understand how microglia respond during demyelination, we fed mice cuprizone—a potent demyelinating agent—and assessed the dynamics of genetically fate-mapped microglia. We then used single-cell RNA sequencing to identify and track the microglial subpopulations that arise during demyelination. To understand how microglia contribute to the clearance of dead oligodendrocytes, we ablated microglia starting at the peak of cuprizone-induced cell death and used the viability dye acridine orange to monitor apoptotic and lytic cell morphologies after microglial ablation. Lastly, we treated serum-free primary microglial cultures to model distinct aspects of cuprizone-induced demyelination and assessed the response. Results: The cuprizone diet generated a robust microglial response by week 4 of the diet. Single-cell RNA sequencing at this time point revealed the presence of several cuprizone-associated microglia (CAM) clusters. These clusters expressed a transcriptomic signature indicative of cytokine regulation and reactive oxygen species production with altered lysosomal and metabolic changes consistent with ongoing phagocytosis. Using acridine orange to monitor apoptotic and lytic cell death after microglial ablation, we found that microglia preferentially phagocytose lytic carcasses. In culture, microglia exposed to lytic carcasses partially recapitulated the CAM state, suggesting that phagocytosis contributes to this distinct microglial state during cuprizone demyelination. Conclusions: Microglia serve multiple roles during demyelination, yet their transcriptomic state resembles other neurodegenerative conditions. The phagocytosis of cellular debris is likely a universal cause for a common neurodegenerative microglial state. [ABSTRACT FROM AUTHOR]

Introduction: Patients with chronic pancreatitis (CP) often require opioids for pain control. The goal of our study was to characterize opioid use in patients with CP in a real-life practice using a state-mandated online monitoring program and to assess outcomes compared to CP patients without opioid dependency. Methods: CP patients seen in our Pancreas Center from 2016 to 2021 were divided into two groups—with and without chronic opioid use. Details of opioids and other controlled prescriptions were obtained by review of the Massachusetts Prescription Awareness Tool (MassPat). Results: Of the 442 CP outpatients, 216 used chronic opioids. Patients with opioid use had significantly more recurrent acute pancreatitis (76.6% vs. 52.7%), concurrent alcohol use (11.2% vs. 5.8%), tobacco use (37.8% vs. 19.7%), anxiety (22.4% vs. 16.6%), depression (43.5% vs. 23.5%) and daily pain (59.8% vs. 24.8%) (p < 0.001). They also concurrently used more benzodiazepines (43.7% vs. 12.4%), gabapentinoids (66.4% vs. 31.1%) and medical marijuana (14.9% vs. 4.19%) (p < 0.001). They had more celiac plexus blocks (22.0% vs. 6.67%), surgery (18.3% vs. 8.89%) and more hospitalizations for CP flares (3.6 vs. 1.0 visits) (p < 0.001). Less than 13% patients received opioids by means of ED visits; 81.7% patients received their prescriptions from one facility and 75% received them at regular intervals. Conclusion: Opioid-dependent CP patients exhibit polypharmacy and have worse outcomes with higher resource utilization. The state-monitoring program ensures that the majority of patients receive opioids from a single facility, thereby minimizing misuse. [ABSTRACT FROM AUTHOR]

Introduction: Celiac plexus block is effective for treating intractable cancer pain and has been the focus of many studies. Several guiding techniques such as fluoroscopy, computed tomography, and endoscopy have been devised, and the target of the block has varied in previous studies as both the celiac plexus and splanchnic nerve, which is the main origin of the celiac plexus, have been targeted. At our affiliated institution, fluoroscopy-guided splanchnic nerve block with a single needle via transintervertebral disc approach is the first choice. However, there have been few reports on the use of this technique. This study investigated the efficacy and safety of this technique. Methods: This multicenter retrospective observational study reviewed the medical records of patients who underwent neurolytic splanchnic nerve block (NSNB) via transintervertebral disc approach for intractable cancer pain at five tertiary hospitals in Japan from April 2005 to October 2020. The primary outcome was the clinical success ratio of NSNB, and the secondary outcome was the incidence ratio of NSNB-related adverse events. Results: In total, 103 patients were included in the analysis. Of these, 77 patients met the definition of clinical success, with a ratio of 74.8%. The incidence ratio of NSNB-related adverse events was 40.8% (hypotension, 21.4%; alcohol intoxication, 13.6%; diarrhea, 11.7%; and vascular puncture, 3.9%; duplicates were present). All adverse events improved with observation and symptomatic treatment only. No patient had infection or serious adverse events such as organ or nerve damage. Conclusions: The clinical success ratio of this technique was 74.8%. Although the incidence of adverse events was 40.8%, all events were mild and no serious adverse events were observed. The findings demonstrate the efficacy and safety of our NSNB in patients with intractable cancer pain. Plain Language Summary: In patients with intractable pain from abdominal cancer, fluoroscopy-guided neurolytic splanchnic nerve block via transintervertebral disc approach is an effective and safe procedure. It can be completed with a single needle puncture, and is anatomically less likely to cause organ or nerve damage compared with other approaches. The analgesia produced by this technique, along with conventional pharmacotherapy for cancer pain, may reduce opioid dose and its side effects and improve patients' quality of life. [ABSTRACT FROM AUTHOR]

Celiac plexus SBRT (CP-RT 25Gy/1fx) is an effective method of palliative pain relief for patients suffering from celiac axis tumor invasion. Standard complex/SBRT radiotherapy (RT) workflows for simulation and planning delay time to pain relief during end-of-life care. We propose a sim free, direct-to-unit (DTU) adaptive radiotherapy (ART) approach, using a diagnostic CT (dxCT) pre-plan and online adaptation for final plan construction to enable same-day radiation oncology consult and CP-RT. We aimed to demonstrate that hCBCT imaging enables this DTU, adaptive CP-RT workflow in silico with acceptable plan quality. Five patients with abdominal malignancies were imaged on a HyperSight CBCT (hCBCT) solution on a c-arm linear accelerator as part of a prospective imaging clinical trial. Next, existing patient-specific dxCTs were used to generate CP-RT pre-plans. A radiation oncologist contoured initial pre-plan organ-at-risk (OARs; stomach, duodenum, small and large bowel, liver, kidneys, spinal cord) and targets. The CP-RT target (PTV25Gy) was defined as a 5mm ant-left/right rind around the aorta from the level of T12 to L2. An additional 5mm isotropic expansion was used to create the PTV20Gy. A semi-automated ART planning template developed for CP-RT was then applied. After pre-plan construction, to simulate a sim-free, DTU workflow, hCBCTs were injected into a CT-guided ART emulator environment as the primary dataset, with contours propagated from the registered dxCT. Contours were updated as needed to reflect the treatment anatomy and positioning. A standard online ART workflow was utilized for predicted and final adaptive plan calculation. Dosimetric statistics for each clinical goal were compared between predicted and final plans. DTU adaptive CP-RT plans were successfully created for all 5 patients and met all clinical goals. Table 1 shows comparative PTV coverage and OAR sparing of predicted and final ART plans. Without adaptation, predicted plans were infeasible for clinical use; 3/5 patients had non deliverable predicted plans. In contrast, all ART plans were clinically deliverable and met clinical goals. DTU ART for CP-RT is dosimetrically feasible. Adaptation is a critical component for DTU CP-RT to achieve deliverable plans. This approach could reduce treatment delay for cancer-related celiac pain. A prospective pilot clinical trial is in development. [ABSTRACT FROM AUTHOR]

Pain management for pancreatic cancer is crucial for patients, often involving high doses of opioids with associated side effects. Trials have been performed irradiating the celiac plexus (CP) for pain management, however, accurately delineating the CP using CT images is challenging. Due to limited soft tissue resolution, a large CP surrogate structure is required to ensure that the plexus is actually irradiated. To address this, use of MR-Linac based treatments is evaluated to determine whether MR can provide superior soft tissue contrast and allow for smaller treatment volumes by targeting individual ganglion. MRIs and CTs from ten pancreatic cancer patients treated on 0.35T MR-Linac were retrospectively acquired. CP surrogate and celiac ganglia were contoured on MRI, while CTs were used only for electron density information. Planning was performed on a treatment planning system, generating two sets of plans: CT plans treating surrogate structure and MR plans treating celiac ganglia. A proof-of-principle, unilateral plan was generated to demonstrate potential of targeting unilateral pain. MR treatment plans delivered high dose to the celiac ganglia while treating significantly smaller tissue volumes, thereby protecting surrounding organs-at-risk (OARs) compared to CT plans. Average size of irradiated volumes for MRI plans was 1.16 ± 1.24cc versus for 32.04 ± 5.8cc CT plans (P <0.001). In comparison, mean dose to ganglia for MRI plans was 25.4 ± 1.2Gy versus 20.8 ± 2.4Gy for CT plans (P <0.001). Unilateral MRI plans can be created and delivered with comparable plan quality. This study suggests MR-Linac based celiac plexus irradiation could deliver higher dose to specific ganglia and lower dose to surrounding OARs, potentially reducing complications and enhancing pain control. Although prospective data is needed to evaluate achievable pain control and other clinical outcomes, this emphasizes the importance of MR-based treatment for more precise and effective radiation therapy in palliative care. [ABSTRACT FROM AUTHOR]

An unidentified cause of functional dyspepsia (FD) is closely associated with medication resistance. Acid suppression is a traditional and preferential method for the treatment of FD, but the efficacy of this treatment varies between epigastric pain syndrome (EPS) and postprandial syndrome (PDS): it is efficient in the former but not much in the latter. Transepithelial electrical resistance (TEER), a surrogate of mucosal barrier function, was measured under pH 3 and pH 5 acidic conditions using duodenal biopsy specimens obtained from the patients with EPS and PDS and asymptomatic healthy controls. The infiltration of inflammatory cells to the duodenal mucosa was accessed by immunohistochemical analysis. The duodenal mucosal TEER in EPS patients was decreased by exposure to the acidic solution compared to that of the controls and the PDS patients. The decrease in TEER of the EPS patients was observed even under pH 5 weak acidic condition and was correlated to degree of the epigastric pain. Moreover, the duodenal mucosa of EPS patients presented an increase in mast cells and plasma cells that expressed Ig-E. Duodenal mucosal vulnerability to acid is likely to develop EPS. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is one of the most malignant tumors of the digestive tract, with the poor prognosis and low 5-year survival rate less than 10%. Although surgical resection and chemotherapy as gemcitabine (first-line treatment) has been applied to the pancreatic cancer patients, the overall survival rates of pancreatic cancer are quite low due to drug resistance. Therefore, it is of urgent need to develop alternative strategies for its treatment. In this review, we summarized the major herbal drugs and metabolites, including curcumin, triptolide, Panax Notoginseng Saponins and their metabolites etc. These compounds with antioxidant, anti-angiogenic and anti-metastatic activities can inhibit the progression and metastasis of pancreatic cancer. Expecting to provide comprehensive information of potential natural products, our review provides valuable information and strategies for pancreatic cancer treatment. [ABSTRACT FROM AUTHOR]

Here, we report that pancreatic cancer-derived extracellular vesicles (EVs) carry adipocyte-targeting integrins and induce lipolysis, constituting the underlying mechanism of cancer-associated cachexia (CAC). GLO:F2H7/01nov22:ctm21089-fig-0003.jpg PHOTO (COLOR): 3 Panc-1 cell-derived extracellular vesicles (EVs) preferably distribute to adipose and lung tissues via ITGB1 and ITGA6. EVs derived from normal cells induce lipolysis only slightly because these EVs are rarely captured by adipocytes. After 4 h, more Panc-1-derived EVs were taken up by EV-treated adipocytes compared with Capan-2 EVs (Figure S3C). [Extracted from the article]

Background: Malignant tumors initially presenting with portal vein thrombosis (PVT) are extremely uncommon. Methods: In this rare case, a 61-year-old male was admitted with pancreatitis-like symptoms and initial imaging manifestations of PVT. The initial abdominal enhanced computed tomography (CT) scan and pathology examination did not show obvious signs of pancreatic cancer. Results: After 3 months, both the enhanced CT scan and intraoperative frozen section examination indicated pancreatic cancer with liver metastasis, while thrombosis was ruled out. Chemotherapy was administered following the operation. Conclusions: For unexplained PVT, doctors need to be highly vigilant about the possibility of pancreatic malignant tumors to avoid clinical missed diagnosis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare acute gastrointestinal (GI) toxicities in patients who underwent 3-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in chemoradiotherapy (CRT) with S-1 including prophylactic regions for pancreatic cancer. We also investigated the predictive factor of acute GI toxicities in dose volume histogram (DVH) parameters. Patients who received CRT with S-1 for pancreatic cancer between January 2014 and March 2021 were included. Radiotherapy (RT) with a total dose of 50-54 Gy was delivered. We examined the differences in the frequencies of acute GI toxicity of grade 2 or higher and DVH parameters of the stomach (ST) and duodenum (DU) between the 3DCRT group and the IMRT group. The RT-related predictive factors of acute GI toxicities were investigated by univariate and multivariate analyses. There were 25 patients in the 3DCRT group and 31 patients in the IMRT group. The frequencies of acute GI toxicity of G2 or higher were 36% in the 3DCRT group and 9.7% in the IMRT group (p = 0.035). ST V50 was the most predictive factor (p = 0.001), and the incidences of acute GI toxicity of G2 or higher in ST V50 ≥ 4.1 cc and < 4.1cc were 43.7% and 7.7%, respectively. ST V40 was also a significant predictive factor of acute GI toxicity (p = 0.002). IMRT could reduce acute GI toxicities in CRT with S-1 including prophylactic regions for pancreatic cancer. Acute GI toxicities may be affected by moderate to high doses to the ST. [ABSTRACT FROM AUTHOR]

We describe a dataset from patients who received ablative radiation therapy for locally advanced pancreatic cancer (LAPC), consisting of computed tomography (CT) and cone-beam CT (CBCT) images with physician-drawn organ-at-risk (OAR) contours. The image datasets (one CT for treatment planning and two CBCT scans at the time of treatment per patient) were collected from 40 patients. All scans were acquired with the patient in the treatment position and in a deep inspiration breath-hold state. Six radiation oncologists delineated the gastrointestinal OARs consisting of small bowel, stomach and duodenum, such that the same physician delineated all image sets belonging to the same patient. Two trained medical physicists further edited the contours to ensure adherence to delineation guidelines. The image and contour files are available in DICOM format and are publicly available from The Cancer Imaging Archive (https://doi.org/10.7937/TCIA.ESHQ-4D90, Version 2). The dataset can serve as a criterion standard for evaluating the accuracy and reliability of deformable image registration and auto-segmentation algorithms, as well as a training set for deep-learning-based methods. Measurement(s) Image Segmentation • Stomach • Duodenum • Small Intestine Technology Type(s) Computed Tomography • Kilovoltage Cone Beam Computed Tomography • Manual Factor Type(s) Treatment planning dose Sample Characteristic - Organism Homo sapiens [ABSTRACT FROM AUTHOR]

Head and neck cancer etiology and architecture is quite diverse and complex, impeding the prediction whether a patient could respond to a particular cancer immunotherapy or combination treatment. A concomitantly arising caveat is obviously the translation from pre-clinical, cell based in vitro systems as well as syngeneic murine tumor models towards the heterogeneous architecture of the human tumor ecosystems. To bridge this gap, we have established and employed a patient-derived HNSCC (head and neck squamous cell carcinoma) slice culturing system to assess immunomodulatory effects as well as permissivity and oncolytic virus (OV) action. The heterogeneous contexture of the human tumor ecosystem including tumor cells, cancer-associated fibroblasts and immune cells was preserved in our HNSCC slice culturing approach. Importantly, the immune cell compartment remained to be functional and cytotoxic T-cells could be activated by immunostimulatory antibodies. In addition, we uncovered that a high proportion of the patient-derived HNSCC slice cultures were susceptible to the OV VSV-GP. More specifically, VSV-GP infects a broad spectrum of tumor-associated lineages including epithelial and stromal cells and can induce apoptosis. In sum, this human tumor ex vivo platform might complement pre-clinical studies to eventually propel cancer immune-related drug discovery and ease the translation to the clinics. [ABSTRACT FROM AUTHOR]