Hepatobiliary Pancreat Dis Int

	2019 Vol. 18 No. 6
	Published: 2019-12-15


	Pages 503-602
	EDITORIAL META-ANALYSIS REVIEW ARTICLES ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas CLINICAL IMAGE LETTERS TO THE EDITOR

EDITORIAL

	503	Armellini E
		Endosonography guided ethanol ablation for pancreatic cystic lesions: Current status
		During the last 30 years, endoscopic ultrasound (EUS) has evolved from a diagnostic tool to an interventional instrument with impressive and rapidly evolving applications that range from tissue acquisition to biliary tree drainage or creation of anastomosis [1]. Pancreatic lesion ablation using thermal energy or through the injection of substances under EUS guidance is one of the more promising applications [2,3].
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 503-504 . [Abstract] ( 104 ) [HTML 1KB] [PDF 0KB] ( 155 )

META-ANALYSIS

	505	Voutsadakis IA
		PD-1 inhibitors monotherapy in hepatocellular carcinoma: Meta-analysis and systematic review ^Hot!
		Background: Immunity plays a major role in carcinogenesis and this is the case also for hepatocellular carcinomas (HCC). Checkpoint inhibitors, novel drugs that enhance the immune system’s ability to attack cancers, have been successfully introduced for the therapy of various malignancies including HCC. An important target of these drugs is the PD-L1/PD-1 ligand/receptor pair and several clinically available inhibitors of this pair exist. Data sources: A search of the literature until April 20, 2019 was performed in the MEDLINE/PubMed database, the Embase database and the Cochrane Central Register of Controlled Trials. The clinical studies describing treatment with PD-L1/PD-1 inhibitors as monotherapy in HCC patients were retrieved. Patient characteristics with relevance for treatment efficacy, such as liver function, disease extend and previous treatment, were extracted from identified articles. Response and survival outcomes were the primary fo- cus of the meta-analysis. Summary estimates of response rates and survival were calculated using a ran- dom or fixed effect model, depending on heterogeneity. Most common adverse effects were also recorded and summarized. Results: Three studies (two on nivolumab and one on pembrolizumab) with a total of 400 patients were included in the analysis. The summary response rate (RR) was 17.3% [95% confidence interval (CI): 13.2%–21.4%]. The summary disease control rate (DCR) was 56.6% (95% CI: 44.7%–68.5%). Summary progression free survival (PFS) was 3.5 months (95% CI: 2.8–4.2 months). Summary overall survival (OS) was 10.4 months (95% CI: 3.5–17.2 months). Adverse effect rate was low and also consistent with the adverse effect profile of PD-L1/PD-1 inhibitors in other disease locations. Conclusions: Pembrolizumab and nivolumab are the only checkpoint inhibitors with data in HCC. Meta- analysis of their effectiveness discloses rates not dissimilar to other systemic therapies available for this disease. Of interest also are the observed long responses in a sub-set of responders. Further development is clearly warranted.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 505-510 . [Abstract] ( 107 ) [HTML 1KB] [PDF 0KB] ( 176 )

REVIEW ARTICLES

	511	Jiang PC, Bu SR
		Clinical value of circular RNAs and autophagy-related miRNAs in the diagnosis and treatment of pancreatic cancer
		Background: Circular RNAs (circRNAs) are a special group of long-chain and non-coding RNAs characterized by a closed-loop structure without 3 and 5 polarity. In recent years, studies have demonstrated that circRNAs act as microRNA (miRNA) sponges to regulate the function of miRNAs. Increasing evidence indicates that circRNAs and targeted miRNAs are involved in the development, progression and metas- tasis of various cancers and drug resistance. A number of miRNAs are known to be associated with the pathogenesis, development and treatment of pancreatic cancer by regulating the autophagic activity. Data sources: A comprehensive literature search was executed in PubMed and EMBASE using the medical subject headings (MeSH) terms “Pancreatic Neoplasms”,“autophagy”,“RNA, circular”and “microRNA”. We also used text terms such as “diagnosis”,“prognosis”and “biomarker”to supplement the results. Results: Autophagy-related miRNAs is closely related to pancreatic cancer. On basis of the retrieval results, we summarized the synthesis, features and functions of circRNAs and analyzed the association between autophagy-related miRNAs and pancreatic cancer. Conclusions: circRNAs act as the miRNA sponges and there is an association between miRNAs and autophagy, which provides a new concept to broaden the knowledge about the mechanisms underlying the development, progression and metastasis of pancreatic cancer. Additionally, clinical value of circRNAs and autophagy-related miRNAs in the diagnosis and treatment of pancreatic cancer would be further verified with in-depth researches.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 511-516 . [Abstract] ( 101 ) [HTML 1KB] [PDF 0KB] ( 182 )

ORIGINAL ARTICLES/Transplantation

	517	Lai Q, Iesari S, Finkenstedt A, Hoppe-Lotichius M, Foguenne M, Lehner K, Otto G, Lerut J
		Hepatocellular carcinoma recurrence after acute liver allograft rejection treatment: A multicenter European experience ^Hot!
		Background: During the last decades, several risk factors for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) have been investigated. However, the impact of two important drivers of oncogenesis, namely the immunosuppression and the treatment of acute cellular rejection (ACR) have been marginally addressed. This study aimed at investigating the impact of ACR treatment on the incidence of tumor recurrence in a large European HCC-LT population. Methods: Seven hundred and eighty-one adult patients transplanted between February 1, 1985 and June 30, 2016 were retrospectively analyzed. After propensity score match, 116 patients treated for ACR using steroid boluses were compared with 115 patients who did not present any ACR or a histologic but clinical irrelevant ACR. Results: Steroid boluses treated patients had a 18-fold higher overall incidence of HCC recurrence than those non-treated patients (16.4% vs. 0.9%; P < 0.0001). At multivariate Cox regression analysis, steroid boluses used to treat ACR were an independent risk factor for HCC recurrence (HR = 14.2; 95% CI: 1.8–110.4; P = 0.010). Conclusions: The decision to treat ACR as well as to reinforce immunosuppression load should be cau- tiously taken in view of the presented results. Prospective studies are needed to further elucidate the clinical impact of immunosuppression on HCC recurrence after transplantation.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 517-524 . [Abstract] ( 107 ) [HTML 1KB] [PDF 0KB] ( 162 )

ORIGINAL ARTICLES/Liver

	525	Wan ZH, Ma YH, Jiang TY, Lin YK, Shi YY, Tan YX, Dong LW, Wang HY
		Six2 is negatively correlated with prognosis and facilitates epithelial-mesenchymal transition via TGF-β/Smad signal pathway in hepatocellular carcinoma
		Background: Increasing evidence indicates that Six2 contributes to tumorigenesis in various tumor including hepatocellular carcinoma (HCC). This study aimed to determine the role of Six2 in HCC and to elucidate the association of Six2 with clinical pathological characteristics. Methods: The expressions of Six2 in HCC tumor, para-tumor tissue and portal vein tumor thrombus (PVTT) were detected by tissue microarray technique, immunohistochemistry, real-time RT-PCR and Western blotting. Chi-square and Kaplan-Meier analysis were used to analyze the correlation between Six2 expression and prognosis of HCC patients. Lentivirus mediated Six2 knockdown, spheroid formation assay, proliferation assay and subcutaneous tumor implantation were performed to determine the function of Six2. Results: In 274 HCC samples, Six2 was strongly expressed. Kaplan-Meier analysis revealed that high ex- pression of Six2 was correlated with a shorter overall survival (OS) and disease-free survival (DFS). Moreover, Six2 expression was associated with sex, alpha-fetoprotein, tumor size and portal vein invasion. Six2 was highly expressed in PVTT. Six2 knockdown inhibited HCC cell lines proliferation, migration, and self-renewal in vitro and in vivo. In addition, low-expression of Six2 weakened TGF-β induced Smad4 activation and epithelial-mesenchymal transition in HCC cell lines. Conclusions: Elevated Six2 expression in HCC tumor patients was associated with negative prognosis. Upregulated Six2 promoted tumor growth and facilitated HCC metastasis via TGF-β/Smad signal pathway.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 525-531 . [Abstract] ( 105 ) [HTML 1KB] [PDF 0KB] ( 191 )

	532	Fang Q, Xie QS, Chen JM, Shan SL, Xie K, Geng XP, Liu FB
		Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: A single-center experience in China ^Hot!
		Background: Currently, hepatectomy remains the first-line therapy for hepatocellular carcinoma (HCC). However, surgery for patients with huge ( > 10 cm) HCCs is controversial. This retrospective study aimed to explore long-term survival after hepatectomy for patients with huge HCC. Methods: The records of 188 patients with pathologically confirmed HCC who underwent curative hepatectomy between 2007 and 2017 were reviewed; patients were divided into three groups according to tumor size: huge ( > 10 cm; n = 84), large (5–10 cm; n = 51) and small ( < 5 cm; n = 53) HCC. Kaplan-Meier analysis was used to assess overall survival (OS) and disease-free survival (DFS), and log-rank analysis was performed for pairwise comparisons among the three groups. Risk factors for survival and recurrence were analyzed using the Cox proportional hazard model. Results: The median follow-up period was 20 months. Although the prognosis of small HCC was better than that of huge and large HCC, OS and DFS were not significantly different between huge and large HCC ( P = 0.099 and P = 0.831, respectively). A family history of HCC, poor Child-Pugh class, vascular invasion, diolame, pathologically positive margins, and operative time ≥240 min were identified as independent risk factors for OS and DFS in a multivariate model. Tumor size ( > 10 cm) had significant effect on OS, and postoperative antiviral therapy and postoperative complications also had significant effects on DFS. Conclusions: Huge HCC is not a contraindication of hepatectomy. Although most of these patients expe- rienced recurrence after surgery, OS and DFS were not significantly different from those of patients with large HCC after resection.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 532-537 . [Abstract] ( 90 ) [HTML 1KB] [PDF 0KB] ( 195 )

	538	Li MX, Li QY, Xiao M, Wan DL, Chen XH, Zhou L, Xie HY, Zheng SS
		Survival comparison between primary hepatic neuroendocrine neoplasms and primary pancreatic neuroendocrine neoplasms and the analysis on prognosis-related factors
		Background: Primary hepatic neuroendocrine neoplasms (PHNENs) are extremely rare and few articles have compared the prognosis of PHNENs with other neuroendocrine neoplasms (NENs). This study aimed to investigate the different prognosis between PHNENs and pancreatic NEN (PanNENs) and evaluate the relevant prognosis-related factors. Methods: From January 2012 to October 2016, a total of 44 NENs patients were enrolled and divided into two groups according to the primary tumor location which were named group PHNENs (liver; n = 12) and group PanNENs (pancreas; n = 32). Demographic, clinical characteristics and survival data were compared between the two groups with Kaplan-Meier method and log-rank tests. Prognostic factors were analyzed using the Cox regression model. Results: The overall survival of group PHNENs and group PanNENs were 25.4 ± 6.7 months and 39.8 ±3.7 months, respectively ( P = 0.037). The cumulative survival of group PanNENs was significantly higher than that of group PHNENs ( P = 0.029). Univariate analysis revealed that sex, albumin, total bilirubin, total bile acid, aspartate aminotransferase, alkaline phosphatase, α-fetoprotein and carbohydrate antigen 19-9, histological types, treatments and primary tumor site were the prognostic factors. Further multivariate analysis indicated that albumin ( P = 0.008), histological types NEC ( P = 0.035) and treatments ( P = 0.005) were the independent prognostic factors. Based on the histological types, the cumulative survival of pa- tients with well-differentiated neuroendocrine tumor was significant higher than that of patients with poorly differentiated neuroendocrine carcinoma in group PHNENs ( P = 0.022), but not in group PanNENs ( P > 0.05). According to the different treatments, patients who received surgery had significantly higher cumulative survival than those with conservative treatment in both groups ( P < 0.05). Conclusions: PHNENs have lower survival compared to PanNENs. Histological types and treatments affect the prognosis. Surgical resection still remains the first line of treatment for resectable lesions and can significantly improve the survival.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 538-545 . [Abstract] ( 88 ) [HTML 1KB] [PDF 0KB] ( 148 )

	546	Xie PY, Hu XJ, Guo RM, Meng XC, Pang PF, Zhou ZY, Li D, Shan H
		Generation of functional hepatocyte-like cells from human bone marrow mesenchymal stem cells by overexpression of transcription factor HNF4α and FOXA2
		Background: Our previous study showed that overexpression of hepatocyte nuclear factor 4α (HNF4α) could directly promote mesenchymal stem cells (MSCs) to differentiate into hepatocyte-like cells. However, the efficiency of hepatic differentiation remains low. The purpose of our study was to establish an MSC cell line that overexpressed HNF4 αand FOXA2 genes to obtain an increased hepatic differentiation efficiency and hepatocyte-like cells with more mature hepatocyte functions. Methods: Successful establishment of high-level HNF4 αand FOXA2 co-overexpression in human induced hepatocyte-like cells (hiHep cells) was verified by flow cytometry, immunofluorescence and RT-PCR. Measurements of albumin (ALB), urea, glucose, indocyanine green (ICG) uptake and release, cytochrome P450 (CYP) activity and gene expression were used to analyze mature hepatic functions of hiHep cells. Results: hiHep cells efficiently express HNF4 αand FOXA2 genes and proteins, exhibit typical epithelial morphology and acquire mature hepatocyte-like cell functions, including ALB secretion, urea production, ICG uptake and release, and glycogen storage. hiHep cells can be activated by CYP inducers. The percent-age of both ALB and α-1-antitrypsin (AAT)-positive cells was approximately 72.6%. The expression levels of hepatocyte-specific genes ( ALB, AAT , and CYP1A1 ) and liver drug transport-related genes ( ABCB1, ABCG2 , and SLC22A18 ) in hiHep cells were significantly higher than those in MSCs-Vector cells. The hiHep cells did not form tumors after subcutaneous xenograft in BALB/c nude mice after 2 months. Conclusion: This study provides an accessible, feasible and efficient strategy to generate hiHep cells from MSCs.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 546-556 . [Abstract] ( 97 ) [HTML 1KB] [PDF 0KB] ( 183 )

ORIGINAL ARTICLES/Biliary

	557	Wu X, Huang ZJ, Zhong JY, Ran YH, Ma ML, Zhang HW
		Laparoscopic common bile duct exploration with primary closure is safe for management of choledocholithiasis in elderly patients
		Background: Laparoscopic common bile duct exploration (LCBDE) is one of the minimally invasive options for choledocholithiasis. Primary closure of the common bile duct (CBD) upon completion of laparoscopic choledochotomy is safe in selected patients. The present study aimed to evaluate the feasibility and safety of primary closure of CBD after LCBDE in patients aged 70 years or older. Methods: A total of 116 patients (51 males and 65 females) who suffered from choledocholithiasis and underwent primary closure of the CBD (without T-tube drainage) after LCBDE from January 2003 to De- cember 2017 were recruited. They were classified into two groups according to age: group A ( ≥70 years, n = 56), and group B ( < 70 years, n = 60). The preoperative characteristics, intraoperative details, and postoperative outcomes of the two groups were evaluated. Results: The mean operative time was 172.02 min for group A and 169.92 min for group B (P = 0.853). The mean hospital stay was 7.40 days for group A and 5.38 days for group B ( P < 0.001). Bile leakage occurred in two patients in group A and one in group B (3.57% vs 1.67%, P = 0.952). There were no significant differences in the rates of postoperative complications and mortality between the two groups. At median follow-up time of 60 months, stone recurrence was detected in one patient in group A and two in group B (1.79% vs 3.33%, P = 1.000). Stenosis of CBD was not observed in group A and slight stenosis in one patient in group B (0 vs 1.67%, P = 1.000). Conclusion: Primary closure of the CBD upon completion of laparoscopic choledochotomy is safe and feasible in elderly patients ≥70 years old.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 557-561 . [Abstract] ( 97 ) [HTML 1KB] [PDF 0KB] ( 187 )

ORIGINAL ARTICLES/Pancreas

	562	Choi JH, Lee SH, Choi YH, You MS, Shin BS, Paik WH, Ryu JK, Kim YT
		Safety of endoscopic ultrasound-guided ethanol ablation for pancreatic cystic lesions: A single-center experience of 214 patients ^Hot!
		Background: Endoscopic ultrasound-guided ethanol ablation (EUS-EA) for pancreatic cystic lesions (PCLs) has been used in recent years as a feasible treatment modality for low malignant probability PCLs or patients considered high-risk for surgery. The present study aimed to confirm the safety of EUS-EA and to find predictive factors for adverse event (AE). Methods: A retrospective review was performed from the prospectively maintained database of patients who underwent EUS-EA for PCLs from June 2006 to April 2018 at Seoul National University Hospital. The primary outcomes of the study were the rates of AEs and severe AEs by EUS-EA. The secondary outcome was the predictive factors of AEs including acute pancreatitis and abdominal pain. Results: A total of 214 patients were evaluated and the diagnoses of PCLs according to cystic fluid analysis and clinical features were as follows: serous cystic neoplasm (32.2%), mucinous cystic neoplasm (26.6%), branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) (29.4%), and pseudocyst (11.7%). Three patients (1.4%) experienced severe AEs. Overall, AEs occurred in 71 (33.2%) patients. BD-IPMN (OR: 2.87; 95% CI: 1.05–7.84; P = 0.040), multilocular cysts (OR: 3.59; 95% CI: 1.09–11.85; P = 0.036), suspected ethanol leakage during procedure (OR: 10.68; 95% CI: 1.98–57.53; P = 0.006), and sticky cystic fluid (OR: 3.83; 95% CI: 1.20–12.24; P = 0.024) were predictive factors for post-procedural acute pancreatitis. PCLs of uncinate process (OR: 2.99; 95% CI: 1.22–7.35; P = 0.017) and PCLs with exophytic portion (OR: 3.70; 95% CI: 1.96–7.01; P < 0.001) were predictive factors for post-procedural abdominal pain. Conclusions: EUS-EA is a safe procedure with a very low rate of severe AEs. It seems possible to predict the AEs according to the features of the procedure and PCLs.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 562-568 . [Abstract] ( 96 ) [HTML 1KB] [PDF 0KB] ( 161 )

	569	Gwiasda J, Qu Z, Schrem H, Oldhafer F, Winny M, Klempnauer J, Grannas G, Kaltenborn A
		Prediction of survival after left-sided pancreatic resection for adenocarcinoma: Introduction of a new prognostic score ^Hot!
		Background: Due to the clinically unapparent course the entity of left-sided pancreatic adenocarcinoma is often diagnosed at advanced stages, resulting in small numbers of patients qualifying for pancreatectomy. This study strives to develop a prognostic model for survival after left-sided pancreatic resection. Methods: A total of 54 patients were analyzed. Pre- and intra-operative predictive factors for 18-month mortality were identified with multivariable binary logistic regression analysis and compiled into a prognostic model. The applicability was evaluated by assessment of the area under the receiver operating characteristic curve (AUROC). The model was internally validated applying a randomized backwards boot-strapping analysis. Results: The 18-month mortality rate was 74.1% ( n = 40). Mean survival was 19.1 months. A prognostic model for 18-month mortality after left sided-pancreatectomy showed an AUROC > 0.800: 18-month mortality risk in% = Exp(Y) / (1 + Exp(Y)) with y = -0.927 + (1.724, if CA 19-9 elevated, otherwise 0) + (1.212 × number of intra-operative transfused packed red blood cells) + (2.771, if prior abdominal surgery, otherwise 0) −(3.612, if gastric resection, otherwise 0) This model was internally validated in 40 randomized backwards bootstrapping steps with AUROCs ranging from 0.757 to 0.971. Conclusions: The 18-month mortality risk for patients after left-sided pancreatectomy for adenocarcinoma of the pancreatic body can be assessed with the number of intra-operatively transfused packed red blood cells, elevated CA 19-9 levels, additional gastric resection and prior abdominal surgeries in the patient’s history.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 569-575 . [Abstract] ( 101 ) [HTML 1KB] [PDF 0KB] ( 153 )

	576	de Pretis N, Vieceli F, Brandolese A, Brozzi L, Amodio A, Frulloni L
		Autoimmune pancreatitis not otherwise specified (NOS): Clinical features and outcomes of the forgotten type
		Background: Autoimmune pancreatitis (AIP) is a well-recognized fibroinflammatory disease of the pancreas. Despite the significant number of studies published on AIP type 1 and 2, no studies have been focused on AIP type not otherwise specified (NOS) and therefore very little is known about clinical features and long-term outcomes of these patients. The aim of this study was to investigate clinical and radiological features of AIP type NOS-patients. Methods: Patients classified as AIP type NOS at clinical onset included in our database prospectively maintained since 1995 were evaluated. Epidemiological, clinical data were collected and analyzed. Results: Forty-six patients were included in the study. The clinical onset was mainly characterized by weight loss, jaundice and acute pancreatitis. Eight patients (17.4%) were reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis. Seven patients (15.2%) experienced relapse after steroid treatment but only one (2.2%) needed immunosuppressive drugs because of recurrent relapses. Conclusions: AIP type NOS shares clinical features similar to AIP type 2 and a relevant proportion of patients was reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis. The risk of relapse is low but not irrelevant.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 576-579 . [Abstract] ( 123 ) [HTML 1KB] [PDF 0KB] ( 187 )

	580	Liu L, Liu FB, Huang M, Xie K, Xie QS, Liu CH, Shen MJ, Huang Q
		Circular RNA ciRS-7 promotes the proliferation and metastasis of pancreatic cancer by regulating miR-7-me diate d EGFR/STAT3 signaling pathway ^Hot!
		Background: Pancreatic ductal adenocarcinoma (PDAC) is the most deadly type of tumor, and its pathogenesis remains unknown. Circular RNAs (circRNAs) may be functional and bind to microRNAs and consequently, influence the activity of targeted mRNAs. Recent researches indicate that one circRNA, ciRS-7, acts as a sponge of miR-7 and thus, inhibits its activity. It is well known that miR-7 is a cancer suppressor in many cancers. However, the relationship between ciRS-7 and miR-7, and the role of ciRS-7 in PDAC, remains to be elucidated. Methods: miR-7 and ciRS-7 expression in 41 pairs of PDAC tumors and their paracancerous tissues were detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The relationships between their expression levels and clinicopathological features in PDAC tissues were assessed. The relationship between miR-7 and ciRS-7 was also assessed by Spearman’s correlation. We also used cell lines to evaluate the role of ciRS-7 in cell line behavior. The ciRS-7 interfere RNA (siRNA) and its empty vector were transfected into PDAC cells. PDAC cells proliferation and invasion abilities were detected by MTT assay and invasion analysis. The expression of proteins was assessed by Western blotting. Results: ciRS-7 expression was significantly higher in PDAC tissues than paracancerous tissues ( P = 0.002). However, miR-7 expression showed the opposite trend ( P = 0.048). Moreover, ciRS-7 expression was in- versely correlated with miR-7 in PDAC ( r s = −0.353, P = 0.023). ciRS-7 expression was also signifi- cantly elevated in venous invasion (3.72 ±2.93 vs. 2.14 ±1.26; P = 0.028) and lymph node metastasis (4.19 ±2.75 vs. 2.32 ±1.90; P = 0.016) in PDAC patients. Furthermore, ciRS-7 knockdown suppressed cell proliferation and invasion of PDAC cells ( P < 0.05), and the downregulation of ciRS-7 resulted in miR-7 overexpression and subsequent inhibition of epidermal growth factor receptor (EGFR) and signal transducer and activator of transcription 3 (STAT3). Conclusions: Circular RNA ciRS-7 plays an oncogene role in PDAC, partly by targeting miR-7 and regulating the EGFR/STAT3 signaling pathway.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 580-586 . [Abstract] ( 90 ) [HTML 1KB] [PDF 0KB] ( 181 )

CLINICAL IMAGE

	587	Pastor Perez P, Gonzalez Valverde FM, Pastor Quirante F
		Macrocystic serous cystadenoma of the pancreas
		Cystic pancreatic lesions are common, and about 90% of these lesions are pseudocysts or retention cysts. True cysts of the pancreas are rare. The majority of pancreatic serous cystadenomas are microcystic. Macrocystic serous cystadenoma is an unusual and essentially benign pancreatic tumor. The radiologic features of this subtype may resemble a pseudocyst or a mucinous cystadenoma. Thus, it is often difficult to make a correct diagnosis [1,2] . Herein, we report on a macrocystic serous cystadenoma of the pancreas in a 46-year-old female patient, with a preoperative diagnosis of pancreatic pseudocyst by radiologic imaging.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 587-589 . [Abstract] ( 91 ) [HTML 1KB] [PDF 0KB] ( 159 )

	590	Markovic V, Stojakov D, Micev M, Kmezic S, Saponjski D, Krivokapic Z
		Castleman’s disease presented as a rare unicentric pancreatic mass
		A 44-year-old male patient was initially presented with pain in the upper abdomen. Weight loss, jaundice and digestive disorders were not reported. Blood analysis showed white blood cell count 9.02 × 10 9 , C-reactive protein (CRP) 3 mg/L, and gastrin 38 ng/L. Abdominal ultrasonography revealed tumor in the projection of duodenum and pancreatic head. Colonoscopy and tumor markers (CA19-9, CEA, CA72-4, and AFP) were all negative.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 590-592 . [Abstract] ( 96 ) [HTML 1KB] [PDF 0KB] ( 171 )

	593	Li DB, Tang ZX, Ye JX, Li Z, Yang XH, Qin L, Zhao H
		Hemobilia with acute pancreatitis secondary to biliary tract infection
		Hemobilia is a rare medical condition with variety of etiologies. Among them, two in thirds are iatrogenic. Hemobilia combined with acute pancreatitis is unusual. Herein we reported a case of hemobilia with acute pancreatitis secondary to biliary tract infection.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 593-595 . [Abstract] ( 95 ) [HTML 1KB] [PDF 0KB] ( 172 )

	596	Huang HT, Ling Q
		Is an accessory nipple associated with an intrapancreatic accessory spleen?
		Intrapancreatic accessory spleen (IPAS) is a rare differential diagnosis of a solitary hypervascular lesion. It is not uncommon to misdiagnose IPAS as pancreatic tumors since no specific imaging has been developed for the differential diagnosis. We described a rare case of a male patient with a unilateral accessory nipple and a solitary hypervascular lesion in the pancreas. The patient underwent a distal pancreaticosplenectomy, and IPAS was finally diagnosed.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 596-597 . [Abstract] ( 97 ) [HTML 1KB] [PDF 0KB] ( 164 )

LETTERS TO THE EDITOR

	598	Pease M, Baltatzis M, Nadarajah V, Sheen AJ, Siriwardena AK, Jamdar S
		Computed tomographic angiography for diagnosis of post-pancreatoduodenectomy hemorrhage?
		Even in high volume specialist hepato-pancreato-biliary surgery centres, hemorrhage after pancreatoduodenectomy remains a feared and potentially lethal complication [1] and an important cause of postoperative morbidity and mortality [2] .
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 598-600 . [Abstract] ( 101 ) [HTML 1KB] [PDF 0KB] ( 169 )

	601	Jia JJ, Li JH, Xin L, Li HY, Badiwala M, Sun Y, Xu X, Zheng SS
		International Organ Protection Symposium: The fusion of engineering and medicine
		The International Organ Protection Symposium was held in Toronto, Canada on May 15–16, 2019. This symposium focused on the fusion of engineering and medicine, bringing together experts in organ transplantation, organ repair, artificial organs, precision medicine, automation, micro and nanotechnologies. This letter highlights some of the innovative and impactful presentations in this symposium.
		Hepatobiliary Pancreat Dis Int. 2019; 18(6): 601-602 . [Abstract] ( 97 ) [HTML 1KB] [PDF 0KB] ( 166 )

Forgot your password?

Enter your e-mail address to receive an e-mail with your account information.

Submission Guidance

Top cited articles

- Most Cited Hepatobiliary & Pancreatic Diseases International Articles

- Most Downloaded Hepatobiliary & Pancreatic Diseases International Articles

more>>

Top downloaded articles

more>>

Services

Web feed

hbpdint@126.com

hbpdje@zju.edu.cn

Copyright © Official Publication of First Affiliated Hospital
Official Publication of First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
浙ICP备05050873号-1