Effect of pancreatic extracorporeal shock wave lithotripsy on chronic pancreatitis stones / 中华外科杂志

Objective: To analyze the therapeutic effect and safety of pancreatic extracorporeal shock wave lithotripsy(P-ESWL) for patients with chronic pancreatitis complicated by stones of the pancreatic duct and to investigate the influencing factors. Methods: A retrospective analysis was performed on clinical data from 81 patients with chronic pancreatitis complicated by pancreatic duct calculus treated with P-ESWL in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi 'an Jiaotong University from July 2019 to May 2022. There were 55 males(67.9%) and 26 females(32.1%). The age was (47±15)years (range: 17 to 77 years). The maximum diameter(M(IQR)) of the stone was 11.64(7.60) mm, and the CT value of the stone was 869 (571) HU. There were 32 patients (39.5%) with a single pancreatic duct stone and 49 patients(60.5%) with multiple pancreatic duct stones. The effectiveness, remission rate of abdominal pain, and complications of P-ESWL were evaluated. Student's t test, Mann Whitney U test, χ2 test, or Fisher's exact test was used to compare the characteristics between the effective and ineffective groups of lithotripsy. The factors influencing the effect of lithotripsy were analyzed by univariate and multivariate logistic regression analysis. Results: Eighty-one patients with chronic pancreatitis were treated with P-ESWL 144 times, with an average of 1.78 (95%CI:1.60 to 1.96) times per person. Among them, 38 patients(46.9%) were treated with endoscopy. There were 64 cases(79.0%) with effective removal of pancreatic duct calculi and 17 cases(21.0%) with ineffective removal. Of the 61 patients with chronic pancreatitis accompanied by abdominal pain, 52 cases(85.2%) had pain relief after lithotripsy. After lithotripsy treatment, 45 patients(55.6%) developed skin ecchymosis, 23 patients(28.4%) had sinus bradycardia, 3 patients(3.7%) had acute pancreatitis, 1 patient(1.2%) had a stone lesion, and 1 patient(1.2%) had a hepatic hematoma. Univariate and multivariate logistic regression analysis showed that the factors affecting the efficacy of lithotripsy included the age of patient(OR=0.92, 95%CI: 0.86 to 0.97), the maximum diameter of the stone(OR=1.12,95%CI:1.02 to 1.24) and the CT value of the stone(OR=1.44, 95%CI: 1.17 to 1.86). Conclusions: P-ESWL is effective in the treatment of patients with chronic pancreatitis complicated by calculi of the main pancreatic duct.Factors affecting the efficacy of lithotripsy include patient's age, maximum stone diameter, and CT value of calculi.

Effect and mechanism of metformin on TGF-β1expression in pancreatic cancer / 西安交通大学学报(医学版)

Objective: To investigate the effect of metformin on TGF-β1 expression in pancreatic cancer and further analyze the underlying mechanism. Methods: After metformin intervention, cell proliferation and invasion ability were detected by MTT assay and Transwell method, respectively. The expression of TGF-β1 in pancreatic cancer cell lines Panc-1 and BxPC-3 was detected by qRT-PCR, Western blot and immunofluorescence. The expression of AMPK/p-AMPK was detected by Western blot; ELISA method was used to measure the content of TGF-β1 in cell supernatant. After silencing AMPK expression in pancreatic cancer cell lines, the cells were treated with metformin and the expression of TGF-β1 was detected by qRT-PCR and Western blot. Results: The phosphorylation level of AMPK in Panc-1 (P<0.001) and BxPC-3 (P<0.001) cells was significantly decreased after metformin intervention. In addition, the expression of TGF-β1 in tumor cells was significantly decreased. However, the reduced expression of TGF-β1 by metformin was reversed by AMPK silencing in cancer cells (P<0.05). Conclusion: Metformin can inhibit TGF-β1 expression in pancreatic cancer cells by inducing AMPK phosphorylation.