Search Results (138)

Introduction: Minimally invasive pancreatoduodenectomy (MIPD), including laparoscopic (LPD) and robotic approaches (RPD), has gained increasing attention as an alternative to open pancreatoduodenectomy (OPD). Despite rapid technological progress, concerns persist regarding safety, reproducibility, and oncological adequacy. The publication of randomized controlled trials (RCTs) provides essential high-level evidence to reassess the true benefits and limitations of MIPD. Methods: This narrative review synthesizes all available RCTs comparing LPD and RPD with OPD. Major domains evaluated include mortality, major morbidity, intraoperative parameters, postoperative recovery, oncological outcomes, conversion, costs, and the influence of surgeon experience and institutional volume. The objective is to contextualize RCT findings rather than perform a quantitative meta-analysis. Discussion: Across studies, LPD demonstrates comparable mortality and complication rates to OPD in high-volume centers, with consistent reductions intraoperative blood loss (IBL) and shorter recovery or length of stay (LOS). RPD shows more heterogeneous results: one large trial reported improved postoperative recovery, whereas the EUROPA trial identified higher rates of pancreatic fistula (POPF) and delayed gastric emptying (DGE) alongside significantly increased costs. Both LPD and RPD achieve oncological outcomes equivalent to OPD, and 3-year survival data confirm the long-term non-inferiority of LPD. However, operative time remains longer for all minimally invasive approaches, and conversion persists as a marker of technical difficulty and incomplete learning curve. Conclusions: Current RCT evidence indicates that MIPD is safe, feasible, and oncologically sound only when performed by surgeons who have surpassed the demanding learning curve within specialized, high-volume centers. The benefits, mainly reduced IBL and faster recovery, must be weighed against longer operative times, conversion risks, and substantially higher costs for RPD. MIPD should therefore be considered an advanced option rather than a universal standard, and its broader implementation requires structured training pathways, appropriate patient selection, and institutional readiness. Full article

Background and Objectives: Dichrostachys glomerata and Cissus quadrangularis, two species traditionally used in Cameroon, are recognized for their weight-reducing potential. This study examined the effects of standardized extracts of these botanicals on glucagon-like peptide-1 (GLP-1), dipeptidyl peptidase-4 (DPP-4), and key metabolic outcomes in individuals with excess body weight. Materials and Methods: In this 16-week, randomized, double-blind, placebo-controlled trial, 248 adults (126 women and 122 men; mean age 41.3 ± 0.3 years; BMI 25–34.9 kg/m²) were assigned to receive 400 mg D. glomerata extract (DGE), 300 mg C. quadrangularis extract (CQE), semaglutide (dose-escalated from 3 mg to 14 mg), or placebo, administered once daily. These are all standard clinical regimens. Primary assessments included changes in GLP-1 levels and DPP-4 activity. Secondary evaluations included body composition, caloric intake, satiety response, fasting glucose levels, and lipid profiles. Results: Participants receiving DGE or CQE displayed notable elevations in circulating GLP-1 (+38.6 pg/mL and +42.2 pg/mL, respectively; p < 0.01) and significant reductions in DPP-4 activity (−15.3% and −17.8%; p < 0.01) compared with placebo. Both extracts produced substantial improvements in body weight (−5.2% and −5.8%), body fat (−10.3% and −10.9%), energy intake (−16.2% and −17.5%), and satiety (+25.6% and +27.4%) (p < 0.01). Significant changes in fasting glucose and serum lipid levels were also observed (p < 0.05). These responses are comparable to those of semaglutide. Moreover, GLP-1 increments showed strong negative correlations with body fat percentage (r = −0.91 to −0.92; p < 0.001) and DPP-4 activity (r = −0.97 to −0.98; p < 0.001). Conclusions: Supplementation with D. glomerata and C. quadrangularis extracts enhanced GLP-1 secretion and reduced DPP-4 activity, yielding significant benefits for body composition and metabolic parameters. These findings indicate that both botanicals are promising natural agents for managing obesity through incretin-based mechanisms. Full article

In tilapia, males grow faster than females, but the metabolites/pathways behind this sexual dimorphism remain unclear. In this study, we first examined growth, feeding, serum biochemical parameters, and mRNA expression in tilapia under mono-sex and mixed-sex cultures. Tilapia raised mono-sexually grow faster than those raised in mixed-sex environments. We conducted a combined analysis of the gas chromatography–mass spectrometry (GC-MS)-based metabolome and digital gene expression (DGE) profile in the livers of immature and mature tilapia, with special reference to the sexual differences. The glucose and lipid metabolism pathways exhibited significant sexual dimorphism. The concentrations of melatonin, oxoadipate, and glucuronic acid in the tryptophan metabolism pathway showed sexual differences. Melatonin implantation inhibited food intake and growth in tilapia and impacted their glucose and lipid metabolism. After melatonin implantation, the glucose tolerance of tilapia improved, especially in females. This study generates comprehensive data elucidating the mechanisms underlying sexual dimorphism in glucose and lipid metabolism and establishes a reliable scientific basis for investigating the role of melatonin in the sexual dimorphism of tilapia. Full article

Computed tomography (CT) is a major source of low-dose ionizing radiation exposure in medical imaging. Risk assessment at this dose level is difficult and relies on the hypothetical linear no-threshold model. To address the response to such low doses in patients undergoing CT scans, we examined radiation-induced alterations at the transcriptomic and DNA damage levels in peripheral blood cells. Peripheral whole blood of 60 patients was collected before and after CT. Post-CT samples were obtained 4–6 h after scan (n = 28, in vivo incubation) or alternatively immediately after the CT scan, followed by ex vivo incubation (n = 32). The gene expression of known radiation-responsive genes (n = 9) was quantified using qRT-PCR. DNA double-strand breaks (DSB) were assessed in 12 patients through microscopic γ-H2AX + 53BP1 DSB focus staining. The mean dose–length product (DLP) across all scans was 561.9 ± 384.6 mGy·cm. Significant differences in the median differential gene expression (DGE) were detected between in vivo and ex vivo incubation conditions, implicating that ex vivo incubation masked the true effect in low-dose settings. The median DGE of in vivo-incubated samples showed a significant upregulation of EDA2R, MIR34AHG, PHLDA3, DDB2, FDXR, and AEN (p ranging from <0.001 to 0.041). In vivo, we observed a linear dose-dependent upregulation for several genes and an explained variance of 0.66 and 0.56 for AEN and FDXR, respectively. DSB focus analysis revealed a slight, non-significant increase in the average DSB damage post-exposure, at a mean DLP of 321.0 mGy·cm. Our findings demonstrate that transcriptional biomarkers are sensitive indicators of low-dose radiation exposure in medical imaging and could prove themselves as clinically applicable biodosimetry tools. Furthermore, the results underscore the need for dose optimization. Full article

In this paper we investigate the short-run and long-run determinants of the informal economy in Romania using Dynamic General Equilibrium (DGE)-based estimates of informal output as the dependent variable. An ARDL model is used to analyze macroeconomic and institutional variables for Romania during the period of 1995–2023, including inflation (INF), primary net lending/borrowing (NLB), the political stability index (PSI), interest payments (INTPAY), gross domestic product per capita (GDP), and self-employment (SEMP). The findings show that inflation, fiscal balance, political stability, interest payments, and GDP per capita have a short- and long-run impact on informal output. In the long run, a 1% increase in inflation raises informal output by 0.03%, while a 1% rise in GDP per capita reduces it by 0.29%. The error correction term suggests a rapid adjustment speed of 79% toward the long-run equilibrium. These findings suggest that institutional reforms, sustained economic growth, and stable macroeconomic policies play an important role in reducing informality and promoting sustainable economic resilience in Romania. Full article

Background: Glucose, a central carbohydrate in higher organisms’ metabolism, can undergo extensive oxidative modification under conditions of excessive inflammation or elevated reactive oxygen and nitrogen species (RONS). Such modifications yield glucose oxidation products (GOPs) with potential biological relevance and toxicity. This study aimed to systematically characterize GOP formation under defined oxidative conditions generated by gas plasma treatment. Methods: D-glucose solutions were prepared at 0.25 mM (hypoglycemic/diabetic range), 2.5 mM (sub-physiological), and 25 mM (peritoneal dialysis fluid). Samples were exposed for up to 20 min to the atmospheric-pressure argon plasma jet kINPen, which produces a wide spectrum of RONS. Treatment time-dependent glucose oxidation was assessed by high-resolution mass spectrometry (HRMS) and tandem mass spectrometry (MS/MS) to identify the oxidation products. Results: Gas plasma exposure generated various oxidation products and their abundance profiles depended on initial glucose concentration and treatment duration. Identified products included 2-keto-D-glucose, 3-deoxyglucosone (3DG), 3,4-dideoxyglucosone-3-ene (3,4DGE), furaldehyde, methylglyoxal, and acetaldehyde. HRMS/MS analysis confirmed diagnostic fragment ions for each GOP and revealed distinct formation across the model scenarios. Conclusions: Cold gas plasma induces a spectrum of glucose oxidation products under biomedically relevant glucose levels. The identified GOPs, many of which have known cytotoxic or signaling properties, provide mechanistic insight into glucose oxidation in inflamed or oxidative microenvironments. These findings support the utility of plasma-based oxidative models for studying GOP-associated biological effects and potential pathophysiological consequences. Full article

Background and Objectives: Pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are the two most frequently employed reconstruction techniques following pancreaticoduodenectomy (PD), yet the optimal method remains debated. The objective of this study was to compare perioperative outcomes of PG versus PJ in patients undergoing PD for resectable periampullary tumors at a high-volume center. Materials and Methods: We conducted a retrospective cohort study including 604 consecutive patients who underwent PD between January 2019 and May 2025. Reconstruction of the pancreatic remnant was achieved by binding PG in 415 patients and duct-to-mucosa PJ in 189 patients. Demographics, intraoperative data, and postoperative outcomes were analyzed using standardized ISGPS/ISGLS definitions. Results: The overall complication rate was similar between groups (43.9% vs. 47.1%; p = 0.481). However, PG was associated with significantly lower rates of postoperative pancreatic fistula (POPF) (12.3% vs. 18.5%; p = 0.042) and postoperative biliary fistula (POBF) (2.9% vs. 6.3%; p = 0.044) compared with PJ. No significant differences were observed in delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), intra-abdominal abscess, relaparotomy, length of postoperative stay, or 90-day mortality. Conclusions: PG was associated with reduced rates of anastomotic fistulas compared with PJ, while other perioperative outcomes were comparable. These findings suggest that PG may be particularly advantageous in patients with a soft pancreatic remnant or nondilated duct, where the risk of fistula is higher, whereas PJ remains appropriate for firm, fibrotic glands with dilated ducts. Tailoring the reconstructive technique to pancreatic texture and ductal anatomy may therefore improve surgical outcomes and reduce postoperative morbidity. Full article

Background: Pancreaticoduodenectomy (PD) with portal–superior mesenteric vein (PV-SMV) resection is increasingly performed in borderline-resectable periampullary cancer. While conventional PD is the reference standard, robotic PD (RPD) may improve operative ergonomics and recovery; its performance and learning curve in PV-SMV resection remain unclear. Materials and Methods: We retrospectively reviewed consecutive patients undergoing PD with PV-SMV resection at a single tertiary center by a single surgeon (July 2016–September 2022). Twenty-seven patients met the inclusion criteria and were grouped as conventional PD (n = 14) or RPD (n = 13). To assess the learning curve, RPD cases were stratified as early (cases 1–3) versus late (cases 4–13). Primary outcomes were operative time and blood loss; secondary outcomes included 90-day morbidity/mortality, R0 margin, lymph node yield, length of stay, readmission, and overall survival. Results: Baseline characteristics were comparable between conventional PD and RPD. Median operative time was longer with RPD vs. conventional PD (624.0 [IQR 579.0–794.0] vs. 529.5 [456.5–636.5] mins; p = 0.024). Median blood loss trended lower with RPD (350.0 [200.0–1950.0] vs. 1455.0 [630.0–2940.0] mL; p = 0.254). Rates of clinically relevant complications (including POPF, DGE, and hemorrhage), R0 resection (69% vs. 64%), lymph node retrieval, length of stay, 90-day readmission, 90-day mortality, and overall survival were similar between conventional PD and RPD. Within RPD, operative time and blood loss improved from the early to late phases (794.0 → 601.5 min; 1950.0 → 275.0 mL), consistent with a learning-curve effect, though not statistically significant in this small cohort. Conclusions: In selected patients, RPD with PV-SMV resection is feasible and achieves oncologic and short-term clinical outcomes comparable to conventional PD, with evidence of efficiency gains as experience accrues. These findings support structured training and case accumulation for the safe adoption of complex robotic pancreatic surgery. Full article

The dedifferentiation of smooth muscle cells (SMCs) is the main cause of atherosclerosis and vascular calcification. This study integrated the gene expression data of multiple microarrays to identify relevant marker molecules. A total of 72 Gene Expression Omnibus (GEO) samples (GSM) were collected from 10 gene expression data series (GSE) and divided into five groups: non-SMC, SMC, atherosclerotic SMC (SMC-ath), calcified SMC (SMC-calc), and treated SMC (SMC-t). The SMC-t group included synthetic SMCs that had undergone treatment to inhibit proliferation, migration, or inflammation. The gene expression data were merged, normalized, and batch effects were removed before differential gene expression (DGE) analysis was performed via linear models for microarray data (limma) and statistical analysis of metagenomic profiles (STAMPs). The genes with expressions that significantly differed were subsequently subjected to protein-protein interaction (PPI) and functional prediction analyses. In addition, the random forest method was used for classification. Twelve proteins that may be marker molecules for SMC differentiation and dedifferentiation were identified, namely, Proprotein convertase subtilisin/kexin type 1 (PCSK1), Transforming growth factor beta-induced (TGFBI), Complement C1s (C1S), Phosphomannomutase 1 (PMM1), Claudin 7 (CLDN7), Calcium binding and coiled-coil domain 2 (CALCOCO2), SAC3 domain-containing protein 1 (SAC3D1), Natriuretic peptide B (NPPB), Monoamine oxidase A (MAOA), Regulator of the Cell Cycle (RGCC), Alpha-crystallin B Chain (CRYAB), and Alcohol dehydrogenase 1B (ADH1B). Finally, their possible roles in SMCs are discussed. This study highlights the feasibility of bioinformatics analysis for studying SMC dedifferentiation. Full article

This study evaluates the technical and economic feasibility of liquid polymer emulsions as substitutes for powder polymers in polymer flooding applications, particularly in space-constrained, low-permeability reservoirs in Austria. Rheological tests determined that target viscosities of 20 mPa·s at 20 °C and a shear rate of 7.94 s⁻¹ were achieved using concentrations of 1200 ppm for liquid polymer 1 (LP1), 2250 ppm for liquid polymer 2 (LP2), and 1200–1400 ppm for powder polymers. Injectivity tests revealed that liquid polymers encountered challenges in 60 mD and 300 mD core plugs, with pressure stabilization not achieved at injection rates of 1–2.5 ft/day. Powder polymers demonstrated stable injectivity, with powder polymer 1 (PP1) showing an optimal performance at 10 ft/day and a low residual resistance factor (RRF). Two-phase core floods using PP1 and powder polymer 2 (PP2) at 1 ft/day yielded incremental oil recovery factors of approximately 5%, with a maximum of 8% observed for higher viscosity slugs. Economic analysis indicated that over a 3-year horizon, liquid polymers are 30% cheaper than powder polymer Option 1 but 100% more expensive than Option 2. Over a 10-year horizon, liquid polymers are 50% more expensive than both powder polymer options. Although liquid polymers offer logistical advantages, they are unsuitable for low-permeability reservoirs. Powdered polymers, particularly PP1, are recommended for pilot implementation due to superior injectivity, mechanical stability, and recovery performance. Full article

Background: Pancreatic and hepatobiliary tumors continue to rank among the deadliest cancers worldwide. Due to a low response rate to treatment, these tumors continue to have a high death rate, a poor prognosis and survival rate, and an overall poor patient outcome. The multimodal strategy used in current treatment includes systemic therapy, radiation therapy, and surgery. However, surgery remains the only treatment with curative intent. Preoperative biliary drainage has a direct impact on the perioperative prognosis of patients with obstructive jaundice and significantly compromised liver function due to hepato-bilio-pancreatic malignancies. Our study’s goal was to determine the safest and most efficient preoperative biliary drainage technique by conducting a systematic review and meta-analysis of resectable periampullary cancers. Methods: Our approach consisted of searching PubMed, BMC Medicine, and Scopus databases using keywords with a result of 1104 articles from 2010 to 2023. The remaining 24 articles that met our inclusion criteria were subjected to meta-analysis using R Commander 4.3.2. Results: Endoscopic retrograde biliary drainage (ERBD) demonstrated a higher rate of postprocedural pancreatitis (RR = 2.22, p < 0.01), intra-abdominal abscess (RR = 1.64, p < 0.01), and delayed gastric emptying (DGE) (RR = 2.07, p < 0.01) than percutaneous transhepatic biliary drainage (PTBD) or endoscopic nasobiliary drainage (ENBD). Plastic stent (PS) had higher rates of catheter occlusion (RR = 2.20, p < 0.01) and POPF (RR = 1.66, p < 0.01) compared to self-expandable metallic stent (SEMS), which could explain a longer hospital stay (MD = 2.41 days, p < 0.01). However, PS had lower rates of grade 1–2 complications (RR = 0.79, p = 0.017) and wound infection rates (RR = 0.66, p = 0.017) than self-expandable metallic stent (SEMS). Conclusions: The choice of a preoperative drainage method can influence postprocedural and postoperative complications rates. ERBD appears to be associated with higher procedure-related and postoperative complication rates and may be linked to a prolonged hospital stay compared to ENBD or PTBD. Moreover, the type of stent placed through ERBD procedure had an important impact on prognosis, as PS had a higher rate of catheter occlusion and POPF, with a prolonged hospital stay compared to SEMS, while mild complications and wound infections were less common in PS group. Full article

Background: Despite advances in surgical techniques and perioperative care, pancreatic resections such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) remain high-risk procedures. Postoperative complications significantly impact morbidity, mortality, and patient quality of life. Methods: This narrative review summarizes recent literature on major complications following pancreatic surgery, including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and post-pancreatectomy hemorrhage (PPH), with an emphasis on incidence, risk factors, outcomes, and current preventive strategies. Results: POPF is a leading complication, occurring in 5–22% of cases and often linked with sepsis and hemorrhage. Key risk factors include high BMI, soft pancreatic texture, and small duct size. Preventive measures like Pasireotide, modified anastomosis techniques, and neoadjuvant therapy show variable success. DGE affects up to 57% of PD patients and is associated with prolonged recovery; antecolic reconstruction and erythromycin may reduce incidence. PPH, though less frequent (3–13%), can be life-threatening, particularly when secondary to POPF. Endovascular approaches are now favored for late arterial bleeding. Other complications include wound infections, abscesses, bile leaks, and pulmonary issues, all contributing to extended hospital stays and diminished quality of life. Conclusions: Pancreatic surgery continues to carry significant risks, with POPF, DGE, and PPH being the most impactful complications. While multiple interventions have shown promise, standardized protocols and predictive tools are still needed. Surgery should be performed in high-volume centers with experienced multidisciplinary teams to optimize outcomes. Full article

This study aims to elucidate the molecular mechanisms underlying cyanogenic glycoside accumulation in flax. As an important oil and fiber crop, the nutritional value of flax is compromised by the toxicity of cyanogenic glycoside. To clarify the key genetic regulators and temporal patterns of cyanogenic glycoside biosynthesis, transcriptomic sequencing was performed on seeds from high- and low-cyanogenic glycoside flax varieties (‘MONTANA16’ and ‘Xilibai’) at three developmental stages: bud stage, full flowering stage, and capsule-setting stage. A total of 127.25 Gb of high-quality data was obtained, with an alignment rate exceeding 87.80%. We identified 31,623 differentially expressed genes (DEGs), which exhibited distinct variety- and stage-specific expression patterns. Principal component analysis (PCA) and hierarchical clustering demonstrated strong reproducibility among biological replicates and revealed the seed pod formation stage as the period with the most significant varietal differences, suggesting it may represent a critical regulatory window for cyanogenic glycoside synthesis. GO and KEGG enrichment analyses indicated that DEGs were primarily involved in metabolic processes (including secondary metabolism and carbohydrate metabolism), oxidoreductase activity, and transmembrane transport functions. Of these, the cytochrome P450 pathway was most significantly enriched at the full bloom stage (H2 vs. L2). A total of 15 LuCYP450 and 13 LuUGT85 family genes were identified, and their expression patterns were closely associated with cyanogenic glycoside accumulation: In high-cyanogenic varieties, LuCYP450-8 was continuously upregulated, and LuUGT85-12 was significantly activated during later stages. Conversely, in low-cyanogenic varieties, high expression of LuCYP450-2/14 may inhibit synthesis. These findings systematically reveal the genetic basis and temporal dynamics of cyanogenic glycoside biosynthesis in flax and highlight the seed pod formation stage as a decisive regulatory window for cyanogenic glycoside synthesis. This study provides new insights into the coordinated regulation of cyanogenic pathways and establishes a molecular foundation for breeding flax varieties with low CNG content without compromising agronomic traits. Full article

Delayed gastric emptying (DGE) is a significant complication following pancreaticoduodenectomy, affecting 20–40% of patients and impacting hospital stay, healthcare costs, and adjuvant therapy initiation. Different gastrojejunostomy configurations have been investigated to reduce DGE rates, with conflicting results presented in the literature. This retrospective study analyzed 65 consecutive patients who underwent pylorus-preserving pancreaticoduodenectomy at Bnai-Zion Medical Center between August 2018 and December 2023. All procedures were performed by a single experienced surgeon using either antecolic (AC, n = 25) or transmesocolic (TMC, n = 40) reconstruction. DGE was classified according to International Study Group of Pancreatic Surgery criteria. The statistical analysis included logistic regression to identify risk factors. The overall DGE incidence was 23.1% (15/65 patients). The AC group demonstrated significantly higher DGE rates compared to the TMC group (40% vs. 12.5%, p = 0.01). Logistic regression analysis revealed a 5.91-fold increased risk of DGE with AC reconstruction (OR: 5.91; 95% CI: [1.44, 24.25]; p = 0.014). All severe DGE cases (grades B and C) occurred exclusively in the AC group. Hospital stay was significantly longer in DGE patients (median: 26 vs. 13 days, p < 0.001). Other variables, including age, gender, smoking, diabetes, BMI, and surgical approach, showed no significant association with DGE. In this single-surgeon study, antecolic reconstruction was associated with significantly higher rates and severities of delayed gastric emptying compared to transmesocolic reconstruction. These findings suggest that reconstruction technique represents a modifiable risk factor for DGE prevention, though larger prospective studies are needed to confirm these results. Full article

Parkinson’s disease (PD) is one of the most rapidly growing neurological disorders globally. The molecular relationship between common respiratory infections (RIs) and idiopathic Parkinson’s disease (iPD) remains a controversial issue. Multiple studies have linked acute respiratory infections to PD, but the molecular mechanism behind this connection is not significantly defined. Therefore, the aim of our study was to investigate potential molecular interactions between RIs and PD. We retrieved eight publicly available RNA-seq datasets from the NCBI Gene Expression Omnibus (NCBI GEO) and performed extensive bioinformatics analysis, including differential gene expression (DGE) analysis, the identification of overlapped differentially expressed genes (DEGs), weighted gene co-expression network analysis (WGCNA), pathway and functional enrichment analysis, the construction of protein–protein networks, and the identification of hub genes. Additionally, we applied a machine learning method, a Random Forest model (RF), to external RIs datasets to identify the most important genes. We found that ribosomal subunits, mitochondrial complex proteins, proteasome subunits, and proteins encoding ubiquitin are simultaneously downregulated and co-expressed in RIs and PD. Dysregulation of these proteins may disturb multiple pathways, such as those responsible for ribosome biogenesis, protein synthesis, autophagy, and apoptosis; the ubiquitin–proteasome system (UPS); and the mitochondrial respiratory chain. These processes have been implicated in PD’s pathology, namely in the aggregation of α-synuclein, mitochondrial dysfunction, and the death of dopaminergic neuron cells. Our findings suggest that there are significant similarities in transcriptional responses and dysfunctional molecular mechanisms between RIs, PD, and aging. RIs may modulate PD-relevant pathways in an age- or immune-dependent manner; longitudinal studies are needed to examine the RIs risk factor. Therefore, future studies should experimentally investigate the influence of age, vaccination status, infection type, and severity to clarify the role of RIs in PD’s pathogenesis. Full article