Rare causes of gastrointestinal hemorrhage in infancy

Gastrointestinal hemorrhage in children is a critical condition that demands quick and effective management. The differential diagnosis of gastrointestinal hemorrhage is wide. Heterotopic pancreas is a rare congenital anomaly and usually discovered incidentally. It is generally asymptomatic, but symptoms may occur when complicated by inflammation, bleeding, obstruction or malign transformation. Heterotopic pancreas may present throughout the gastrointestinal tract, but it is most commonly found in the stomach, duodenum and proximal jejunum. Juvenile polyps are common during childhood and present most often with painless rectal hemorrhage. They remain the most common colonic polyps in children. Colonoscopic polypectomy is the most effective procedure in the treatment of juvenile polyps. In this study, we describe rare causes of gastrointestinal system hemorrhage in infancy and discuss some diagnostic and therapeutic approaches.     

The European evidence-based guidelines on pancreatic cystic neoplasms (PCN) in clinical practice: The development of relative and absolute indications for surgery during prospective IPMN surveillance

IntroductionThe European evidence-based guidelines on PCN recommend surveillance for IPMN patients who are fit for surgery but who have no indication for immediate surgery. Our aim was to demonstrate the feasibility of the new guidelines in clinical practice.MethodsThis is a prospective cohort study of patients included in the IPMN register in Tampere University Hospital, Finland. IPMN was diagnosed from January 1, 2013 to December 31, 2018. Patients were analyzed for surveillance and indications for surgery according to the European guidelines on PCN.ResultsOut of 128 patients in register 23 was decided to operate upfront and 105 patients were included in the surveillance programme. Invasive carcinoma was found in 4/23 of operated patients. Median follow-up time was 26 months (6–69). Median size of the cyst at the beginning and end of the surveillance was 16 mm (4–58 mm). During surveillance 0/105 (0.0%) patients had or developed an absolute indication for surgery. Relative indication for surgery was present in 8/105 (7.6%) patients in the beginning surveillance and 9/105 (8.6%) patients developed at least one relative indication for surgery during surveillance. From the surveillance cohort 2/105 patients were operated. Surveillance was abandoned in 15/105 (14.1%) patients all due to poor general condition or other medical conditions.ConclusionsIn clinical practice, surveillance of IPMN according to the European guidelines on PCN is feasible. Among our patients 16% were detected to have relative indications for surgery during the median 26 (range 3–135) months of surveillance. Nearly 15% became surgically unfit during surveillance period.     

胰腺胃肠间质瘤4例报告及文献分析

目的 讨论胰腺胃肠间质瘤的临床病理特征、预后影响因素及基因突变特征。方法 回顾性分析2010年5月至2018年10月西南医科大学附属医院确诊的4例胰腺胃肠间质瘤，并通过Pubmed及国内主要数据库检索国内外文献，进行文献复习及统计分析。结果 国内外报道病例共55例，合并本次报道共59例。男性30例，女性29例，最常见临床首发症状为腹部疼痛或不适有38例（64.4%）、腹部肿块10例（16.9%）、体检发现或其他症状11例（18.7%）；53例具有完整的影像学资料及组织学分型，影像学CT检查示肿瘤为不均匀低密度影，呈囊实性21例（39.7%）、呈实性20例（37.7%）、呈囊性12例（22.6%）；最常见组织学类型是梭形细胞为主型44例（83.0%）、混合型7例（13.2%）、上皮细胞为主型2例（3.8%）。5年总存活率及无疾病存活率分别为79.7%及39.3%；单因素及多因素分析均显示，核分裂象>5个/50HPF是影响病人术后复发转移的独立因素（P均<0.05）。10例基因突变病人中9例（90.0%）为c-kit基因突变，1例（10.0%）为PDGFRα基因突变。结论 胰腺胃肠间质瘤临床症状缺乏特异性，通常发现时肿瘤体积较大，多数病人具有高度风险性，且核分裂象>5个/50HPF是影响预后的独立因素,以c-kit基因突变多见。     

Fault Detection and Safety in Closed-Loop Artificial Pancreas Systems

Continuous subcutaneous insulin infusion pumps and continuous glucose monitors enable individuals with type 1 diabetes to achieve tighter blood glucose control and are critical components in a closed-loop artificial pancreas. Insulin infusion sets can fail and continuous glucose monitor sensor signals can suffer from a variety of anomalies, including signal dropout and pressure-induced sensor attenuations. In addition to hardware-based failures, software and human-induced errors can cause safety-related problems. Techniques for fault detection, safety analyses, and remote monitoring techniques that have been applied in other industries and applications, such as chemical process plants and commercial aircraft, are discussed and placed in the context of a closed-loop artificial pancreas.     

Using technology to advance type 1 diabetes care among women during the reproductive years and in pregnancy

The prevalence of diabetes is increasing globally. Technology to improve care among individuals with diabetes is constantly being developed. Women living with Type 1 Diabetes Mellitus (T1DM) have unique challenges affecting their glucose control relating to menstrual cycles, pregnancy, and menopause. The purpose of this review is to examine the literature related to the use of technology to help women with T1DM manage their diabetes during the reproductive years, pregnancy, and beyond. Continuous subcutaneous insulin infusion (CSII) therapy can provider equivalent or better glucose control when compared with multiple daily injections (MDI), with less hypoglycemia, diabetic ketoacidosis, and weight gain. The CSII therapy has features that could help improve glucose control over the menstrual cycle, menopause, and pregnancy, although the most studied of these stages is pregnancy. Continuous glucose monitoring (CGM) can be combined with any insulin delivery system (MDI or CSII) to provide data on glucose values every few minutes and show glucose trends over time. CGM introduction can highlight glucose variability for women with T1DM, may be beneficial during pregnancy, and can reduce hypoglycemia. Sensor-augmented pump therapy and hybrid artificial pancreas (closed-loop) systems are promising tools that improve outcomes among individuals with diabetes. The use of modern technology to improve glucose and metabolic control among menopausal women with diabetes has not been well studied. Internet and phone-based technologies are emerging as important tools that may help with diabetes self-care for women living with diabetes.