Heterotopic pancreas (HP) refers to the presence of ectopic pancreatic tissue located outside of the normal pancreatic location without anatomical or vascular continuity with the pancreas. HP within the gallbladder (HPGB) was first described by Otschkin in 1916. It remains an exceedingly rare pathology with few reported cases. Here we describe a case of HPGB in a 42-year-old female following laparoscopic cholecystectomy for symptoms of biliary colic. She presented with epigastric pain, elevated levels in liver function tests, and gallbladder sludge on ultrasound. Her lipase and bilirubin levels were within normal limits. Histopathological assessment of the gallbladder identified mild chronic cholecystitis and pancreatic heterotopia adjacent to the cystic duct of the gallbladder with all three elements (ducts, acini, and endocrine islets) of the pancreas, consistent with type 1 based on the classification of Gaspar Fuentes et al.HPGB is often diagnosed incidentally during histopathological examination after cholecystectomy. Preoperative diagnosis is challenging due to its rarity. It is thought to be asymptomatic. Although the clinical significance of HPGB remains uncertain, it has been hypothesized that HPGB can cause acalculous cholecystitis and also have the potential for malignant transformation. Our case supports the theory that the exocrine function of an ectopic pancreatic tissue may contribute to chronic inflammation in the gallbladder. In conclusion, although HPGB is a rare finding with unclear clinical relevance, its potential for malignancy and association with cholecystitis warrant further investigation. Given its scarcity, most knowledge about HPGB comes from case reports and case series. This report adds to the existing literature.

Heterotopic pancreas (HP) refers to the presence of ectopic pancreatic tissue located outside of the normal pancreatic location without anatomical or vascular continuity with the pancreas. HP within the gallbladder (HPGB) was first described by Otschkin in 1916. It remains an exceedingly rare pathology with few reported cases. Here we describe a case of HPGB in a 42-year-old female following laparoscopic cholecystectomy for symptoms of biliary colic. She presented with epigastric pain, elevated levels in liver function tests, and gallbladder sludge on ultrasound. Her lipase and bilirubin levels were within normal limits. Histopathological assessment of the gallbladder identified mild chronic cholecystitis and pancreatic heterotopia adjacent to the cystic duct of the gallbladder with all three elements (ducts, acini, and endocrine islets) of the pancreas, consistent with type 1 based on the classification of Gaspar Fuentes et al.HPGB is often diagnosed incidentally during histopathological examination after cholecystectomy. Preoperative diagnosis is challenging due to its rarity. It is thought to be asymptomatic. Although the clinical significance of HPGB remains uncertain, it has been hypothesized that HPGB can cause acalculous cholecystitis and also have the potential for malignant transformation. Our case supports the theory that the exocrine function of an ectopic pancreatic tissue may contribute to chronic inflammation in the gallbladder. In conclusion, although HPGB is a rare finding with unclear clinical relevance, its potential for malignancy and association with cholecystitis warrant further investigation. Given its scarcity, most knowledge about HPGB comes from case reports and case series. This report adds to the existing literature.

Heterotopic pancreas (HP) refers to the presence of ectopic pancreatic tissue located outside of the normal pancreatic location without anatomical or vascular continuity with the pancreas. HP within the gallbladder (HPGB) was first described by Otschkin in 1916. It remains an exceedingly rare pathology with few reported cases. Here we describe a case of HPGB in a 42-year-old female following laparoscopic cholecystectomy for symptoms of biliary colic. She presented with epigastric pain, elevated levels in liver function tests, and gallbladder sludge on ultrasound. Her lipase and bilirubin levels were within normal limits. Histopathological assessment of the gallbladder identified mild chronic cholecystitis and pancreatic heterotopia adjacent to the cystic duct of the gallbladder with all three elements (ducts, acini, and endocrine islets) of the pancreas, consistent with type 1 based on the classification of Gaspar Fuentes et al.HPGB is often diagnosed incidentally during histopathological examination after cholecystectomy. Preoperative diagnosis is challenging due to its rarity. It is thought to be asymptomatic. Although the clinical significance of HPGB remains uncertain, it has been hypothesized that HPGB can cause acalculous cholecystitis and also have the potential for malignant transformation. Our case supports the theory that the exocrine function of an ectopic pancreatic tissue may contribute to chronic inflammation in the gallbladder. In conclusion, although HPGB is a rare finding with unclear clinical relevance, its potential for malignancy and association with cholecystitis warrant further investigation. Given its scarcity, most knowledge about HPGB comes from case reports and case series. This report adds to the existing literature.

No abstract available.
Drug-Induced Liver Injury ; Ribavirin

Objective: The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC). Methods: We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups. Results: Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend. Conclusion For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.

Objective: The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC). Methods: We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups. Results: Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend. Conclusion For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.

Objective: The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC). Methods: We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups. Results: Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend. Conclusion For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.

BACKGROUND: This study determined current status of laboratory biosafety in Nigerian veterinary research facilities. METHODS: A questionnaire was developed to obtain information from researchers across Nigeria from July 2014 to July 2015. Information regarding demographics, knowledge of laboratory biosafety, availability and proper use of personal protective equipment (PPE), any priority pathogens researched, attitude on and use of standard laboratory practices, and biosafety awareness was obtained using a numeric scoring system. Data were analyzed with descriptive statistics, and univariate and multivariate logistic regression. RESULTS: A total of 74 participants from 19 facilities completed the questionnaire. General knowledge scores ranged from 3 to 28 (out of 28 possible points), with 94.6% of respondents receiving low scores (scores < mean + 1 standard deviation). Very few (17.6%) reported availability or use PPE. Many participants (63.5%) reported no access to biosafety level (BSL)-1–3 facilities. None reported availability of a BSL-4 facility. Knowledge scores pertaining to biosafety management practices ranged from 0 to 14 (out of 14 possible points) with 47.3% of respondents receiving good scores (scores > mean + 1 standard deviation). Only 16.2% of respondents (from four facilities) reported having biosafety officers. Rabies virus was the most researched pathogen (31.1% of respondents). The majority (71.6%) were unaware of laws guiding biosafety. Researchers [odds ratio (OR) = 18.0; 95% confidence interval (CI): 1.63, 198.5; p = 0.023], especially in BSL-2 (OR = 258.5; 95% CI: 12.71, 5256; p < 0.001) facility of research institute (OR = 25.0; 95% CI: 5.18, 120.6; p < 0.001), are more likely to have adequate access to and properly utilize biosafety devices and PPE. CONCLUSIONS: Current knowledge of laboratory biosafety is limited except among a few researchers.
Academies and Institutes ; Demography ; Jurisprudence ; Logistic Models ; Nigeria* ; Personal Protective Equipment ; Rabies virus ; Surveys and Questionnaires

No abstract available.
Lung Diseases, Interstitial

Background::Erosive esophagitis (EE) is a gastroesophageal reflux disease characterized by mucosal breaks in the esophagus. Proton pump inhibitors are widely used as maintenance therapy for EE, but many patients still relapse. In this trial, we evaluated the noninferiority of vonoprazan vs. lansoprazole as maintenance therapy in patients with healed EE. Methods::We performed a double-blind, double-dummy, multicenter, phase 3 clinical trial among non-Japanese Asian adults with endoscopically confirmed healed EE from April 2015 to February 2019. Patients from China, South Korea, and Malaysia were randomized to vonoprazan 10 mg or 20 mg once daily or lansoprazole 15 mg once daily for 24 weeks. The primary endpoint was endoscopically confirmed EE recurrence rate over 24 weeks with a noninferiority margin of 10% using a two-sided 95% confidence interval (CI). Treatment-emergent adverse events (TEAEs) were recorded.Results::Among 703 patients, EE recurrence was observed in 24/181 (13.3%) and 21/171 (12.3%) patients receiving vonoprazan 10 mg or 20 mg, respectively, and 47/184 (25.5%) patients receiving lansoprazole (differences: -12.3% [95% CI, -20.3% to-4.3%] and -13.3% [95% CI, -21.3% to -5.3%], respectively), meeting the primary endpoint of noninferiority to lansoprazole in preventing EE recurrence at 24 weeks. Evidence of superiority (upper bound of 95% CI <0%) was also observed. At 12 weeks, endoscopically confirmed EE recurrence was observed in 5/18, 2/20, and 7/20 of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. TEAEs were experienced by 66.8% (157/235), 69.0% (156/226), and 65.3% (158/242) of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. The most common TEAE was upper respiratory tract infection in 12.8% (30/235) and 12.8% (29/226) patients in vonoprazan 10 mg and 20 mg groups, respectively and 8.7% (21/242) patients in lansoprazole group.Conclusion::Vonoprazan maintenance therapy was well-tolerated and noninferior to lansoprazole for preventing EE recurrence in Asian patients with healed EE.Trial Registration::https://clinicaltrials.gov; NCT02388737.