Category: 8. Health

Introduction

The annular pancreas is a rare congenital malformation that causes duodenal obstruction at birth.¹ The annular pancreas is characterized by partial or total encirclement of the second segment of the duodenum by a strip of pancreatic tissue during embryonic development.² It is commonly found below the ampulla of Vater in about 85% of confirmed cases and rarely above 15%.³ Annular pancreas occurs in approximately 1 out of every 20,000 live births.⁴ Due to the infrequency of this congenital condition, the specific cause related to the formation of an annular pancreas is not well established. Still, the annular pancreas is regarded as an embryopathy.⁵ In the initial four to eight weeks of embryonic development, the pancreas typically forms as the dorsal and ventral pancreatic buds rotate and fuse, driven by the expansion of the duodenum. The ventral bud gives rise to the inferior section of the head and the uncinate process of the pancreas, while the dorsal bud develops into the body and tail of the pancreas. The formation of the annular pancreas is thought to be a migration defect occurring due to the inability of the ventral bud to rotate and grow in a way that fully or partially surrounds the second portion of the duodenum.^6,7

Symptoms associated with annular pancreas can vary greatly from one individual to another. In certain instances, it may lead to intense symptoms shortly after delivery, whereas in other cases, it could stay asymptomatic throughout a person’s life.⁴ In neonates, typical symptoms include difficulties with feeding, vomiting, and abdominal bloating. In adults, the symptoms often resemble those of gastric outlet obstruction, including persistent abdominal pain, nausea, a feeling of fullness after eating, and vomiting.⁸ The intensity of the symptoms is linked to the degree of pressure exerted by the annular pancreas on the duodenum.⁴ Nevertheless, the severity of duodenal obstruction and the accompanying obstructive symptoms can vary, and there have been cases of the unrecognized annular pancreas being found in teenagers or even adults.¹ Understanding the clinical features of patients with an annular pancreas is tremendously valuable in diagnosing this condition. Typically, annular pancreas is identified during routine prenatal ultrasounds through the detection of the double bubble sign in the fetal abdomen, allowing for both diagnosis and treatment to be effectively carried out shortly after delivery.⁹ Different imaging methods, such as ultrasonography, X-ray, endoscopic retrograde cholangiopancreatography (ERCP), and computed tomography (CT), can also be used to diagnose an annular pancreas. In adults who are affected, CT is more frequently used.¹⁰ A definitive diagnosis of the annular pancreas relies on imaging studies and findings observed during surgery. Surgery is the gold standard for diagnosing the annular pancreas. Imaging studies play a suggestive role in the diagnosis before surgery.¹¹ CT and MRI reveal pancreatic tissue surrounding the duodenum.¹² There are no established guidelines or protocols for managing an annular pancreas.¹³ Several surgical techniques can be employed to treat the annular pancreas, with the primary goal being to alleviate the obstructive symptoms associated with this congenital condition.¹⁰ Duodenoduodenostomy, duodenojejunostomy, or gastroduodenostomy may be carried out, and the section of the duodenum, along with a ring of pancreatic tissue, can be excised as a single unit.¹² Here, we report a rare case of annular pancreas in a 13-year-old boy with a delayed clinical presentation of a partial duodenal obstruction (obstruction of the first part of the duodenum). This case highlights the challenges of diagnosis, which was achieved through surgical exploration in a resource-limited setting, and it was treated successfully with gastroduodenostomy.

Case Presentation

A 13-year-old boy came to the emergency department complaining of recurrent episodes of vomiting and abdominal pain over the past 3 years. The vomiting was non-bilious, projectile, and occurred after meals. Its frequency and severity have been gradually increasing. The abdominal pain was primarily in the epigastric region and was relieved after vomiting. On physical examination, the patient was in fair general condition, alert, and slightly dehydrated with normal vital parameters. The patient’s systemic examination was normal. On laboratory examination, the white blood cell count, hemoglobin, electrolytes, urea, creatinine, and albumin were all within normal limits. On imaging, plain CT and post-IV contrast CT of the abdomen and pelvis revealed marked distention of the stomach with abrupt tapering of the first part of the duodenum and collapse of the rest of the duodenum. The pancreas was normal in size and showed homogeneous enhancement on post-contrast scans, with no evidence of calcifications. The rest of the small bowel loops, liver, gall bladder, spleen, kidneys, urinary bladder, and abdominal aorta were normal (Figure 1). The patient underwent a surgical exploration. Intraoperatively, a band of pancreatic tissue is found encircling the first part of the duodenum, causing an obstruction (Figure 2), with marked dilatation of the stomach (Figure 3), without any additional abnormal findings. A gastroduodenostomy was performed. The patient experienced an uneventful postoperative recovery, during which he received intravenous fluids, analgesics, and antibiotics. On the third day after surgery, oral sips were introduced, gradually increasing the diet from liquids to semi-liquids and then to full solid foods over three weeks. After discharge from the hospital, the patients attended follow-up appointments and showed improvement with no further vomiting, abdominal pain, or negative complications.

Figure 1 Abdominal CT shows marked distension of the stomach (thick arrows) with abrupt tapering of the first part of the duodenum and collapse of the rest of the duodenum.

Figure 2 Intraoperative image showing the pyloric region of the stomach (black arrow), a band of pancreatic tissue encircling the first part of the duodenum, causing obstruction (green asterisks). The second part of the duodenum is normal (yellow arrow).

Figure 3 Intraoperative image showing a dilatation of the stomach (blue asterisks).

Discussion

The annular pancreas is a rare congenital anomaly characterized by the abnormal rotation of the pancreas. This condition infrequently occurs in adults.¹¹ The differential diagnosis can be divided into intrinsic and extrinsic. Notable intrinsic causes to consider include duodenal atresia, duodenal stenosis, paraduodenal hernias, Meckel diverticulum, and duodenal webs. At the same time, significant extrinsic factors to consider are gut malrotation and midgut volvulus. In adults suspected of having annular pancreas, peptic ulcer disease, pancreatic divisum, and primary duodenal and pancreatic cancers should also be included in the differential diagnosis.^14,15 Various imaging modalities are being actively considered for diagnosing annular pancreas. CT is used to diagnose and analyze the annular pancreas.¹⁰ CT results indicate an enlargement of the pancreatic head with enhanced visibility of the second portion of the duodenum.¹³ In a case of annular pancreas reported by Moon, an abdominal CT scan revealed pancreatic tissue surrounding the second part of the duodenum, leading to the diagnosis of an annular pancreas.¹ In this patient, plain CT and post-IV contrast CT of the abdomen and pelvis revealed marked distention of the stomach with abrupt tapering of the first part of the duodenum and collapse of the rest of the duodenum. The pancreas was normal in size and showed homogeneous enhancement on post-contrast scans, with no evidence of calcifications (Figure 1). In this case, the preoperative imaging with plain CT provided features of gastric outlet obstruction, which made the diagnosis challenging. This challenge necessitated reliance on surgical exploration for accurate diagnosis. Although the patient’s clinical characteristics are not unique to the annular pancreas, they provided some clues to the diagnosis, which necessitated the decision to perform surgical exploration. The definitive diagnosis was confirmed by surgical exploration, which revealed a band of pancreatic tissue encircling the first part of the duodenum, causing an obstruction. In contrast, the second part of the duodenum was normal (Figure 2). This finding is consistent with a case reported by Jha et al.⁸ This decision aligns with the existing literature, which emphasizes the importance of having a thorough understanding of the clinical characteristics of the annular pancreas and its associated anomalies when managing this uncommon congenital anomaly.¹⁰ A significant number of individuals with this anomaly stay asymptomatic for their entire lives and are frequently identified incidentally through imaging studies or during autopsies. Nevertheless, a small percentage of patients with an annular pancreas may show clinical symptoms either in childhood or later in life, typically between the ages of 20 and 50.¹⁶ The clinical presentation of the annular pancreas varies by age, resulting in differences in diagnosis.¹³ The emergence of advanced diagnostic techniques has led to an increased recognition of this condition. However, despite radiological advancements, surgical confirmation is required in approximately 40% of annular pancreas cases, establishing it as the gold standard.^13,16 The clinical presentation of the annular pancreas varies by age, resulting in age-related variations in management. The approach to treating an annular pancreas varies based on its clinical presentation. Surgical procedures using different bypass methods, such as duodenoduodenostomy, gastrojejunostomy, gastroduodenostomy, and duodenojejunostomy, are necessary.¹³ However, the decision should be customized for the individual patient.¹⁶ In our patient, we successfully performed a gastroduodenostomy with a transverse incision of the pylorus and a longitudinal incision of the duodenum, resulting in a diamond-shaped anastomosis. After more than six months of follow-up, the patient was feeling well and started to gain weight. The annular pancreas is a rare condition that warrants attention in the differential diagnosis of recurrent vomiting and abdominal pain. This unusual formation of pancreatic tissue encircling the duodenum can lead to gastrointestinal obstruction, which may manifest as persistent nausea, abdominal pain, and vomiting. We recommend that clinicians, especially surgical pediatricians, be vigilant in considering this possibility when evaluating patients with these symptoms.

Conclusion

This case underscores that the annular pancreas, although a congenital condition typically detected in the neonatal period, can manifest later in childhood with insidious and non-specific symptoms such as recurrent non-bilious vomiting and epigastric pain. In our 13-year-old patient, preoperative imaging provided features of gastric outlet obstruction, necessitating surgical exploration for confirmation. The subsequent intraoperative identification of a pancreatic tissue band encircling the duodenum, along with the successful execution of a gastroduodenostomy, highlights not only the diagnostic challenges but also the efficacy of tailored surgical management in resource-limited settings. The favorable postoperative recovery, marked by the resolution of symptoms and gradual weight gain, reinforces the importance of maintaining a high index of suspicion for the annular pancreas in adolescents presenting with chronic gastrointestinal symptoms. This report serves as a reminder that even in the absence of classical radiological findings, meticulous clinical evaluation coupled with timely surgical intervention can markedly improve patient outcomes. Furthermore, documenting such cases is crucial for deepening our understanding of the variable presentations of the annular pancreas. It may pave the way for the development of more standardized diagnostic and therapeutic protocols in the future.

Ethics Statement

An institution’s ethics committee approval is not required for the case reports.

Informed Consent Statement

Written informed consent was obtained from the patient’s parent for the publication of this case report and any accompanying images. The patient’s parent was told about the purpose of this publication and that his identity would be protected.

Acknowledgments

We would like to thank all the participants, Kalkaal Hospital, and the Simad University Research Center for their valuable contributions to the case report.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

References

1. Moon SB. Annular pancreas in an 11-year-old girl: a case report. Int Med Case Rep J. 2017;10:65–67. doi:10.2147/IMCRJ.S128867

2. Nagpal SJS, Peeraphatdit T, Sannapaneni SK, et al. Clinical spectrum of adult patients with annular pancreas: findings from a large single institution cohort. Pancreatology. 2019;19(2):290–295. doi:10.1016/j.pan.2018.12.009

3. Benassai G, Perrotta S, Furino E, et al. “Ductal adenocarcinoma in anular pancreas”. Int J Surg. 2015;21(Suppl 1):S95–7. doi:10.1016/j.ijsu.2015.04.086

4. Taşdemir Ü, Demirci O. Clinical Analysis of Congenital Duodenal Obstruction and the Role of Annular Pancreas. Medicina. 2025;61(1):61. doi:10.3390/medicina61010061

5. Nobukawa B, Otaka M, Suda K, Fujii H, Matsumoto Y, Miyano T. An annular pancreas derived from paired ventral pancreata, supporting Baldwin’s hypothesis. Pancreas. 2000;20(4):408–410. doi:10.1097/00006676-200005000-00012

6. Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR Am J Roentgenol. 2009;193(2):455–460. doi:10.2214/AJR.08.1596

7. Alahmadi R, Almuhammadi S. Annular pancreas: a cause of gastric outlet obstruction in a 20-year-old patient. Am J Case Rep. 2014;15:437–440. doi:10.12659/AJCR.891041

8. Jha S, Luitel S, Kushwaha N, Singh S, Jha SK. Partial Annular Pancreas Causing Obstruction of the First Part of the Duodenum: an Exceedingly Rare Conundrum-A Rare Case Report and Comprehensive Literature Review. Clin Case Rep. 2025;13(7):e70614. doi:10.1002/ccr3.70614

9. Zhang B, Zhang W, Hu Y, Pang H, Yang H, Luo H. Evaluation of prenatal and postnatal ultrasonography for the diagnosis of fetal double bubble sign. Quant Imaging Med Surg. 2024;14(9):6386–6396. doi:10.21037/qims-24-445

10. Plutecki D, Ostrowski P, Bonczar M, et al. Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis. HPB (Oxford). 2024;26(4):486–502. doi:10.1016/j.hpb.2024.01.006

11. Yi D, Ding XB, Dong SS, Shao C, Zhao LJ. Clinical characteristics of adult-type annular pancreas: a case report. World J Clin Cases. 2020;8(22):5722–5728. doi:10.12998/wjcc.v8.i22.5722

12. Azadi J, Zaheer A. Case 67: annular Pancreas. In: Pancreatic Imaging: A Pattern-Based Approach to Radiologic Diagnosis with Pathologic Correlation. Cham: Springer International Publishing; 2017:287.

13. Ahmetgjekaj I, Roy P, Hyseni F, et al. Annular pancreas: beneath the intestinal obstruction-A case report. Radiol Case Rep. 2023;18(3):1364–1367. doi:10.1016/j.radcr.2022.11.083

14. Whittingham-Jones PM, Riaz AA, Clayton G, Thompson HH. Annular pancreas – a rare cause of gastric obstruction in an 82-year-old patient. Ann R Coll Surg Engl. 2005;87(1):W13–5. doi:10.1308/147870804902

15. Kweun JA, Kang HM, Kim JE, Park SJ. Annular Pancreas: a Rare Cause of Upper Gastrointestinal Bleeding in Adults. Korean J Gastroenterol. 2022;79(4):182–186. doi:10.4166/kjg.2022.012

16. Cai H, Wang X, Cai YQ, Li YB, Meng LW, Peng B. Laparoscopic Roux-en-Y duodenojejunostomy for annular pancreas in adults: case report and literature review. Ann Transl Med. 2018;6(11):211. doi:10.21037/atm.2018.05.13

Researchers have created a remarkable new approach to repairing spinal cord injuries by merging 3D printing, stem cells, and lab-grown tissues.

They engineered tiny scaffolds that guide stem cells to form nerve fibers capable of bridging severed spinal cords. In experiments with rats, this method restored nerve connections and movement, offering new hope that one day similar techniques could help people living with paralysis.

Breakthrough in Spinal Cord Injury Treatment

For the first time, scientists at the University of Minnesota Twin Cities have successfully combined 3D printing, stem cell science, and lab-grown tissues to explore a new approach for treating spinal cord injuries.

Details of the work appear in the journal Advanced Healthcare Materials, a peer-reviewed scientific journal.

Spinal cord injuries affect more than 300,000 people in the United States, according to the National Spinal Cord Injury Statistical Center. There is still no treatment that can fully reverse the paralysis and long-term damage these injuries cause. One of the biggest barriers to recovery is that nerve cells die, and the remaining fibers cannot regrow across the site of injury. The Minnesota team designed their study to directly address this challenge.

3D-Printed Scaffolds and Stem Cells

The researchers developed a specialized 3D-printed structure known as an organoid scaffold. This tiny framework contains microscopic channels that are filled with spinal neural progenitor cells (sNPCs). These cells, which originate from human adult stem cells, can divide and develop into specific types of mature nerve cells.

“We use the 3D printed channels of the scaffold to direct the growth of the stem cells, which ensures the new nerve fibers grow in the desired way,” said Guebum Han, a former University of Minnesota mechanical engineering postdoctoral researcher and first author on the paper who currently works at Intel Corporation. “This method creates a relay system that when placed in the spinal cord bypasses the damaged area.”

Successful Transplants in Animal Models

In their study, the researchers transplanted these scaffolds into rats with spinal cords that were completely severed. The cells successfully differentiated into neurons and extended their nerve fibers in both directions—rostral (toward the head) and caudal (toward the tail)—to form new connections with the host’s existing nerve circuits.

The new nerve cells integrated seamlessly into the host spinal cord tissue over time, leading to significant functional recovery in the rats.

The method involves creating a unique 3D-printed framework for lab-grown organs, called an organoid scaffold, with microscopic channels. Credit: McAlpine Research Group, University of Minnesota

Toward Future Clinical Translation

“Regenerative medicine has brought about a new era in spinal cord injury research,” said Ann Parr, professor of neurosurgery at the University of Minnesota. “Our laboratory is excited to explore the future potential of our ‘mini spinal cords’ for clinical translation.”

While the research is in its beginning stages, it offers a new avenue of hope for those with spinal cord injuries. The team hopes to scale up production and continue developing this combination of technologies for future clinical applications.

Reference: “3D-Printed Scaffolds Promote Enhanced Spinal Organoid Formation for Use in Spinal Cord Injury” by Guebum Han, Nicolas S. Lavoie, Nandadevi Patil, Olivia G. Korenfeld, Hyunjun Kim, Manuel Esguerra, Daeha Joung, Michael C. McAlpine and Ann M. Parr, 23 July 2025, Advanced Healthcare Materials.
DOI: 10.1002/adhm.202404817

In addition to Han and Parr, the team included Hyunjun Kim and Michael McAlpine from the University of Minnesota Department of Mechanical Engineering; Nicolas S. Lavoie, Nandadevi Patil and Olivia G. Korenfeld from the University of Minnesota Department of Neurosurgery; Manuel Esguerra from the University of Minnesota Department of Neuroscience; and Daeha Joung from the Department of Physics at Virginia Commonwealth University.

This work was funded by the National Institutes of Health, the State of Minnesota Spinal Cord Injury and Traumatic Brain Injury Research Grant Program and the Spinal Cord Society.

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Nutrition is an important and often overlooked aspect of the oncology treatment paradigm that could significantly impact the health and quality of life of patients undergoing radiation therapy, chemotherapy, and other modalities for cancer.

Denise B. Reynolds, RD, spoke with CancerNetwork® about common nutritional challenges she observes in patients undergoing treatment for cancer or in cancer survivors, as well as strategies she employs to help mitigate their frequency and severity. Specifically, she addressed common treatment-emergent adverse effects (TEAEs) associated with cancer treatment, such as nausea and vomiting, weight gain/loss, taste and smell alterations, and mucositis or dysphagia.

She began by highlighting appetite-related concerns that emerge with the cancer itself, with a particular focus on weight loss. Reynolds expressed that unintentional weight loss often prompts patients to consult with a dietitian. Furthermore, she touched upon the use of nutritional supplements in patients with cancer, suggesting that some iron supplementation may be used for anemia, but she discouraged the use of immune-boosting supplementation, which can interfere with cancer treatment.

Reynolds then outlined strategies for combating various TEAEs, such as foods having a metallic taste and electrolyte-enriched beverages for nausea, and counteracting taste changes with contrasting food types, such as adding spices to patients who report food tasting bland. For longer-term health in patients who have finished treatment or who are cancer survivors, Reynold’s practice recommends patients adhere to the New American plate diet, which restricts the intake of animal proteins and encourages a greater consumption of fruits, vegetables, whole grains, nuts, and fiber, which she expressed may help patients reach and maintain a healthy weight.

In conclusion, she touched upon optimal strategies for collaboration among dietitians and oncologists.

CancerNetwork: What are some of the most common nutritional challenges you see in patients with cancer, and how do you approach these?

Reynolds: Many times, the cancer itself will cause issues with appetite, [gastrointestinal] upset, things like that: it is different for everyone. Cancer treatment can make those situations worse, but some of the issues that they have start with weight loss, which is one of the reasons why they go to their doctor. They [may say] “I have lost this weight. I do not know why I am not eating.” They may know that they have a loss of appetite, but they do not feel like they have done anything to create that weight loss themselves. It was not intentional, and that is one of the things that drives them to the doctor to figure out what is going on with them.

Are there any specific vitamins or minerals that you find are consistently deficient in patients with cancer, and do you recommend supplementation?

Reynolds: It is different for every cancer, and cancer treatment is individualized. There are issues. For example, if you have nausea and vomiting, then you are [likely] losing a lot of fluid [and] you are not keeping the calories down. Overall, if someone is eating well, they should not be deficient in any specific vitamins. Now, the cancer treatment itself can cause anemia, because you are breaking down cells––breaking down red blood cells. A physician may ask that you take iron or may have an iron infusion. If you are deficient in vitamin D, which so many of us are, even without cancer, they might recommend a vitamin D supplement. Other than that, we do not recommend any supplements while you are receiving cancer care.

Certain supplements can be high in, say, antioxidants, and that can interfere with the chemotherapy [or] radiation. For [patients] who do not recognize that, they [may] have friends and family who give them high-powered supplements or drink something that helps boost their immune system, so to speak. We do not want that. That can interfere with some of the treatment that we offer our patients.

What nutritional strategies do you recommend to ensure adequate intake [and combat vomiting and nausea]?

Reynolds: As a dietitian, you will probably often hear me say small, frequent meals… quite a bit, [Many] times, you cannot eat a [food in volume or] sit down and eat a regular-sized meal. Eating a little bit throughout the day will help keep your nutrition level up, and it may actually help with the nausea. Unlike certain nausea that you get when you have the flu or food poisoning, you do not feel like eating, and you do not want to put anything in your stomach, but having something in your stomach during the nausea and vomiting from chemotherapy can help quell some of that nausea.

I think of it a lot like pregnancy nausea. I tell [patients] to keep crackers by their bed, to eat first thing in the morning to help quell that nausea. It is similar. Crackers, dry toast, and chicken noodle soup are things that are bland and comforting, things without [many] smells, because that smell can also trigger nausea for [patients], and trying to keep things as simple as possible. Replacing fluids–ginger ale can be helpful. Sometimes plain water can be a bit nauseating. Having something with electrolytes in it, like a Gatorade or a Pedialyte [may help].

What advice would you give patients to help cope and combat taste and smell changes?

Reynolds: One of the most common taste changes that we see is with one chemotherapy that makes [many] things taste like metal, and in those cases, we recommend using plastic forks or using chopsticks [and] eating foods that are frozen vs canned. Getting frozen vegetables and frozen fruits, vs canned [and] drinking out of a plastic bottle or with a straw so that you are not touching that metal, may help].

Some of the other taste changes we hear about are things tasting [abnormally] bitter. In that case, adding a bit of sweetness to your food can help, even if it’s a citrusy type of flavor.Chicken with orange sauce, or beef with orange sauce, something like that, will help bring a little bit of sweetness to the food and make it not taste quite so bitter. If something tastes bland, which we get [frequently] with our radiation patients, instead of adding extra salt, which we know is not good for you, adding strong spices like oregano, or if they can tolerate something spicy, go for a bit of hot sauce or chili powder, or something like that [can help].

If they are having any issues with their mouth––sore mouth or anything––then, of course, we want to avoid the spicy foods. All that being said, [we try] balancing whatever taste that you have with the opposite. If things are too sweet, balance it with something bitter. If something is too bitter, balance it with something sweet.

How do you manage the nutritional needs of patients with mucositis or dysphagia?

Reynolds: The mucositis and the mouth sores that can come from chemotherapy can also come from radiation to the head and neck. That beam can hit and cause inflammation on the inside of the mouth. Then dysphagia is trouble swallowing. The first thing is to try something soft, trying, say, scrambled eggs or a chicken salad, vs a chicken breast. Something that is soft and moist will be a bit easier to [swallow].

Things that are cold soothe the mouth. [Many] times, we have patients who will hold ice in their mouth to help freeze that area a little bit, make it feel a bit more soothing. Rinsing the mouth out––keeping good oral care during that time [will help] if you are having sores in your mouth, which can lead to bacteria, and it can lead to things like gingivitis and infections of the mouth. Keeping the mouth rinsed clean with something, [an alcohol-free rinse], because [alcohol] would burn.

Spicy foods can be painful if you are having issues with dysphagia. Again, the softer foods, adding moisture, and cooking foods. If you are eating meat, cooking it in a crock pot can help bring some of the moisture back to the food and help it go down a bit easier. Adding gravies and sauces to foods can help with that as well.

For patients who have survived cancer, what nutritional advice would you give to help them promote even longer-term health?

Reynolds: We always follow the American Institute for Cancer Research guidelines. They have something called the New American plate, and it is similar to a Mediterranean-style diet, in that we are reducing the amount of red meat that they are eating, and then fish and chicken are in smaller portion sizes. We are trying not to overload [them] with animal proteins and bring back those fruits and vegetables, nuts, seeds, whole grains, increasing the amount of fiber that someone is getting, trying to get someone to reach a healthy weight, whether they are underweight or overweight. [We are] trying to get their nutrition status back to where they are reaching that healthy weight again.

Not necessarily nutrition-based, but we always want to get people moving again if they can. Fatigue is a common lingering effect for cancer survivors after they have finished their treatment, but eating a good, healthy diet, rich in fruits and vegetables and whole grains, and getting in some exercise can help with that fatigue. Lastly, staying hydrated, because it’s easy to get dehydrated, even again, for a healthy person. Making sure that, as a survivor, you are staying hydrated can also affect fatigue.

What is the best way for clinicians to collaborate with a registered dietitian to improve patient outcomes?

Reynolds: We have 18 dietitians here at Atrium Health, and most of our dietitians are helping patients while they are [undergoing] active treatment, and they are helping with those nutrition impact symptoms: the nausea, [gastrointestinal] upset, taste changes, weight loss, and all of the things that come surrounding a cancer treatment. Helping someone be the best they can to get through that treatment, just ask the nurse, ask your doctor for a referral to a dietitian, and we are more than happy to come talk to you, either on the phone or while you are in the clinic.

Is there anything else that you would like to highlight today?

Reynolds: [Remember] that food is fuel. We are always here to answer questions for you, whether it is about supplements or a particular food or a something you have heard [or to correct] misinformation. We can help clear that up for you. Always ask questions, always be your best advocate, and we are all here to help you through this journey.

Reference

Setting Your Table to Prevent Cancer. American Institute for Cancer Research. Accessed September 2, 2025. https://tinyurl.com/w7pfsc9d

Is it possible to treat obesity without reducing food intake? A new study co-led by Dr. Antonio Zorzano and Dr. Manuela Sánchez-Feutrie at the Institute for Research in Biomedicine (IRB Barcelona) suggests that this might be a possibility, at least in animal models. Published in Nature Communications, the research identifies a key role for Neuritin 1, a protein previously linked to the nervous system, which is also produced in brown adipose tissue, where it acts as a powerful driver of energy expenditure and metabolic health.

Unlike current anti-obesity and antidiabetic drugs, such as Ozempic or tirzepatide, which work by suppressing appetite, Neuritin 1 boosts energy burning without affecting food intake.

By increasing the levels of Neuritin 1 specifically in brown fat, we observed that the animals burned more energy, which helped prevent fat accumulation.”

Dr. Antonio Zorzano, professor at the University of Barcelona and researcher at CIBERDEM

This metabolic boost led to significant improvements in several health indicators, including reduced weight gain, improved insulin sensitivity, and lower liver inflammation, even in animals fed high-calorie diets.

Neuritin 1: a new player in energy metabolism

Previously described for its role in neuronal plasticity, Neuritin 1 is now shown to have a metabolic function in brown fat, a type of fat specialised in generating heat through a process known as thermogenesis. This process involves burning energy to maintain body temperature, particularly in response to cold. In this context, Neuritin 1 stimulates mitochondrial activity and promotes the expression of thermogenic genes.

To trigger its expression, the researchers used a viral vector that drives Neuritin 1 overexpression exclusively in thermogenic fat cells. The result was a sustained increase in metabolic activity, without affecting food consumption or physical activity in the animals.

“These findings point to Neuritin 1 as a promising therapeutic candidate for treating obesity and its associated conditions, such as type 2 diabetes and fatty liver disease, through a mechanism that differs from current approaches,” highlights Dr. Sánchez-Feutrie.

Relevance to human health

Beyond the animal model results, genetic data in humans also show a correlation between Neuritin 1 and susceptibility to obesity, reinforcing the potential relevance of the discovery. The team is currently exploring ways to translate these findings into a future therapeutic strategy.

The study was made possible thanks to the contributions of several IRB Barcelona core facilities, including Bioinformatics and Biostatistics, Functional Genomics, Protein Expression, and Histopathology. It also involved collaborators from international institutions such as the CNRS (France), Karolinska Institutet (Sweden), and the University of Houston (USA).

Kelli Lehto, Associate Professor of Neuropsychiatric Genomics at the University of Tartu, is leading a prestigious European Research Council (ERC) grant project that brings together genetics, psychology, and data science to investigate the causes of attention deficit hyperactivity disorder (ADHD) in adults and enhance diagnostic methods.

ADHD is a highly heritable neurodevelopmental condition, which has been primarily diagnosed in children and is characterised by impulsivity, hyperactivity and attention problems. Recently, an increasing number of adults are being diagnosed with ADHD. According to data from the Estonian Biobank over the past five years, the number of ADHD diagnosed among adults has multiplied. This trend is also confirmed by international studies.

According to Lehto, the rapid increase in the number of diagnoses suggests that symptoms characteristic of ADHD – such as restlessness and difficulties with concentration, planning, and completing tasks – are affecting a growing number of adults. While ADHD has been thoroughly studied in children, the causes and mechanisms behind the increasingly common adult ADHD remain unknown.

The situation is further complicated by the fact that, in adults, ADHD symptoms often significantly overlap with those of many other mental health issues, such as depression or anxiety. These problems can also arise due to environmental factors like fatigue and stress. “However, existing data suggest that ADHD is associated with a large number of specific gene variants, which are not yet used in diagnosis but could prove to be very helpful,” Lehto explained, referring to the issue that inspired her research project.

Genetics related to ADHD

Over the next five years, Lehto’s research group plans to investigate the causes of adult ADHD-related issues using genetic data alongside environmental and lifestyle information, including data on the use of smart devices. In addition to the University of Tartu Estonian Biobank, the analysis will also draw on data from biobanks in Norway, the Netherlands, Sweden, and the United Kingdom. The study will focus on the genetics of ADHD symptoms to determine which traits are most strongly linked to ADHD genetically, and which may stem from other factors.

Lehto acknowledges that the tools currently available to doctors do not allow for sufficiently accurate differentiation between mental health conditions.

Currently, no diagnostic biomarkers are used in psychiatry. All diagnoses are still based primarily on what the patient reports.”

Kelli Lehto, Associate Professor of Neuropsychiatric Genomics, University of Tartu

More accurate diagnostic methods

The ultimate goal of the project is to develop an innovative tool for more precise identification of adult ADHD. Using machine learning methods, the team will analyse questionnaire data on hundreds of mental health symptoms, lifestyle and personality traits to identify clusters of symptoms that are strongly associated with genetic risk for ADHD. Based on these findings, the research group aims to create a more accurate screening questionnaire that could help diagnose adult ADHD without the need for costly genetic testing. “This is where the innovation of our project lies. The result will be a novel biology-based assessment tool that will hopefully make it possible to more accurately identify adults who were not diagnosed with ADHD in childhood and who can finally receive the appropriate treatment for their lifelong problems. Even more importantly, this approach could also help to better identify other mental health conditions that are currently difficult to distinguish,” Lehto explained.

The research project has a budget of nearly €1.5 million, funded by the European Commission. European Research Council grants are among the most prestigious in the scientific world. The competition attracted over 3,928 proposals,12% of which were funded.

First-year undergraduates who grew up with overly cautious or controlling parents tend to experience increased anxiety when faced with stresses associated with the transition to university, researchers from McGill University and the University of California (Los Angeles) have found.

The researchers asked 240 first-year McGill students to fill out several questionnaires in the first six weeks of the fall semester. The questionnaires used well-established scales to measure the parenting style they were raised with, current anxiety symptoms and different types of stressors they encountered during the transition to university, including housing difficulties, personal loss or even life-threatening situations.

The team then looked at associations among those variables, focusing on how the relationship between exposure to stressors and current experiences of anxiety correlated with different parental behaviours.

“We found that students whose parents are very protective experience a stronger link between exposure to stressful events and feelings of anxiety,” explained Lidia Panier, the study’s lead author. Panier, a PhD student in the Department of Psychology, is a member of the Translational Research in Affect and Cognition (TRAC) Lab led by Professor Anna Weinberg, the study’s senior author and principal investigator.

While cautioning that their study model does not allow them to conclude that overprotective parenting causes anxiety in children, the researchers note that such a conclusion would be consistent with the existing body of research.

“Previous findings show that overprotective parenting leads to insecure attachment and poorer emotion regulation, both of which are linked to greater vulnerability to anxiety,” Panier said.

She said she believes overprotective parenting in childhood and adolescence may not be helpful in teaching kids how to adapt to stressful situations in the long term. At the same time, she noted that the overprotective parenting might in some cases be a response to a child’s anxious behaviours: parents might develop watchful attitudes or controlling habits to protect a child who often appears fearful.

“These interpretations are not mutually exclusive,” explained Panier. “A bi-directional dynamic where child behaviours influence parenting, which then affects child development, is also well-supported in the literature.”

The researcher said she hopes that future studies can clarify these links, as well as explore ways to better support young adults experiencing anxiety, especially during key transitional periods.

“It would be interesting to see if these patterns can change over time, such as whether supportive peer relationships in university can help young adults become more resilient, even if they experienced overprotective parenting,” she said.

About the study

“Parental overprotection moderates the association between recent stressor exposure and anxiety during the transition to university” by Lidia Panier et al. was published in Development and Psychopathology.

This research was supported by the Canada Research Chair in Clinical Neuroscience, the Canadian Institutes of Health Research (CIHR), the California Governor’s Office of Planning and Research/California Initiative to Advance Precision Medicine and the California Department of Health Care Services.

Adhering to a Mediterranean diet has been found to reduce the risk of Alzheimer’s disease even among individuals who are genetically predisposed to developing the neurodegenerative condition, according to a study by researchers in the US.

Deriving its name from the region where it’s popular, the diet prioritizes fruit and vegetables, as well as olive oil, fish, nuts, and whole grains. Red meat, processed foods, and sweets are kept to a minimum.

While variations of the Mediterranean diet have been linked to reduced dementia risk before, a team led by researchers from the Harvard T.H. Chan School of Public Health found that it could be especially protective for people with two copies of the APOE4 gene variant, almost acting as a countermeasure.

Related: Vegetarian Diets Can Slash Cancer Risk by Up to 45%, Large Study Finds

“One reason we wanted to study the Mediterranean diet is because it is the only dietary pattern that has been causally linked to cognitive benefits in a randomized trial,” says epidemiologist Yuxi Liu, from the Harvard Chan School.

Alzheimer’s is a complex condition, with risk factors known to include sleep quality, diet, and mental health. There’s also a genetic element, because having one or two copies of the APOE gene significantly increases the chances of getting the disease.

The researchers investigated the Mediterranean diet in people with specific genetic backgrounds, while also analyzing blood metabolites: molecules that can act as indicators of how the body is functioning and processing food.

Data from 4,215 women (logged between 1989 to 2023) and 1,490 men (logged between 1993 and 2023) were analyzed, with cross-referencing done on dementia diagnoses, dietary habits, and genetic information.

Those that most closely followed the Mediterranean diet were least likely to show signs of cognitive decline or develop dementia, the researchers found – but the biggest difference was in the group at most risk, in terms of their genetics.

What’s more, the researchers found the Mediterranean diet regulated metabolites related to dementia, particularly in participants whose genes put them at high risk of Alzheimer’s. This could give us a greater understanding of how Alzheimer’s risk factors influence each other.

“These findings suggest that dietary strategies, specifically the Mediterranean diet, could help reduce the risk of cognitive decline and stave off dementia by broadly influencing key metabolic pathways,” says Liu.

“This recommendation applies broadly, but it may be even more important for individuals at a higher genetic risk, such as those carrying two copies of the APOE4 genetic variant.”

While the association is significant, the findings are based on well-educated individuals of European ancestry, and don’t show direct cause and effect, suggesting there may be unknown factors having an impact.

In addition, the metabolite markers were only measured once, so the researchers don’t have a full picture of how diet or the symptoms of dementia might have changed them over time.

In the future, metabolite markers might be used to evaluate dementia risk and to target specific biological pathways for treatment.

“In future research, we hope to explore whether targeting specific metabolites through diet or other interventions could provide a more personalized approach to reducing dementia risk,” says Liu.

The research has been published in Nature Medicine.

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The multi-arm, multi-stage prostate cancer clinical trial, STAMPEDE, has evaluated the clinical benefits of adding various drugs to the standard of care treatment for men with newly diagnosed metastatic prostate cancer.

One of the trials within this platform tested whether the diabetes drug metformin could improve survival and/or reduce the severity of common and unpleasant side effects associated with treatment.

Results published in Lancet Oncology show that metformin significantly decreases the metabolic side effects associated with standard of care prostate cancer therapy. The Phase III trial was co-led by Professor Noel W. Clarke (The Christie NHS Foundation Trust) and Professor Silke Gillessen (Oncology Institute of Southern Switzerland).

Prostate cancer standard of care drives major side effects

The standard of care for advanced metastatic prostate cancer is lifelong androgen deprivation therapy (ADT), with or without radiation therapy and other systemic treatments. ADT is a type of hormone therapy that lowers testosterone levels, and since most prostate cancer cells rely on testosterone to grow, lowering testosterone can slow cancer progression.

However, ADT can also drive metabolic side effects, including increased fat mass and weight, decreased insulin sensitivity and altered lipid profiles. These issues can lead to metabolic syndrome, a cluster of conditions that raise the risk of heart disease and type 2 diabetes.

Prior small-scale trials have hinted that metformin has anticancer properties, for example by improving castration-resistant prostate cancer-free survival. Furthermore, epidemiological evidence suggests that metformin use can reduce cancer risk and cancer deaths among people with diabetes. Metformin was therefore included as an arm of the STAMPEDE study due to its demonstrated anticancer activity in several malignancies, including prostate cancer, and to evaluate its potential in mitigating the metabolic side effects associated with ADT.

Metformin mitigates metabolic effects of hormone therapy

Between 2016 and 2023, 1,874 patients with metastatic prostate cancer were randomly assigned either:

• Standard of care treatment, or
• Standard of care plus metformin

Most participants had synchronous metastatic disease, where metastases are diagnosed at the same time as the primary tumor, while a small subset (6%) had metachronous relapsing disease, where metastases developed after initial treatment for localized prostate cancer. Standard of care was long-term ADT for all patients, with additional treatments including radiation therapy, docetaxel or androgen receptor pathway inhibitors.

The key findings of the paper were:

• Patients receiving metformin gained only 2 kg, compared to 4.4 kg gained by the control group.
• Total cholesterol, blood sugar and waist measurements were all significantly lower in the metformin group.
• Fewer patients reported signs of metabolic syndrome.
• Metformin was generally well tolerated, with diarrhea being the most common side effect.
• There was no significant evidence of an overall survival benefit of adding metformin to standard of care in the overall population of patients. However, there was some indication of potential oncological benefit observed in patients with high-volume disease.

Improving quality of life and possible benefits in high-volume disease

Morphometric and metabolic outcomes from metformin use in the STAMPEDE trial showed that it does significantly reduce the adverse metabolic side effects associated with ADT use.

While metformin didn’t show significant overall survival benefits, the study also found evidence that metformin may have a greater benefit for patients with high-volume disease, where the cancer has spread more extensively through the body. In the high-volume disease subgroup, there was a 10-month improvement in overall survival with the addition of metformin. However, the study was not sufficiently powered to draw conclusions between disease subgroups.

One of the proposed mechanisms by which metformin confers anticancer properties is by activation of adenosine monophosphate-activated protein kinase (AMPK), a key regulator of cellular energy use. AMPK activation results in mammalian target of rapamycin (mTOR) inhibition, leading to reduced cell growth, proliferation and metabolic activity – all processes necessary for cancer development and progression.

Together, data from this trial suggest potential for a personalized treatment approach, where patients with higher disease burden may benefit most from metformin. Moreover, the results underscore the broader therapeutic potential of metabolically targeted agents in this disease setting.

For many people with prostate cancer, ADT is a long-term or even lifelong treatment. Therefore, even moderate improvements in side-effect profiles can significantly improve quality of life. By reducing the risk of metabolic syndrome, metformin may also lower the need for additional interventions such as diabetes or heart disease management, lessening healthcare system burdens.

Crucially, metformin is well tolerated and inexpensive, making it an accessible addition to standard of care treatment to reduce side effects and improve quality of life in patients.

It should be noted that the population of patients in the study was a limitation, with most patients having synchronous disease, making extrapolation of data to metachronous disease difficult. Additionally, the trial was open-label rather than blinded, although survival outcomes and metabolic parameters are unlikely to be affected by clinicians’ or patients’ knowledge of metformin use.

Identifying patient subsets for metformin-based cancer therapy

Future work will be necessary to elucidate the potential anticancer effects observed in patients with high-volume disease fully and determine exactly which subset of patients metformin could benefit. This objective aligns closely with the aims of the translational program associated with the metformin trial, currently being conducted through the University of Manchester.

Reference: Gillessen S, Murphy L, James ND, et al. Metformin for patients with metastatic prostate cancer starting androgen deprivation therapy: a randomized phase 3 trial of the STAMPEDE platform protocol. Lancet Oncol. 2025;26(8):1018-1030. doi:10.1016/S1470-2045(25)00231-1 

Bimekizumab therapy may lead to greater numbers of individuals attaining complete clearance of psoriasis across both skin and nails, compared with ustekinumab, adalimumab, and secukinumab, among patients with nail psoriasis at baseline, new data suggest.¹

These new findings highlighting bimekizumab’s efficacy among such patients were the result of a recent evaluation of concurrent nail clearance and complete skin clearance among those with moderate-to-severe plaque psoriasis who were treated with bimekizumab or active comparators. Joseph F. Merola, MD, MMSc, from the Department of Dermatology and Department of Medicine at UT Southwestern Medical Center, Dallas a team of investigators in conducting this analysis.

Merola and coauthors highlighted that approximately 1 of every 3 with psoriasis progress to psoriatic arthritis (PsA) over the course of their skin disease.² Consequently, they pointed to a need for understanding of nail disease among clinicians to improve the identification high risk patients who may see their disease progress to PsA.

“To evaluate the efficacy of bimekizumab in different domains of psoriatic disease at the same time, we assessed concurrent clearance of both skin and nails at any given timepoint post hoc in patients with moderate-to-severe plaque psoriasis treated with bimekizumab versus adalimumab, ustekinumab, and secukinumab during head-to-head phase III trials,” Merola et al wrote.¹

The investigative team’s analyses included findings from several different studies, including the phase 3 BE SURE and BE VIVID trials. The team also looked at these studies’ open-label extension study BE BRIGHT in addition to the phase 3b BE RADIANT trial and its extension phase.

Those who had taken part were adults living with moderate-to-severe plaque psoriasis, defined by baseline criteria of Psoriasis Area and Severity Index (PASI) ≥12 as well as ≥10% body surface area involvement, and an Investigator’s Global Assessment score ≥3 on a 5-point scale. Merola and colleagues would only evaluate individuals showing baseline nail involvement, determined by a modified Nail Psoriasis Severity Index (mNAPSI) score of >0, who proceeded into their respective extension studies.

The outcomes reported by the investigators were aimed at the proportion of patients who attained simultaneous clearance of their skin, determined through 100% Psoriasis Area and Severity Index score improvement from baseline (PASI 100) and clearance of their nails (mNAPSI 0). These data were presented for participants treated with bimekizumab compared with active comparators during the randomized trial phases, and for those on continuous bimekizumab therapy or switched from comparators at the time of the extension phases. The findings were analyzed using modified non-responder imputation.

Statistical analyses were highlighted by Merola and coauthors as descriptive in nature, and they were applied across all endpoints. These endpoints included those in the electronic supplementary material. There was no hypothesis testing conducted for post hoc assessments. During the conclusion of the comparator-controlled study periods, the investigative team determined that concurrent achievement of PASI 100 and mNAPSI 0 was seen in:

• 45.8% of individuals on bimekizumab (N = 151) compared with 18.3% treated with adalimumab (N = 91) by the 24-week mark in BE SURE
• 51.1% of individuals on bimekizumab (N = 169) compared with 26.5% treated with ustekinumab (N = 92) by the 52-week mark in BE VIVID
• 63.3% of individuals on bimekizumab (N = 182) compared with 36.1% treated with secukinumab (N = 155) by the 48-week mark in BE RADIANT

In their evaluation of those on long-term therapy, Merola et al found that the proportions of participants attaining both PASI 100 and mNAPSI 0 were shown to be:

• 57.7% of individuals who switched from adalimumab and 49.1% of those who were on continuous bimekizumab at by the 4-year mark in BE SURE/BE BRIGHT
• 52.2% of individuals who switched from ustekinumab and 48.3% of those maintained on bimekizumab at the 4-year mark in BE VIVID/BE BRIGHT
• 51.9% of individuals who switched from secukinumab and 57.4% of those on continuous bimekizumab at the 3-year mark in BE RADIANT

“Patients switching from comparators to bimekizumab demonstrated further improvement in skin and nail symptoms, and sustained complete clearance of both in the long term, similar to those continuously treated with bimekizumab,” Merola et al concluded.¹ “The ability of bimekizumab to treat multiple domains of psoriatic disease could be highly advantageous to patients with psoriasis who are candidates for systemic therapy.”

References

1. Merola JF, Warren RB, Gisondi P, et al. Bimekizumab Complete Clearance of Both Skin and Nail Psoriasis: Comparative Efficacy in Phase III/IIIb Studies. Am J Clin Dermatol. 2025 Aug 31. doi: 10.1007/s40257-025-00968-2. Epub ahead of print. PMID: 40886218.

2. Armstrong AW, Bohannan B, Mburu S, et al. Patient perspectives on psoriatic disease burden: results from the Global Psoriasis and Beyond Survey. Dermatology. 2023;239:621–34. Accessed September 4, 2025. https://doi.org/10.1159/000528945.