Biomedical subjects

D P Berry

Publications and source records attributed to D P Berry.

At least 19 recordsLinked to original sources

PubMed2007

Associations among body condition score, body weight, and reproductive performance in seasonal-calving dairy cattle.

The objective of the present study was to identify and quantify relationships between body condition score (BCS) and body weight (BW) in dairy cows with reproduction variables in pasture-based, seasonal-calving dairy herds. Over 2,500 lactation records from 897 spring-calving Holstein-Friesian dairy cows were used in the analyses. Eleven BCS- and 11 BW-related variables were generated, including observations at calving, nadir, planned start of mating (PSM), and first service, as well as days to nadir and the amount and rate of change between periods. The binary reproductive variables were cycling by PSM, mated in the first 21 d from PSM, pregnant to first service, and pregnant in the first 21, 42, and 84 d of the seasonal mating period. Generalized estimating equations were used to identify BCS and BW variables that significantly affected the probability of a successful reproductive outcome. After adjusting for the fixed effect of year of calving, parity (for cycling by PSM only), and the interval from calving to either first service or PSM, reproductive performance was found to be significantly affected by BW or BCS at key points, and by BCS and BW change during lactation. All reproductive response measures were negatively affected when BCS and BW measures indicated an increased severity and duration of the postpartum negative energy balance. In particular, cycling by PSM was positively associated with calving BCS, whereas pregnancy at 21, 42, and 84 d post-PSM were positively associated with nadir BCS and BW gain post-PSM, and negatively associated with BCS loss between calving and nadir. The results highlight the important role that BCS and BW loss has on reproductive performance, especially in seasonal-calving dairy systems because of the short period between calving and PSM.

Animals↗

PubMed2006

Assessment of pancreatic malignancy with laparoscopy and intraoperative ultrasound.

BACKGROUND: Staging laparoscopy for pancreatic malignancy is controversial. This study aimed to assess the efficacy of laparoscopy with intraoperative ultrasound in the management of patients with pancreatic carcinoma. METHODS: The study involved patients undergoing laparoscopy and intraoperative ultrasound over a period of 42 months. The entry criteria specified radiologic (computed tomography) diagnosis of pancreatic carcinoma and no evidence of metastases. RESULTS: The study enrolled 100 patients (52 men and 48 women) ages 21 to 83 years (mean, 63 years). On the basis of imaging, 75 patients had lesions judged to be operable, and 25 patients had a pancreatic head lesion larger than 4 cm radiologically, considered to be unresectable, but with no evidence of metastatic disease. At laparoscopy, three patients had a normal examination, with no evidence of a pancreatic mass, and an additional seven patients had other pathology including one lymphoma, one ampullary tumor, two cases of chronic pancreatitis, and three sarcomas. Of the patients with radiologically inoperable disease, 16% had previously undetected metastases, but 24% were judged to be suitable for curative resection. Half of these patients underwent successful resection. Of the patients with radiologically operable disease, undetected liver or peritoneal metastases were found in 20% of the body or tail lesions and in 26% of the pancreatic head lesions. Of the pancreatic head tumors, 12% were found to be larger than 4 cm and therefore unsuitable for curative resection. Consequently, only 53% were confirmed to be suitable for resection. Of the patients explored with a view to curative resection, 42% actually underwent resection, with clearance of resection margins achieved in 77.8%. CONCLUSION: Of the patients thought to have a resectable tumor on the basis of good quality preoperative imaging, 44% had their management approach altered after laparoscopy and avoided an open procedure. Laparoscopy should therefore be used in the preoperative staging of pancreatic tumors.

Adult↗

PubMed2006

Nine-year single-center experience with nonparastic liver cysts: diagnosis and management.

This study presents the experience with laparoscopic deroofing of nonparasitic liver cysts at a single center over a 9-year period. A total of 25 patients, undergoing 32 operations, were identified. Median cyst diameter was 10 cm for de novo cysts and 9.5 cm for recurrent cysts. Six patients had multiple cysts consistent with polycystic liver disease. In total, there were 26 laparoscopic procedures and 2 open conversions. Four procedures were commenced as open, three of which were for recurrent cysts. Minor complications were bleeding from a port site (n=1), pneumothorax (n=2), and intra-abdominal collection (n=1). One major complication of bile leak and relaparotomy occurred following an open deroofing. No major complications were recorded for laparoscopic procedures. Symptomatic recurrence of cysts occurred in four patients with simple cysts (5%) and one patient with polycystic liver disease. We conclude that laparoscopic liver cyst deroofing is an effective method of dealing with symptomatic nonparasitic liver cysts.

Adult↗

PubMed2006

Inbreeding trends and pedigree analysis of Irish dairy and beef cattle populations.

The objective of this study was to determine the inbreeding levels and to analyze the pedigree of Irish purebred populations of Charolais, Limousin, Hereford, Angus, and Simmental beef cattle, as well as the Holstein-Friesian dairy breed. Pedigree analyses included quantifying the depth of known pedigree, average generation intervals, effective population size, the effective number of founders, ancestors, and founder genomes, as well as identifying the most influential animals within the current population of each breed. The annual rate of increase in inbreeding over the past decade was 0.13% (P < 0.001) in the Hereford, 0.06% (P < 0.001) in the Simmental, and 0.10% (P < 0.001) in the Holstein-Friesian breeds. Inbreeding in the other breeds remained relatively constant over the past decade. Herefords had the greatest mean inbreeding in 2004, at 2.19%, whereas Charolais had the lowest, at 0.54%. Over half of each purebred population in 2004 was inbred to some degree; the population with the greatest proportion of animals inbred was the Hereford breed (85%). All 6 breeds displayed a generation interval of approximately 6 yr in recent years. In the pure-bred females born in 2004, the 3 most influential animals contributed between 11% (Limousin) and 24% (Hereford) of the genes. Effective population size was estimated for the Hereford, Simmental, and Holstein-Friesian only, and was 64, 127, and 75, respectively. The effective number of founders varied from 55 (Simmental) to 357 (Charolais), whereas the effective number of ancestors varied from 35 (Simmental and Hereford) to 82 (Limousin). Thus, despite the majority of animals being inbred, the inbreeding level across breeds is low but rising at a slow rate in the Hereford, Simmental, and Holstein-Friesian.

Animals↗

PubMed2006

Artificial insemination increases the probability of a male calf in dairy and beef cattle.

The objective of this study was to determine if natural mating affected secondary sex ratio. Data consisting of 642,401 calving records from the Irish national database, during the years 2002-2005, were used in the analysis. Factors affecting the logit of the probability of a male calf being born were determined using multiple regression generalised estimating equations with sire of the calf included as a repeated effect. Month of the year at calving, sex of the previous calf born within dam, breed of service sire, parity of dam and type of mating (i.e., natural or artificial insemination) significantly (P<0.05) affected the likelihood of a male calf being born. Male calves were more likely to be born in the warmer months of the year, when the sex of the previous calf born to the same dam was male, in older cows and when the service sire was a beef breed. No significant interaction between the main effects existed. The odds of a male calf being born, following adjustment for confounding effects, varied from 1.04 to 1.08 (P<0.01) across the years of analysis when artificial insemination was used compared to natural mating. This equates to a 1% unit increase in the probability of a male calf being born following artificial insemination.

Animals↗

PubMed2006

Chemoprevention of pancreatic cancer: a review of the molecular pathways involved, and evidence for the potential for chemoprevention.

BACKGROUND: Pancreatic cancer has a poor prognosis. The use of drugs or natural agents which inhibit or slow down tumour growth therefore has important potential in the development of future therapies. METHODS: A literature search of the PubMed and ISI Web of Science databases was undertaken to review the current data available on the alterations in signalling pathways found in pancreatic carcinogenesis, in order to identify sites that could be targeted by chemopreventive agents. Several agents of particular relevance to pancreatic cancer were identified, and their possible mechanisms of action reviewed. RESULTS: Chemopreventive agents such as non-steroidal anti-inflammatory drugs, green tea constituents, and antioxidants have been shown to target various steps in intracellular signalling pathways, particularly those controlling cell proliferation and survival. Work on cell lines and animal models has shown that some of these agents may be able to modulate the growth of pancreatic tumours. Initial clinical trials of some chemopreventives in pancreatic cancer have been undertaken, and have yielded mixed results, prompting the need for further studies. CONCLUSION: As the molecular pathology of pancreatic cancer becomes better understood, sites of action of chemopreventive substances have been uncovered. Several agents have shown promising results by their ability to inhibit pancreatic carcinogenesis in laboratory studies. If these effects can be successfully translated into human studies then these agents may prove to be valuable adjuvant therapies in the future.

Antineoplastic Agents↗

PubMed2006

Molecular prognostic markers in resectable colorectal liver metastases: a systematic review.

BACKGROUND: Determination of prognosis in patients with resectable colorectal liver metastases (CLM) is desirable in order to improve case selection for surgery and tailor adjuvant treatment according to individual recurrence risk. Conventional clinicopathological factors lack the sensitivity to accurately achieve this goal. Consideration of tumour biology and the identification of molecular prognostic markers may allow more accurate risk stratification. METHOD: This systematic review examines evidence from published manuscripts looking at molecular markers in resectable colorectal liver metastases and their correlation with disease recurrence and survival following hepatectomy. RESULTS: Studies have yielded promising results in the search for prognostic molecular markers of CLM. Molecular biomarkers from varied aspects of tumour biology have been examined and a number of these, including proliferation indices, telomerase, thymidylate synthase, microvessel density and thrombospondin-1 appear to have prognostic utility in this context. Validation of other markers, notably p53, has been limited by a failure of methodologies to account for their biological complexity. CONCLUSIONS: A biomarker-based approach may yield significant benefits through informed treatment of resectable metastatic colorectal malignancy. Standardised retrospective analyses are necessary to confirm preliminary findings and identify existing and novel markers for inclusion into prospective studies. Assessment and verification of multiple molecular markers in this manner may allow molecular profiling of metastases and tailoring of therapy according to the biological aggressiveness of individual tumours. The advent of genomic- and proteomic-based technologies will allow the simultaneous analysis of multiple molecular markers and the derivation of disease profiles associated with disease recurrence and poor survival.

Apoptosis↗

PubMed2006

Frozen section diagnosis of pancreatic malignancy: a sensitive diagnostic technique.

BACKGROUND: Patients with potentially resectable pancreatic masses, without evidence of metastatic disease, require surgical exploration. We assessed the reliability of frozen section diagnosis of pancreatic malignancy. METHODS: We analysed data from 120 patients who underwent pancreatic exploration, including frozen section assessment, over a period of 41 months. RESULTS: A total of 310 pancreatic biopsies were sent for frozen section analysis. The frozen section result concurred with the final histological diagnosis in 98.1% of biopsies. The false-negative rate was 1.9%, with the correct diagnosis being established on subsequent frozen section in half of these cases. Only 3 patients were not correctly diagnosed intra-operatively by frozen section. The majority of tumours identified were pancreatic ductal adenocarcinomas, but endocrine tumours and lymphoma were also detected. 15 (12.5%) patients required more than one set of biopsies in order to establish a diagnosis of malignancy. 19 (15.8%) patients had malignant disease outside the pancreas, making their tumours unsuitable for curative resection. CONCLUSIONS: Frozen section diagnosis is very reliable in the assessment of pancreatic masses and accurately differentiates between benign and malignant disease. More than one biopsy is needed to make a diagnosis, and if clinically suspicious, successive sets of biopsies may be required.

Adult↗

PubMed2006

Women presenting with lower abdominal pain: a missed opportunity for chlamydia screening?

INTRODUCTION: Many young women presenting with lower abdominal pain are referred to general surgeons with possible appendicitis. For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? METHODS: One hundred and ninety three women who had been admitted with lower abdominal pain to a single hospital between 1999 and 2001 were identified using computerised records and the notes were examined. One hundred and eighty six women were included in the audit. Investigations and treatments instigated for these patients were then carefully recorded. RESULTS: Seventy-four patients underwent appendicectomy, of which 59 were histologically confirmed. Eighty-nine patients (47.8%) of admissions had no final diagnosis and were not screened for Chlamydia trachomatis. Sexual history was recorded in only 51% of admissions. Vaginal swabs were sent in only 7.3% of admissions. CONCLUSION: Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Officer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a significant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. These women could and probably should be screened for Chlamydia trachomatis.

Abdominal Pain↗

PubMed2006

Clinical aspects of natural anti-angiogenic drugs.

Natural products represent a rich resource for drug delivery and are currently being exploited to target tumour angiogenesis. A vast array of products of natural origin have been shown to have anti-angiogenic potential in preclinical models, including purified endogenous inhibitors, and exogenous compounds derived from varied species of plant, animal and micro-organism. Over a dozen of these agents have now entered clinical trial. This review discusses evidence for the efficacy of this drug class and key issues in the translation of pre-clinical results into the development of efficacious drugs for clinical use.

Angiogenesis Inhibitors↗

PubMed2006

Pre-conception energy balance and secondary sex ratio--partial support for the Trivers-Willard hypothesis in dairy cows.

According to the Trivers-Willard hypothesis, maternal condition at or around conception affects the secondary sex ratio in mammals. However, there are little or no data available on indicators of maternal condition in dairy cows on the sex of the resultant offspring. A total of 76,607 body condition score (BCS; scale of 1 to 5) records and 76,611 body weight (BW) records from 3,209 lactations across 1,172 cows were extracted from a research database collated from one research herd between 1986 and 2004, inclusive. Exclusion of multiple births and cows with no information before calving (e.g., nulliparous animals) resulted in 2,029 records with BCS and BW observations from the previous calving, and 2,002 and 1,872 lactations with BCS and BW observations at conception and midgestation, respectively. Change in BCS and BW between calving and conception and between conception and midgestation was calculated per lactation. Generalized estimating equations were used to model the logit of the probability of a male calf, in which cow was included as a repeated effect with a first-order autoregressive correlation structure assumed among records within cow. Of the BCS variables investigated, there was a linear relationship between the logit of the probability of a male calf and BCS change between calving and conception, the rate of BCS change over this period (BCS divided by days in milk), and BCS at the calving event immediately before conception. The birth of a bull calf was 1.85 times more likely in cows that lost no BCS from calving to conception compared with cows that lost one BCS unit from calving to conception. This increase in odds was equivalent to a 14% unit increase in the probability of a male calf (from 54 to 68%). The amount of BW lost between calving and conception and the rate of loss affected the sex of the resultant offspring. Less BW loss or greater BW gain between calving and conception was associated with greater likelihood of a male calf. Results suggested a positive effect of pre-conception BCS and BW change on secondary sex ratio, agreeing with the Trivers-Willard hypothesis that females in good physiological condition are more likely to produce male offspring.

Animal Feed↗

PubMed2006

Periparturient climatic, animal, and management factors influencing the incidence of milk Fever in grazing systems.

The objective of the present study was to quantify the climatic, animal, and management factors influencing incidence of milk fever (MF) in cows exposed to grazing systems. Data were extracted on 4,469 calvings of multiparous cows in a seasonal calving research herd between 1970 and 2000. Climatic data during the calving period also were extracted for these years. Poisson regression was used to investigate the effect of climate on frequency of MF within year; the offset variable was the number of cows at risk for MF at that time. Generalized estimating equations, with cow included as a repeated effect, were used to quantify the effect of parturition-associated cow and management factors on the logit of the probability of MF. Both univariate and multivariate analyses were performed. Explanatory variables investigated included time of calving relative to the herd-year calving period, parity, body weight, breed of cow, body condition score at calving, weight and gender of the calf, incidence of twin calves, calving inductions, and calving assistance. Odds of recurring MF within cow, as well as the timing of MF relative to day of calving, was quantified using generalized estimating equations with cow included as a repeated effect. Results show significant effects of evaporation, minimum grass temperature, difference between ambient maximum and minimum temperature, and rainfall on the odds of MF occurring, with a greater incidence at greater evaporation, larger diurnal variation in air temperature, greater rainfall, and lesser grass minimum temperature. Cow factors, such as age, excessive or poor body condition score, and requirement for calving assistance increased the odds of MF; a lesser odds ratio was observed in cows hormonally induced to calve and those that had twin births. Results indicate that herd managers may identify the day of greatest risk for MF and cows that are at greatest risk of MF based on climatic, cow, and management factors.

Animals↗

PubMed2006

Short communication: genetic selection for milk production increases plasma ghrelin in dairy cows.

Ghrelin is an endogenous ligand of the growth hormone secretagogue receptor and a potent orexigenic agent in human and rodent studies, but there is limited information about its effect in dairy cows. Twelve low genetic merit and 9 high genetic merit Holstein-Friesian dairy cows in peak lactation that were offered unrestricted access to fresh pasture were used to determine whether genetic selection for milk production resulted in an associated increase in plasma ghrelin concentration in grazing dairy cows. Blood samples were taken prior to the a.m. milking (i.e., baseline) and following 2 h of grazing after the a.m. milking on 2 consecutive wk during peak lactation. Milk production and dry matter intake were greater in high genetic merit cows compared with low genetic merit cows. Plasma ghrelin and growth hormone concentrations were elevated in high genetic merit cows pre- and postgrazing, and there was no significant interaction between genetic merit and time of sampling. Genetic merit did not affect the plasma nonesterified fatty acid or glucose concentration, but the plasma concentrations of metabolites and hormones measured were diminished 2 h after feeding. Data indicate an increase in plasma ghrelin associated with genetic selection for milk production, and an associated increase in dry matter intake.

Animal Feed↗

PubMed2006

Holstein-Friesian strain and feed effects on milk production, body weight, and body condition score profiles in grazing dairy cows.

Data from 113 lactations across 76 cows between the years 2002 to 2004 were used to determine the effect of strain of Holstein-Friesian (HF) dairy cow and concentrate supplementation on milk production, body weight (BW), and body condition score (BCS; 1 to 5 scale) lactation profiles. New Zealand (NZ) and North American (NA) HF cows were randomly allocated to 1 of 3 levels of concentrate supplementation [0, 3, or 6 kg of dry matter (DM)/cow per d] on a basal pasture diet. The Wilmink exponential model was fitted within lactation (Y(DIM) = a + b e(-0.05 x DIM) + c x DIM). The median variation explained by the function for milk yield was 86%, between 62 and 69% for milk composition, and 80 and 70% for BW and BCS, respectively. North American cows and cows supplemented with concentrates had greater peak and 270-d milk yield. Concentrate supplementation tended to accelerate the rate of incline to peak milk yield, but persistency of lactation was not affected by either strain of HF or concentrate supplementation. No significant strain by diet interaction was found for parameters reported. New Zealand cows reached nadir BCS 14 d earlier and lost less BW (22 kg) postcalving than NA cows. Concentrate supplementation reduced the postpartum interval to nadir BW and BCS, and incrementally increased nadir BCS. New Zealand cows gained significantly more BCS (i.e., 0.9 x 10(-3) units/d more) postnadir than NA cows, and the rate of BCS replenishment increased linearly with concentrate supplementation from 0.5 x 10(-3) at 0 kg of DM/d to 0.8 x 10(-3) and 1.6 x 10(-3) units/d at 3 and 6 kg of DM/d concentrates, respectively. Although there was no significant strain by diet interaction for parameters reported, there was a tendency for a strain by diet interaction in 270-d BCS, suggesting that the effect of concentrate supplementation on BCS gain was, at least partly, strain dependent.

Animals↗

PubMed2006

Temporal trends in bulk tank somatic cell count and total bacterial count in Irish dairy herds during the past decade.

The objective of this study was to document temporal trends in bulk tank somatic cell count (SCC) and total bacterial counts (TBC) in Irish dairy herds during the years 1994 to 2004. Three milk processors participated in the study, providing data on 2,754,270 individual bulk tank SCC and 2,056,992 individual bulk tank TBC records from 9,113 herds. Somatic cell counts decreased during the years 1994 to 2000, followed by an annual increase thereafter of more than 2,000 cells/mL. A tendency existed for TBC to decrease over time. Across all years, bulk tank SCC were the lowest in April and highest in November; TBC were the lowest in May and highest in December. The significant seasonal pattern observed in herd SCC and TBC was an artifact of seasonal calving in Ireland. In general, herds selling more milk had lower bulk tank SCC and TBC. Herds having the highest SCC (i.e., > 450,000 cells/mL) and the lowest SCC (i.e., < or = 150,000 cells/mL) both contributed substantially to the mean SCC of the milk pool collected by the milk processors. Derived transition matrices showed that between adjacent years, herds had the greatest probability of remaining in the same annual mean SCC or TBC category.

Animals↗

PubMed2006

Climatic factors and secondary sex ratio in dairy cows.

The hypothesis for this study was that the prevailing climate around the time of conception was associated with changes in the secondary sex ratio (SSR) in grazing, seasonally bred dairy cattle. Calving date, parity, cow breed, and calf sex were obtained for 8,621 lactations (with single births only) from 1,897 cows between 1970 and 2003 (inclusive). Conception date was estimated by subtracting a gestation length of 282 d from the date at calving. Climatic factors, including maximum and minimum ambient temperature, relative humidity, rainfall, sunlight hours, and evaporation rate, were averaged across the week immediately prior to conception for all lactations. Sun radiation data were available after 1976. Generalized estimating equations, with cow included as a repeated effect, were used to determine the effect of climate around the time of conception on the logit of the probability of a male calf. Breed of cow, year of conception, and parity at conception did not affect the SSR. The odds of a male calf being born were 3.74 times greater when the immediately previous calf born was male. A male calf was more likely to be born following periods of elevated air temperature, greater evaporation, or both. A 1 degrees C increase in average maximum air temperature from the average (18.3 degrees C), during the week immediately prior to conception, was associated with a 1-percentage unit increase in the probability of a male calf being born (i.e., from 52 to 53%). A corresponding 1 degrees C increase in average minimum air temperature was reflected in a 0.5-percentage unit increase in the probability of a male calf being born. The probability of a male calf being born increased by 2.9 percentage units with each additional millimeter of evaporation per day. Results indicate that climatic factors associated with elevated temperatures and greater evaporation may influence the SSR in dairy cattle.

Analysis of Variance↗

PubMed2005

Molecular prognostic markers in pancreatic cancer: a systematic review.

Pancreatic cancer is one of the most lethal tumours of the gastrointestinal tract. The ability to predict which patients would benefit most from surgical intervention and/or chemotherapy would be a great clinical asset. Considerable research has focused on identifying molecular events in pancreatic carcinogenesis, and their correlation with clinicopathological variables of pancreatic tumours and survival. This systematic review examined evidence from published manuscripts looking at molecular markers in pancreatic cancer and their correlation with tumour stage and grade, response to chemotherapy and long-term survival. A literature search was undertaken using PubMed and MEDLINE search engines, using the keywords p53, p21, p16, p27, SMAD4, K-ras, cyclin D1, Bax, Bcl-2, EGFR, EGF, c-erbB2, HB-EGF, TGFbeta, FGF, MMP, uPA, cathepsin, heparanase, E-cadherin, laminins, integrins, TMSF, CD44, cytokines, angiogenesis, VEGF, IL-8, beta-catenin, DNA microarray, and gene profiling. A bewildering number of biomarkers are currently under evaluation. For the most part, the evidence regarding their application as prognostic indicators is conflicting. The advent of gene microarray and mass spectrometric protein profiling offers the potential to examine many different biomarkers simultaneously. This 'protein/gene signature' could revolutionise work in this field and allow researchers to develop accurate and reproducible predictions of survival based on protein or gene profiles.

Apoptosis↗

PubMed2005

Role of inflammation in pancreatic carcinogenesis and the implications for future therapy.

BACKGROUND: The link between inflammation and pancreatic cancer has been observed for a number of gastrointestinal neoplasms. This review examines the role of inflammation in pancreatic carcinogenesis and how it can be utilised to develop new therapies against pancreatic cancer. METHODS: A literature review of Pubmed, Medline and Web of Science databases was undertaken using the key words, pancreatic cancer, inflammation, inducible nitric oxide, interleukins, pro-inflammatory cytokines, cyclooxygenase-2, NF-kappa B, reactive oxygen species, DNA adducts, lipoxygenases, chemoprevention. RESULTS: Epidemiological evidence and molecular studies both in vitro and in vivo all support the hypothesis that inflammation plays an important in the initiation and progression of pancreatic tumours. CONCLUSION: Sustained damage caused by chronic inflammation may precede the onset of frank malignancy by a significant interval. As such, suppression of inflammatory changes and oxidative damage, may help delay or even prevent the inception of pancreatic neoplasia.

Cyclooxygenase 2↗