In this interventional pilot study, we investigated the effects of a modified ketogenic diet (KD) on children with autism spectrum disorder (ASD). We previously observed improved behavioral symptoms in this cohort following the KD; this trial was registered with Clinicaltrials.gov (NCT02477904). This report details the alterations observed in the microbiota, inflammation markers, and microRNAs of seven children following a KD for a duration of 4 months. Our analysis included blood and stool samples, collected before and after the KD. After 4 months follow up, we found that the KD led to decreased plasma levels of proinflammatory cytokines (IL-12p70 and IL-1b) and brain-derived neurotrophic factor (BDNF). Additionally, we observed changes in the gut microbiome, increased expression of butyrate kinase in the gut, and altered levels of BDNF-associated miRNAs in the plasma. These cohort findings suggest that the KD may positively influence ASD sociability, as previously observed, by reducing inflammation, reversing gut microbial dysbiosis, and impacting the BDNF pathway related to brain activity. Full article

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease characterized by progressive loss of motor neurons. Emerging evidence suggests a potential link between metabolic dysregulation and ALS pathogenesis. This study aimed to investigate the relationship between metabolic hormones and disease progression in ALS patients. A cross-sectional study was conducted involving 44 ALS patients recruited from a tertiary care center. Serum levels of insulin, total amylin, C-peptide, active ghrelin, GIP (gastric inhibitory peptide), GLP-1 active (glucagon-like peptide-1), glucagon, PYY (peptide YY), PP (pancreatic polypeptide), leptin, interleukin-6, MCP-1 (monocyte chemoattractant protein-1), and TNFα (tumor necrosis factor alpha) were measured, and correlations with ALSFRS-R, evolution scores, and biomarkers were analyzed using Spearman correlation coefficients. Subgroup analyses based on ALS subtypes, progression pattern of disease, and disease progression rate patterns were performed. Significant correlations were observed between metabolic hormones and ALS evolution scores. Insulin and amylin exhibited strong correlations with disease progression and clinical functional outcomes, with insulin showing particularly robust associations. Other hormones such as C-peptide, leptin, and GLP-1 also showed correlations with ALS progression and functional status. Subgroup analyses revealed differences in hormone levels based on sex and disease evolution patterns, with male patients showing higher amylin and glucagon levels. ALS patients with slower disease progression exhibited elevated levels of amylin and insulin. Our findings suggest a potential role for metabolic hormones in modulating ALS progression and functional outcomes. Further research is needed to elucidate the underlying mechanisms and explore the therapeutic implications of targeting metabolic pathways in ALS management. Full article

Certain micronutrients exhibit immunomodulatory effects. However, no intervention has yet investigated the effect of individualized supplementation on the severity of upper respiratory tract infections (URIs). Therefore, we investigated whether a personalized supplementation moderates the incidence and severity of URI. Selenium, zinc, and vitamin D were measured in dried blood spots from 59 healthy participants. Accordingly, a personalized supplement was provided with or without the respective micronutrients. We used WURSS-21 questionnaires to assess the disease status. The blood values converged during the intervention and micronutrients no longer differed between treated and untreated volunteers at the end of the intervention period. The incidence and severity of the illness did not significantly differ between the groups. However, when analyzing the WURSS-21 scores by the intention to treat, the initially randomized treatment arm revealed a significantly higher score than the placebo arm. Upon acute administration, individualized combinations of selenium, zinc and vitamin D do not reduce the number, or contribute to a milder course of URIs. Therefore, supplementation in acute infectious situations seems questionable. Further studies must address the habitual diet in more detail, to better understand the impact of individual micronutrient status on the prevention of URI. Full article

While many countries across the world have had difficulty in providing continuous coronavirus disease (COVID-19) vaccine boosters, in Japan, the number of COVID-19 vaccinations has increased rapidly in the past two years to the point where the vaccination booster numbers are now at the highest level in the world (by March 2023). Against this backdrop, this study aimed to determine the characteristics of individuals who either refused to be vaccinated or who were vaccinated multiple (five) times during this period. We analyzed data from a sample of 3710 Japanese adults that were collected in a nationwide, cross-sectional Internet survey that was undertaken in March 2023. Several demographics (e.g., age, education level, marital status, job status), medical conditions, daily smoking, and mental health/psychological factors (i.e., perceived stress, anxiety symptoms, loneliness) were associated with not having been vaccinated. Although the most frequently vaccinated status was also associated with some demographics (e.g., age, employment status), medical conditions, and daily smoking, other predictors such as having a COVID-19 infection history were unique to this outcome. Moreover, age-stratified analyses showed that depression (OR: 2.05, 95%CI: 1.08–3.89) and anxiety (OR: 3.87, 95%CI: 1.80–8.31) symptoms were associated with higher odds of being unvaccinated while loneliness was associated with lower odds for the most frequently vaccinated status (OR: 0.72, 95%CI: 0.54–0.96) among older adults (aged ≥ 60 years). The findings of this study indicate that many of the same factors are associated with vaccine hesitancy and being vaccinated multiple times among adults in Japan but that among older individuals, worse mental/psychological health problems may be important for vaccine hesitancy/infrequent vaccine uptake in an age range where the majority of individuals (57.7%) had been vaccinated five times. Full article

Plant growth-promoting rhizobacterial strain FP607^T was isolated from the rhizosphere of beets in Wuhan, China. Strain FP607^T exhibited significant antagonism toward several phytopathogenic bacteria, indicating that FP607^T may produce antimicrobial metabolites and has a stronger biocontrol efficacy against plant pathogens. Growth-promoting tests showed that FP607^T produced indole-3-acetic acid (IAA), NH₃, and ferritin. The genome sequence of strain FP607^T was 6,590,972 bp long with 59.0% G + C content. The optimum temperature range was 25–30 °C, and the optimum pH was 7. The cells of strain FP607^T were Gram-negative, short, and rod-shaped, with polar flagella. The colonies on the King’s B (KB) agar plates were light yellow, smooth, and circular, with regular edges. A phylogenetic analysis of the 16S rRNA sequence and a multilocus sequence analysis (MLSA) showed that strain FP607^T was most closely related to the type of strain Pseudomonas farris SWRI79^T. Based on a polyphasic taxonomic approach, strain FP607^T was identified as a novel species within the genus Pseudomonas, for which the name Pseudomonas wuhanensis sp. nov. was proposed. The type of strain used was FP607^T (JCM 35688, CGMCC 27743, and ACCC 62446). Full article

Background: Tracheostomy procedures are performed in the intensive care unit (ICU) for prolonged intubation, unsuccessful weaning and infection prevention through either percutaneous or surgical techniques. This study aimed to outline the impact of tracheostomy timing in the ICU on mortality, need for mechanical ventilation, and complications. Methods: Patients were included in the study on the day of tracheostomy. Demographic information, tracheostomy timing, technique, complications, sedation requirement and need for mechanical ventilation at discharge were recorded by an anesthesiologist, including the pre-tracheostomy period. Results: Tracheostomy was performed on 33 patients during the first 14 days of intubation and on 54 patients on the 15th day and beyond. There was no significant difference between the tracheostomy timing and mortality, sedation requirement, or weaning from the ventilator. We observed that patients who underwent tracheostomy with the surgical technique experienced more complications, but there was no significant difference. Tracheostomy performed after the 14th day was shown to be associated with prolonged hospital stay. Conclusions: Early tracheostomy does not have any influence on the need for mechanical ventilation, sedation and mortality. The optimal timing for tracheostomy is still controversial. We are of the opinion that randomized controlled trials involving patient groups with similar survival expectations are needed. Full article

(1) Background: the aim of the study was to demonstrate its usefulness in the field of imaging evaluation of plaque morphology in psoriasis vulgaris, with an emphasis on the use of confocal microscopy and other advanced skin-imaging techniques. (2) Methods: we conducted a prospective study over two years (July 2022–April 2024), on patients diagnosed with moderate or severe psoriasis vulgaris, treated in the dermatology department of our institution. We selected 30 patients, of whom 15 became eligible according to the inclusion and the exclusion criteria. A total of 60 psoriasis plaques were analyzed by dermatoscopy using a Delta 30 dermatoscope and Vidix 4.0 videodermoscope (VD), by cutaneous ultrasound (US) using a high-resolution 20 MHz linear probe, and by confocal microscopy, along with histopathological analysis. (3) Results: the study included fifteen patients with vulgar psoriasis, diagnosed histopathologically, of whom six were women and nine were men, with an average age of 55. Between two and six plaques per patient were selected and a total of sixty psoriasis plaques were analyzed by non-invasive imaging techniques. Twelve lesions were analyzed with ex vivo fluorescence confocal microscopy (FCM), compared to histology. US showed that the hyperechoic band and the lack of damage to the subcutaneous tissue were the most common criteria. The epidermis and dermis were found to be thicker in the area of psoriasis plaques compared to healthy skin. Dermatoscopy showed that the specific aspect of psoriasis plaques localized on the limbs and trunk was a lesion with an erythematous background, with dotted vessels with regular distribution on the surface and covered by white scales with diffuse distribution. The presence of bushy vessels with medium condensation was the most frequently identified pattern on VD. Good correlations were identified between the histological criteria and those obtained through confocal microscopy. (4) Conclusions: the assessment and monitoring of patients with psoriasis vulgaris can be conducted in a more complete and all-encompassing manner by incorporating dermatoscopy, ultrasonography, and confocal microscopy in clinical practice. Full article

Mycobacterium avium subsp. paratuberculosis (MAP) is responsible for the persistent infectious illness known as bovine paratuberculosis, which is one of the most easily overlooked diseases in China amid a lack of epidemiological data. In this study, we evaluated the agreement of milk and blood antibody tests for paratuberculosis and showed an overall agreement of 92.0%, with a 95.0% negative coincidence rate and a 78.6% positive coincidence rate. The milk test was then used to examine the prevalence and incidence of dairy cows in Hubei Province, China. We found that, at the individual level, the highest lacto-prevalence reached up to 22.9%; the farm-level prevalence was as high as 92.3% (12/13) and 84.6% (11/13) in January and April 2018, respectively. The total incidence risk of all farms was 6% per three months. We also found that large-scale farms had a significantly lower prevalence and incidence than small-scale farms. Finally, the correlation between paratuberculosis and milk quality was evaluated, and we confirmed that MAP can significantly alter milk quality and raise somatic cell counts in the milk. This study provides valuable information for assessing the prevalence and incidence risk of paratuberculosis in China. It further provides an essential basis for calling for the prevention and control of paratuberculosis in China. Full article

Several trichomonad species have already been identified in pigs, and their pathogenic potential may not be ruled out. To date, however, no information is available regarding the prevalence of trichomonads in pigs in Shanxi Province, North China. In the present study, a total of 362 fecal samples collected from pigs in three representative counties (Qi, Jishan, and Shanyin) in this province were examined for Tetratrichomonas buttreyi, Tritrichomonas foetus, and Pentatrichomonas hominis using a nested polymerase chain reaction (PCR) with primers targeting the small subunit ribosomal RNA (SSU rRNA) gene. The overall prevalence of T. buttreyi was 49.72%, and region and age were found to be significantly associated with T. buttreyi infection, respectively. Only one pig fecal sample from Qi County was found to be positive for T. foetus, and all samples were negative for P. hominis. Molecular evolutionary analysis revealed that some T. buttreyi isolates showed complete genetic identity with those reported previously, and some T. buttreyi isolates and one T. foetus isolate showed minor allelic variations compared with those reported previously. This is the report of the molecular epidemiology of T. foetus and T. buttreyi in pigs in Shanxi Province, North China. These findings not only enrich the knowledge on the distribution of these trichomonad species in pigs in China but also provide baseline information for planning future research and control strategies. Full article

Often in the forensic context, child victims and witnesses are interviewed several times, exposing them to suggestive questions and social pressures. The present study had the main purpose of verifying the effect of coping strategies on the levels of immediate suggestibility and on the Resistant Behavioral Responses (RBRs) of children subjected to repeated suggestive interviews. A sample of 90 children, aged between 11 and 14, were administered the two parallel Gudjonsson Suggestibility Scales (GSS2 and GSS1) a few months apart and the Coping Inventory for Stressful Situations (CISS) to detect their coping strategies. The results showed that the avoidance coping increased suggestive vulnerability and reduced resistant responses. Task-oriented coping favored responses with greater source monitoring, which allow for the rejection of misleading information. Coping strategies did not show direct effects on the management of the socioemotional aspects involved in the suggestive interaction. After the negative feedback that invites children to be more accurate, a smaller effect of the avoidance strategy was recorded, indicating how actively requesting greater source monitoring can lead children to better recognize misleading information. Full article

Aiming at the problem that the current double direction buffering algorithm is easy to use to seal the “bottleneck” area when simplifying coastlines, an adaptive simplification method for coastlines using a skeleton line “bridge” double direction buffering algorithm is proposed. Firstly, from the perspective of visual constraints, the relationship between the buffer distance and the coastline line width and the minimum recognition distance of the human eye is theoretically derived and determined. Then, based on the construction of the coastline skeleton binary tree, the “bridge” skeleton line is extracted using the “source tracing” algorithm. Finally, the shoreline adaptive simplification is realized by constructing a visual buffer of “bridge” skeleton lines to bridge the original resulting coastline and the local details. The experimental results show that the proposed method can effectively solve the problem that the current double direction buffering algorithm has, which can significantly improve the quality of simplification. Full article

This article explores the use of olive pit powder (OPP) as a promising resource for enhancing the thermal insulation properties of epoxy mortars. A comprehensive analysis of the chemical and physical characteristics of OPP was conducted, employing analytical techniques including scanning electron microscopy (SEM), thermogravimetric analysis and emitted gas analysis (TG-MS-EGA), and proximal analysis. Experimental samples of epoxy grout were prepared by using different proportions of a conventional inorganic filler, quartz powder, and OPP within an epoxy mortar matrix. As the percentage of OPP in the formulation increased, the microstructure of the samples gradually became more porous and less compact. Consequently, there was a decrease in density with the increase in OPP content. The 28-day compressive strength decreased from 46 MPa to 12.8 MPa, respectively, in the samples containing only quartz (Sample E) and only OPP (Sample A) as a filler. Similarly, flexural strength decreased from 35.2 to 5.3 MPa. The thermal conductivity decreased from 0.3 W/mK in Sample E to 0.11 in Sample A. Therefore, increasing the %wt of OPP improved insulating properties while reducing the mechanical resistance values. This study highlights the potential of OPP as an environmentally friendly and thermally efficient filler for epoxy mortars, thereby promoting sustainable construction practices. Full article

The mainstream approach of regional integration impact assessments is mainly limited to assessing cross-border development projects/programmes. There is still a lack of critical assessment of how stakeholders at different institutional levels conceptualise the border. Local (municipal) strategic plans provide a reflection of the spatial imaginaries of stakeholders, perception planners, institutional power structures, and, to some extent meaning of the border to the local people. Integrated Development Plans (IDPs) in South Africa were adopted as an important development planning strategy in the post-apartheid era. IDPs of 49 borderland municipalities were systematically reviewed using the Key-Word-in-Context (KWIC) content analysis technique of the keyword ‘border’ to determine the importance of state borders in light of regional integration. Border security and management is one of the most common themes associated with the border. This suggested that borders were mainly perceived as threats and barely considered as a potential resource for cross-border cooperation or integration. Full article

The modular multilevel converter (MMC) has many advantages of low switching losses, good harmonic performance and high modularity structure in state-of-the-art HVDC applications. The full-bridge submodules (FBSMs) of the hybrid MMC can inherently output negative voltage to absorb fault currents, and consequently the hybrid MMC can ride through severe DC faults without blocking. During the DC fault-ride-through process, the submodule capacitor voltage and arm current of the MMC will be temporarily increased. These characteristics limit the proportion of the FBSMs, which should not be too low and thus increase the cost and operating losses of the hybrid MMC. In this paper, an improved sorting algorithm of SM capacitor voltage is established, and a novel virtual damping control strategy is proposed that can effectively suppress the increase in submodule capacitor voltage and arm current of the hybrid MMC during the DC fault-ride-through process. By adopting this optimization control, the proportion of FBSMs can be reduced significantly without deteriorating the fault-ride-through capability or safety of the MMC. The effectiveness of the proposed control is verified by careful theoretical analysis and detailed simulation results. Full article

Testing of ChatGPT has recently been performed over a diverse range of topics. However, most of these assessments have been based on broad domains of knowledge. Here, we test ChatGPT’s knowledge of tinnitus, an important but specialized aspect of audiology and otolaryngology. Testing involved evaluating ChatGPT’s answers to a defined set of 10 questions on tinnitus. Furthermore, given the technology is advancing quickly, we re-evaluated the responses to the same 10 questions 3 and 6 months later. The accuracy of the responses was rated by 6 experts (the authors) using a Likert scale ranging from 1 to 5. Most of ChatGPT’s responses were rated as satisfactory or better. However, we did detect a few instances where the responses were not accurate and might be considered somewhat misleading. Over the first 3 months, the ratings generally improved, but there was no more significant improvement at 6 months. In our judgment, ChatGPT provided unexpectedly good responses, given that the questions were quite specific. Although no potentially harmful errors were identified, some mistakes could be seen as somewhat misleading. ChatGPT shows great potential if further developed by experts in specific areas, but for now, it is not yet ready for serious application. Full article

This study aims to evaluate relationships between elemental signatures in calcite and the crystallographic orientation of its planes. The ability of calcite (a widespread calcium carbonate mineral) to entrap various trace and minor elements in its structure is the foundation of multiple methods (also called proxies) to reconstruct paleoenvironment conditions (e.g., temperature, pH, and marine chemistry). Although several element-to-calcium ratios (E/Ca) are routinely measured in marine carbonates and are widely used in paleoclimate studies, some of the controls on the incorporation of these elements are still unclear. Here, we examine the effect of crystallography on (E/Ca)_calcite by growing thin layers of calcite on differently oriented Iceland Spar substrates immersed in modified seawater solution. Newly grown calcite layers were examined with Laser Ablation Inductivity–Coupled Plasma Mass Spectrometry (LA-ICP-MS), Backscattered Electron Imaging (BSE), and Energy Dispersive X-ray Spectroscopy (EDS). We propose that the crystallographic orientation might slightly influence the incorporation of lithium (Li), sodium (Na), magnesium (Mg), sulfur (S), and barium (Ba) into the studied calcite faces and have no impact on the incorporation of boron (B), potassium (K), and strontium (Sr) at least under the conditions of our experiment. Full article

Yams are the edible subterranean rhizomes, or tubers, of plants from the genus Dioscorea. There are approximately 600 species of yam plants in the world, with more than 90 of these growing in East Asia. One particular species, Dioscorea opposita Thunb., is highly praised as “the Chinese yam”. This distinction arises from millennia of storied history, both as a nutritional food source and as a principal ingredient in traditional Chinese medicine. Among the many cultivars of Dioscorea opposita Thunb., Huai Shanyao has been widely regarded as the best. This review surveyed the historical background, physiochemical composition, applications as food and medicine, and research prospects for the Chinese yam. Modern science is finally beginning to confirm the remarkable health benefits of this yam plant, long-known to the Chinese people. Chinese yam promises anti-diabetic, anti-oxidative, anti-inflammatory, immunomodulatory, anti-hyperlipidemic, anti-hypertensive, anti-cancer, and combination treatment applications, both as a functional food and as medicine. Full article

Chlorinated organic compounds, as contaminants in marine fuels, have caused severe damage, affecting both main and auxiliary engines. Contaminated fuels can cause serious damage to an engine and its components, corroding fuel pumps and blocking filters, for example. This affects the operation of the engine, and, in the most severe cases, vessel safety. This study considered fossil diesel containing hydrochloric acid as a possible product formed under certain conditions in fuel contaminated with COCs and its effects on carbon steel, stainless steel, tempering steel, and aluminum. Five fuel samples with different concentrations of hydrochloric acid were prepared, plus one sample of diesel and water. Metal bars were partially immersed in the fuel samples and stored at room temperature for approximately one month. A visual assessment found corrosion across the entire surface of all metal bars when exposed to fuel samples containing hydrochloric acid. Even the smallest acid content (25 ppm) caused corrosion, and the effects were already observable after only two days of exposure. Despite their acid contamination, the measured fuel properties fulfilled the standard for automotive fuels at the beginning of the test. The water in the diesel sample did not cause any visible corrosion. Full article

Acute pancreatitis (AP) is characterized by elevated intracellular Ca²⁺ concentrations, mitochondrial dysfunction, and oxidative stress in pancreatic acinar cells. Algal oil (AO) has demonstrated antioxidant and anti-inflammatory properties. This study aims to explore the effects of algal oil on the microenvironment of AP. Rat pancreatic acinar AR42J cells were pretreated with AO containing 0, 50, 100, or 150 μM of docosahexaenoic acid (DHA) 2 h prior to AP induction using sodium taurocholate (STC). After 1 h of STC treatment, AR42J cells exhibited a significant increase in intracellular Ca²⁺ concentration and the production of amylase, lipase, reactive oxygen species, and pro-inflammatory mediators, including tumor necrosis factor-α and interleukin-6. These STC-induced increases were markedly reduced in cells pretreated with AO. In comparison to cells without AO, those treated with a high dose of AO before STC exposure demonstrated a significant increase in mitochondrial membrane potential and a decrease in lipid peroxidation. Furthermore, STC-activated nuclear factor kappa-B (NF-κB) was attenuated in AO-pretreated cells, as evidenced by a significant decrease in activated NF-κB. In conclusion, AO may prevent damage to pancreatic acinar cells by alleviating intracellular Ca²⁺ overload, mitigating mitochondrial dysfunction, reducing oxidative stress, and attenuating NF-κB-targeted inflammation. Full article

Two-stage reverse osmosis (RO) processes with intermediate concentrate demineralization (ICD) provide an efficient strategy to treat brines with high CaSO₄ contents and reduce concentrate discharge. In this paper, an SRO concentrate is treated using ICD to remove CaSO₄ and then mixed with a PRO concentrate for further desalination in SRO, thereby reducing the discharge of the concentrate. We investigate the selection and degradation of scale inhibitors, as well as seeded precipitation in the two-stage RO process with ICD, to achieve a high water recovery rate. A scale inhibitor is added to restrain CaSO₄ crystallization on the membrane surface, and the optimized scale inhibitor, RO-400, is found to inhibit calcium sulfate scaling effectively across a wide range of the saturation index of gypsum (SIg) from 2.3 to 6. Under the optimized parameters of 40 W UV light and 70 mg/L H₂O₂, UV/H₂O₂ can degrade RO-400 completely in 15 min to destroy the scale inhibitor in the SRO concentrate. After scale inhibitor degradation, the SRO concentrate is desaturated by seeded precipitation, and the reaction degree of CaSO₄ reaches 97.12%, leading to a concentrate with a low SIg (1.07) for cyclic desalination. Three UVD-GSP cycle tests show that the reused gypsum seeds can also ensure the effect of the CaSO₄ precipitation process. This paper provides a combined UVD-GSP strategy in two-stage RO processes to improve the water recovery rate for CaSO₄-contained concentrate. Full article

We analysed the licences issued by British local government authorities under the Dangerous Wild Animals Act 1976, which regulates the private keeping of wild animals categorised as “dangerous”, to assess the scope and scale of private keeping of dangerous wild animals in Great Britain. Results are compared with historical data from England and Wales, showing that there has been an overall decrease both in the total population of dangerous wild animals privately kept under licence and the number of licences, resulting primarily from a decrease in the farming of wild boar and ostrich, and from certain other species no longer requiring a licence to be kept. Nonetheless, the private keeping of dangerous wild animals remains prevalent, with a total population of 3950 animals kept under licence, and at least one-third of local authorities in Britain licensing keepers of one or more such animals. The population of non-farmed dangerous taxa has increased by 59% in 20 years, with notable increases in crocodilians (198%), venomous snakes (94%), and wild cats (57%). We present evidence that the average cost of a licence to keep dangerous wild animals has fallen over time, and that there is a negative association between cost and licensing. The current schedule of species categorised as dangerous is compared to a formally recognised list of species kept in zoos assessed by risk to the public. Problems with the legislation, enforcement of the licensing system, and animal welfare for privately kept dangerous wild animals are identified and discussed. Full article

Clinicians often use endoscopic ultrasonography to survey pancreatic tumors. When endoscopists conduct this examination and find the tumor to be unresectable, a fine-needle biopsy is subsequently performed for tissue confirmation. However, if the tumor is deemed resectable, the necessity of a pre-operative fine-needle biopsy remains debatable. Therefore, we performed a retrospective analysis of a single-center cohort of patients with pancreatic tumors who underwent an endoscopic ultrasound-guided fine-needle biopsy or aspiration (EUS-FNB or FNA) between 2020 and 2022. This study focused on patients diagnosed with resectable malignant pancreatic tumors. The exclusion criteria included individuals diagnosed with benign pancreatic lesions and those with unresectable tumors. A total of 68 patients were enrolled in this study. Histological examination revealed that pancreatic adenocarcinoma was the predominant type of tumor (n = 42, 61.8%), followed by neuroendocrine tumors (n = 22, 32.3%), and metastasis (n = 4, 5.9%). Notably, 17 patients had a history of other cancers, with 23.5% being diagnosed with a metastatic tumor rather than primary pancreatic cancer. Therefore, EUS-FNA/FNB is crucial in patients with a resectable pancreatic tumor and a history of cancer to differentiate between a primary and a metastatic tumor. Full article