Primary immune thrombocytopenia(ITP) is an immunemediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for IT...Primary immune thrombocytopenia(ITP) is an immunemediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for ITP, but only 20%-40% of cases achieve a stable response. Splenectomy is the main therapy for patients failing to respond to corticosteroids for decades, and about two-thirds of patients achieve a long-lasting response. Although some new drugs are developed to treat ITP as second-line therapies in recent years, splenectomy is still the better choice with less cost and more efficiency. Laparoscopic splenectomy(LS) for ITP proves to be a safe technique associated with lower morbidity and faster recovery and similar hematological response when compared to traditional open splenectomy. Based on the unified hematological outcome criteria by current international consensus, the response rate of splenectomy should be reassessed. So far, there are not widely accepted preoperative clinical indicators predicting favorable response to LS. Since the patients undergoing surgery take the risk of complications and poor hematological outcome, the great challenge facing the doctors is to identify a reliable biomarker for predicting longterm outcome of splenectomy which can help make the decision of operation.展开更多
Background and objective:The value of debulking surgery for unresectable well-differentiated metastatic pancreatic neuroendocrine tumor(m-PNET)remains poorly defined.This study aimed to evaluate the outcomes of m-PNET...Background and objective:The value of debulking surgery for unresectable well-differentiated metastatic pancreatic neuroendocrine tumor(m-PNET)remains poorly defined.This study aimed to evaluate the outcomes of m-PNET following debulking surgery in our institute.Methods:Patients with well-differentiated m-PNET in our hospital between February 2014 and March 2022 were collected.Clinicopathological and long-term outcomes of patients treated with radical resection,debulking surgery,and conservative therapy were compared retrospectively.Results:Fifty-three patients with well-differentiated m-PNET were reviewed,including 47 patients with unresectable m-PNET(debulking surgery,25;conservative therapy,22)and 6 patients with resectable m-PNET(radical resection).Patients undergoing debulking surgery had a post-operative Clavien–DindoIII complication rate of 16.0%without mortality.The 5-year overall survival(OS)rate of patients treated with debulking surgery was significantly higher than that of those treated with conservative therapy alone(87.5%vs 37.8%,log-rank P=0.022).Besides,the 5-year OS rate of patients treated with debulking surgery was comparable to that of patients with resectable m-PNET undergoing radical resection(87.5%vs 100%,log-rank P=0.724).Conclusions:Patients with unresectable well-differentiated m-PNET who underwent resection had better long-term outcomes than those who received conservative therapy alone.The 5-year OS of patients undergoing debulking surgery and radical resection were comparable.Debulking surgery could be considered for patients with unresectable well-differentiated m-PNET if no contraindication exists.展开更多
Background:Robotic-assisted pancreatoduodenectomy(RPD)has been routinely performed in a few of centers worldwide.This study aimed to evaluate the perioperative outcomes and the learning curves of resection and reconst...Background:Robotic-assisted pancreatoduodenectomy(RPD)has been routinely performed in a few of centers worldwide.This study aimed to evaluate the perioperative outcomes and the learning curves of resection and reconstruction procedures in RPD by one single surgeon.Methods:Consecutive patients undergoing RPD by a single surgeon at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between July 2016 and October 2022 were included.The perioperative outcomes and learning curves were retrospectively analysed by using cumulative sum(CUSUM)analyses.Results:One-hundred and sixty patients were included.According to the CUSUM curve,the times of resection and reconstruction procedures were shortened significantly after 30 cases(median,284 vs 195 min;P<0.001)and 45 cases(median,138 vs 120 min;P<0.001),respectively.The estimated intraoperative blood loss(median,100 vs 50 mL;P<0.001)and the incidence of clinically relevant post-operative pancreatic fistula(29.2%vs 12.5%;P=0.035)decreased significantly after 20 and 120 cases,respectively.There were no significant differences in the total number of lymph nodes examined,post-operative major complications,or post-operative length-of-stay between the two groups.Conclusions:Optimization of the resection procedure and the acquisition of visual feedback facilitated the performance of RPD.RPD was a safe and feasible procedure in the selected patients.展开更多
Background:The application of robotic-assisted radical resection in perihilar cholangiocarcinoma(pCCA)remains poorly defined.This study aimed to evaluate the safety and efficacy of robotic-assisted radical resection f...Background:The application of robotic-assisted radical resection in perihilar cholangiocarcinoma(pCCA)remains poorly defined.This study aimed to evaluate the safety and efficacy of robotic-assisted radical resection for pCCA in our institute.Methods:Between July 2017 and July 2022,pCCA patients undergoing robotic-assisted and open radical resection at First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)were included.The short-term outcomes were compared by using propensity-scored matching(PSM)analysis.Results:Eighty-six pCCA patients were enrolled.After PSM at a ratio of 1:2,10 and 20 patients were assigned to the roboticassisted and open groups,respectively.There were no significant disparities in the clinicopathological features between the two groups.The robotic-assisted group had significantly longer operation time(median:548 vs 353 min,P=0.004)and larger total number of lymph nodes examined(median:11 vs 5,P=0.010)than the open group.The robotic-assisted group tended to have a lower intraoperative blood loss(median:125 vs 350 mL,P=0.067),blood transfusion rates(30.0%vs 70.0%,P=0.056),and post-operative overall morbidities(30.0%vs 70.0%,P=0.056)than the open group,even though the differences were not statistically significant.There were no significant differences in the negative resection margin,post-operative major morbidities,or post-operative length-of-stay between the robotic-assisted and open groups(all P>0.05).Conclusions:Robotic-assisted radical resection of pCCA may get a larger total number of lymph nodes examined than open surgery.Provided robotic-assisted surgery may be a feasible and safe technique for selected pCCA patients.展开更多
In clinical practice,pancreatic neuroendocrine neoplasms(pNENs)with a diameter smaller than 2 cm are commonly referred to as small pNENs.Due to their generally favorable biological characteristics,the diagnosis and tr...In clinical practice,pancreatic neuroendocrine neoplasms(pNENs)with a diameter smaller than 2 cm are commonly referred to as small pNENs.Due to their generally favorable biological characteristics,the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial.In response to this,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs,which is based on evidence-based medicine and expert opinions.This consensus covers various topics,including concepts,disease assessment,treatment selection,follow-up,and other relevant aspects.展开更多
Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role...Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.展开更多
Background The feasibility of spleen-preserving distal pancreatectomy(SPDP)to treat well-differentiated non-functioning pancreatic neuroendocrine tumors(NF-pNETs)located at the body and/or tail of the pancreas remains...Background The feasibility of spleen-preserving distal pancreatectomy(SPDP)to treat well-differentiated non-functioning pancreatic neuroendocrine tumors(NF-pNETs)located at the body and/or tail of the pancreas remains controversial.Distal pancreatectomy with splenectomy(DPS)has been widely applied in the treatment of NF-pNETs;however,it may increase the post-operative morbidities.This study aimed to evaluate whether SPDP is inferior to DPS in post-operative outcomes and survivals when being used to treat patients with NF-pNETs in our institute.Methods Clinicopathological features of patients with NF-pNETs who underwent curative SPDP or DPS at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2010 and January 2022 were collected.Short-term outcomes and 5-year survivals were compared between patients undergoing SPDP and those undergoing DPS.Results Sixty-three patients(SPDP,27;DPS,36)with well-differentiated NF-pNETs were enrolled.All patients had grade 1/2 tumors.After identifying patients with T1–T2 NF-pNETs(SPDP,27;DPS,15),there was no disparity between the SPDP and DPS groups except for tumor size(median,1.4 vs 2.6 cm,P=0.001).There were no differences in operation time(median,250 vs 295 min,P=0.478),intraoperative blood loss(median,50 vs 100 mL,P=0.145),post-operative major complications(3.7%vs 13.3%,P=0.287),clinically relevant post-operative pancreatic fistula(22.2%vs 6.7%,P=0.390),or post-operative hospital stays(median,9 vs 9 days,P=0.750)between the SPDP and DPS groups.Kaplan–Meier curve showed no significant differences in the 5-year overall survival rate(100%vs 100%,log-rank P>0.999)or recurrence-free survival(100%vs 100%,log-rank P>0.999)between patients with T1–T2 NF-pNETs undergoing SPDP and those undergoing DPS.Conclusions In patients with T1–T2 well-differentiated NF-pNETs,SPDP could achieve comparable post-operative outcomes and prognosis compared with DPS.展开更多
Background Pyroptosis is an emerging form of programmed cell death associated with progression in malignancies.Yet,there are few studies reporting on the association between pancreatic ductal adenocarcinoma(PDAC)and p...Background Pyroptosis is an emerging form of programmed cell death associated with progression in malignancies.Yet,there are few studies reporting on the association between pancreatic ductal adenocarcinoma(PDAC)and pyroptosis.Therefore,we aimed to construct a pyroptosis-related genetic signature to predict the clinical outcome and immune status in PDAC patients.Methods RNA-seq data of 176 PDAC patients from The Cancer Genome Atlas(TCGA)and 167 PDAC patients from the Genotype-Tissue Expression Project were analysed for pyroptosis-related differentially expressed genes(DEGs)between PDAC and normal pancreas.The risk signature of DEGs was analysed using the least absolute shrinkage and selection operator(LASSO)Cox regression analysis and its accuracy was validated in the Gene Expression Omnibus(GEO)cohort(n=190).Functional enrichment analyses were performed to explore the mechanisms of the DEGs.The immune characteristics were evaluated using single-sample gene set enrichment analysis and ESTIMATE algorithms for each group.Results A nine-gene risk signature was generated from LASSO Cox regression analysis and classified PDAC patients into either a high-or low-risk group according to the median risk score.The high-risk group had significantly shorter overall survival than the low-risk group and it was verified in the external GEO database.A nomogrambased on the risk signature was constructed and showed an ideal prediction performance.Functional enrichment analyses revealed that pyroptosis might regulate the tumor immune microenvironment in PDAC.Immune infiltration evaluation suggested that immune status was more activated in the low-risk group than in the high-risk group.Conclusion The risk signature encompassing nine pyroptosis-related genes may be a prognostic marker for PDAC.Pyroptosis might affect the prognosis of PDAC patients via regulating the tumor immune microenvironment.展开更多
The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreat...The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.展开更多
One 42-year-old female suffered from recurrent weakness and diarrhea for 2 years.She had a history of thyroidectomy and patent foramen ovale.At her local hospital,she was diagnosed and treated as transient ischemic at...One 42-year-old female suffered from recurrent weakness and diarrhea for 2 years.She had a history of thyroidectomy and patent foramen ovale.At her local hospital,she was diagnosed and treated as transient ischemic attack,however her symptoms were not relieved and she was eventually referred to our hospital.Laboratory test showed that the fasting serum gastrin(>1,000.0 ng/L;normal:28.1-106.5 ng/L),the insulin(7.54μU/mL;normal:1.9-23.0μU/mL),C-peptide(1.92 nmol/L;normal:0.4-1.7 nmol/L),and isolated parathyroid hormone(214.3 pg/mL;normal:12.0-88.0 pg/mL)were elevated,while the fasting serum glucose(2.0 mmol/L;normal:3.9-7.8 mmol/L)was decreased.展开更多
基金Supported by Science and Technique Project of Guangdong Province,No.2012B031800284
文摘Primary immune thrombocytopenia(ITP) is an immunemediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for ITP, but only 20%-40% of cases achieve a stable response. Splenectomy is the main therapy for patients failing to respond to corticosteroids for decades, and about two-thirds of patients achieve a long-lasting response. Although some new drugs are developed to treat ITP as second-line therapies in recent years, splenectomy is still the better choice with less cost and more efficiency. Laparoscopic splenectomy(LS) for ITP proves to be a safe technique associated with lower morbidity and faster recovery and similar hematological response when compared to traditional open splenectomy. Based on the unified hematological outcome criteria by current international consensus, the response rate of splenectomy should be reassessed. So far, there are not widely accepted preoperative clinical indicators predicting favorable response to LS. Since the patients undergoing surgery take the risk of complications and poor hematological outcome, the great challenge facing the doctors is to identify a reliable biomarker for predicting longterm outcome of splenectomy which can help make the decision of operation.
文摘Background and objective:The value of debulking surgery for unresectable well-differentiated metastatic pancreatic neuroendocrine tumor(m-PNET)remains poorly defined.This study aimed to evaluate the outcomes of m-PNET following debulking surgery in our institute.Methods:Patients with well-differentiated m-PNET in our hospital between February 2014 and March 2022 were collected.Clinicopathological and long-term outcomes of patients treated with radical resection,debulking surgery,and conservative therapy were compared retrospectively.Results:Fifty-three patients with well-differentiated m-PNET were reviewed,including 47 patients with unresectable m-PNET(debulking surgery,25;conservative therapy,22)and 6 patients with resectable m-PNET(radical resection).Patients undergoing debulking surgery had a post-operative Clavien–DindoIII complication rate of 16.0%without mortality.The 5-year overall survival(OS)rate of patients treated with debulking surgery was significantly higher than that of those treated with conservative therapy alone(87.5%vs 37.8%,log-rank P=0.022).Besides,the 5-year OS rate of patients treated with debulking surgery was comparable to that of patients with resectable m-PNET undergoing radical resection(87.5%vs 100%,log-rank P=0.724).Conclusions:Patients with unresectable well-differentiated m-PNET who underwent resection had better long-term outcomes than those who received conservative therapy alone.The 5-year OS of patients undergoing debulking surgery and radical resection were comparable.Debulking surgery could be considered for patients with unresectable well-differentiated m-PNET if no contraindication exists.
基金supported by the National Natural Science Foundation of China[no.82203105].
文摘Background:Robotic-assisted pancreatoduodenectomy(RPD)has been routinely performed in a few of centers worldwide.This study aimed to evaluate the perioperative outcomes and the learning curves of resection and reconstruction procedures in RPD by one single surgeon.Methods:Consecutive patients undergoing RPD by a single surgeon at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between July 2016 and October 2022 were included.The perioperative outcomes and learning curves were retrospectively analysed by using cumulative sum(CUSUM)analyses.Results:One-hundred and sixty patients were included.According to the CUSUM curve,the times of resection and reconstruction procedures were shortened significantly after 30 cases(median,284 vs 195 min;P<0.001)and 45 cases(median,138 vs 120 min;P<0.001),respectively.The estimated intraoperative blood loss(median,100 vs 50 mL;P<0.001)and the incidence of clinically relevant post-operative pancreatic fistula(29.2%vs 12.5%;P=0.035)decreased significantly after 20 and 120 cases,respectively.There were no significant differences in the total number of lymph nodes examined,post-operative major complications,or post-operative length-of-stay between the two groups.Conclusions:Optimization of the resection procedure and the acquisition of visual feedback facilitated the performance of RPD.RPD was a safe and feasible procedure in the selected patients.
文摘Background:The application of robotic-assisted radical resection in perihilar cholangiocarcinoma(pCCA)remains poorly defined.This study aimed to evaluate the safety and efficacy of robotic-assisted radical resection for pCCA in our institute.Methods:Between July 2017 and July 2022,pCCA patients undergoing robotic-assisted and open radical resection at First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)were included.The short-term outcomes were compared by using propensity-scored matching(PSM)analysis.Results:Eighty-six pCCA patients were enrolled.After PSM at a ratio of 1:2,10 and 20 patients were assigned to the roboticassisted and open groups,respectively.There were no significant disparities in the clinicopathological features between the two groups.The robotic-assisted group had significantly longer operation time(median:548 vs 353 min,P=0.004)and larger total number of lymph nodes examined(median:11 vs 5,P=0.010)than the open group.The robotic-assisted group tended to have a lower intraoperative blood loss(median:125 vs 350 mL,P=0.067),blood transfusion rates(30.0%vs 70.0%,P=0.056),and post-operative overall morbidities(30.0%vs 70.0%,P=0.056)than the open group,even though the differences were not statistically significant.There were no significant differences in the negative resection margin,post-operative major morbidities,or post-operative length-of-stay between the robotic-assisted and open groups(all P>0.05).Conclusions:Robotic-assisted radical resection of pCCA may get a larger total number of lymph nodes examined than open surgery.Provided robotic-assisted surgery may be a feasible and safe technique for selected pCCA patients.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)2021-I2M-1-002.
文摘In clinical practice,pancreatic neuroendocrine neoplasms(pNENs)with a diameter smaller than 2 cm are commonly referred to as small pNENs.Due to their generally favorable biological characteristics,the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial.In response to this,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs,which is based on evidence-based medicine and expert opinions.This consensus covers various topics,including concepts,disease assessment,treatment selection,follow-up,and other relevant aspects.
基金supported by the National Natural Science Foundation of China[No.81772522]the China Postdoctoral Science Foundation[No.2018M643327]the China Postdoctoral Science Foundation[No.2018M643325].
文摘Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.
文摘Background The feasibility of spleen-preserving distal pancreatectomy(SPDP)to treat well-differentiated non-functioning pancreatic neuroendocrine tumors(NF-pNETs)located at the body and/or tail of the pancreas remains controversial.Distal pancreatectomy with splenectomy(DPS)has been widely applied in the treatment of NF-pNETs;however,it may increase the post-operative morbidities.This study aimed to evaluate whether SPDP is inferior to DPS in post-operative outcomes and survivals when being used to treat patients with NF-pNETs in our institute.Methods Clinicopathological features of patients with NF-pNETs who underwent curative SPDP or DPS at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2010 and January 2022 were collected.Short-term outcomes and 5-year survivals were compared between patients undergoing SPDP and those undergoing DPS.Results Sixty-three patients(SPDP,27;DPS,36)with well-differentiated NF-pNETs were enrolled.All patients had grade 1/2 tumors.After identifying patients with T1–T2 NF-pNETs(SPDP,27;DPS,15),there was no disparity between the SPDP and DPS groups except for tumor size(median,1.4 vs 2.6 cm,P=0.001).There were no differences in operation time(median,250 vs 295 min,P=0.478),intraoperative blood loss(median,50 vs 100 mL,P=0.145),post-operative major complications(3.7%vs 13.3%,P=0.287),clinically relevant post-operative pancreatic fistula(22.2%vs 6.7%,P=0.390),or post-operative hospital stays(median,9 vs 9 days,P=0.750)between the SPDP and DPS groups.Kaplan–Meier curve showed no significant differences in the 5-year overall survival rate(100%vs 100%,log-rank P>0.999)or recurrence-free survival(100%vs 100%,log-rank P>0.999)between patients with T1–T2 NF-pNETs undergoing SPDP and those undergoing DPS.Conclusions In patients with T1–T2 well-differentiated NF-pNETs,SPDP could achieve comparable post-operative outcomes and prognosis compared with DPS.
基金supported by the National Natural Science Foundation of China[grant no.82072644,no.81772522].
文摘Background Pyroptosis is an emerging form of programmed cell death associated with progression in malignancies.Yet,there are few studies reporting on the association between pancreatic ductal adenocarcinoma(PDAC)and pyroptosis.Therefore,we aimed to construct a pyroptosis-related genetic signature to predict the clinical outcome and immune status in PDAC patients.Methods RNA-seq data of 176 PDAC patients from The Cancer Genome Atlas(TCGA)and 167 PDAC patients from the Genotype-Tissue Expression Project were analysed for pyroptosis-related differentially expressed genes(DEGs)between PDAC and normal pancreas.The risk signature of DEGs was analysed using the least absolute shrinkage and selection operator(LASSO)Cox regression analysis and its accuracy was validated in the Gene Expression Omnibus(GEO)cohort(n=190).Functional enrichment analyses were performed to explore the mechanisms of the DEGs.The immune characteristics were evaluated using single-sample gene set enrichment analysis and ESTIMATE algorithms for each group.Results A nine-gene risk signature was generated from LASSO Cox regression analysis and classified PDAC patients into either a high-or low-risk group according to the median risk score.The high-risk group had significantly shorter overall survival than the low-risk group and it was verified in the external GEO database.A nomogrambased on the risk signature was constructed and showed an ideal prediction performance.Functional enrichment analyses revealed that pyroptosis might regulate the tumor immune microenvironment in PDAC.Immune infiltration evaluation suggested that immune status was more activated in the low-risk group than in the high-risk group.Conclusion The risk signature encompassing nine pyroptosis-related genes may be a prognostic marker for PDAC.Pyroptosis might affect the prognosis of PDAC patients via regulating the tumor immune microenvironment.
文摘The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.
文摘One 42-year-old female suffered from recurrent weakness and diarrhea for 2 years.She had a history of thyroidectomy and patent foramen ovale.At her local hospital,she was diagnosed and treated as transient ischemic attack,however her symptoms were not relieved and she was eventually referred to our hospital.Laboratory test showed that the fasting serum gastrin(>1,000.0 ng/L;normal:28.1-106.5 ng/L),the insulin(7.54μU/mL;normal:1.9-23.0μU/mL),C-peptide(1.92 nmol/L;normal:0.4-1.7 nmol/L),and isolated parathyroid hormone(214.3 pg/mL;normal:12.0-88.0 pg/mL)were elevated,while the fasting serum glucose(2.0 mmol/L;normal:3.9-7.8 mmol/L)was decreased.
