简介：AbstractEndoscopic drainage of pancreatic fluid collections (PFCs) with fewer complications and less trauma has gradually replaced surgery or percutaneous drainage to become the first-line treatment for PFCs. In recent years, the differential efficacy of various stent techniques to drain different types of PFCs has been controversial. This review summarizes the clinical applications of endoscopic ultrasound-guided stent placement for PFCs drainage.

简介：TherevisedAtlantaclassificationofacutepancreatitiswasadoptedbyinternationalconsensus,andisbasedonactuallocalandsystemicdeterminantsofdiseaseseverity.Thelocaldeterminantispancreaticnecrosis(sterileorinfected),andthesystemicdeterminantisorganfailure.Localcomplicationsofpancreatitiscanincludeacuteperi-pancreaticfluidcollection,acutenecroticcollection,pseudocystformation,andwalledoffnecrosis.Interventionalendoscopicultrasound(EUS)hasbeenincreasingutilizedinmanagingtheselocalcomplications.AfterperformingaPubMedsearch,theauthorsmanuallyappliedpre-definedinclusioncriteriaorafiltertoidentifypublicationsrelevanttoEUSandpancreaticcollections(PFCs).Theauthorsthenreviewedtheutility,efficacy,andrisksassociatedwithusingtherapeuticEUSandinvolvedEUSdevicesintreatingPFCs.Duetothedevelopmentandregulatoryapprovalofimprovedandnovelendoscopicdevicesspecificallydesignedfortransmuraldrainageoffluidandnecroticdebris(accessandpatencydevices),theauthorspredictcontinuingevolutioninthemanagementofPFCs.WebelievethatEUSwillbecomeanindispensablepartofproceduresusedtodiagnosePFCsandperformimage-guidedinterventions.AfterdrainingaPFC,theamountoftissuenecrosisisthemostimportantpredictorofasuccessfuloutcome.Hence,itseemslogicaltoclassifythesecollectionsbasedontheirpercentageofnecroticcomponentordebrispresentwhenviewedbyimagingmethodsorEUS.Finally,theauthorsproposeanalgorithmformanagingfluidcollectionsbasedontheirsize,location,associatedsymptoms,internalechogenicpatterns,andcontent.

简介：我们在第6单元了解了收集水晶球的Ellen，她收集的水晶球摆满了一屋子。你有什么课余爱好呢？你也有收藏品吗？看，Lauren也喜欢收集，不过，其爱好有些特别。我们来看看吧!

简介：Inearly2009,IhadthechancetovisitsixJapaneseuniversitylibrariesormuseums,whichhouse15cuneiformtablets,sevenroyalinscriptionsandonecylinderseal.MostofthemseemtohavebeenacquiredfromsomeJapanese

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简介：AbstractDiabetes mellitus and pancreatic ductal adenocarcinoma are two common diseases worldwidely which are both derived from different components of pancreas. The pancreatic and duodenal homeobox-1 (PDX1) is an essential transcription factor for the early development of pancreas that is required for the differentiation of all pancreatic cell lineages. Current evidence suggests an important role of PDX1 in both the origin and progression of pancreatic diseases. In this review, we discussed recent studies of PDX1 in diabetes mellitus and pancreatic cancer, and the therapeutic strategies derived from this transcription factor.

简介：DearEditor,Bomb-radiocarbonanalysisofmoderncarbonhasbeenappliedinmanyfieldsofecology.Themethodallowsde-terrniningtheresidencetimeofcarboninphotosyntheticproductsandthusaUorganicmatterinecosystems.Theatmospheric14Csignaturewillsoondropbelowthepre-bomblevelduetofixationofatmosphericcarboninter-restrialandmarineecosystemsandhighratesoflac-freefossilfuelcombustion.Hence,thetimeisrunningoutforbomb-radiocarbonapplication.Insectcollectionsshelteranimmensequantityofspecimensstoredinalcohol.Weshowhowthosespecimenscanbeusedforexploringthetrophicstructureoffoodwebsbycomparingtheirisotopicradiocarbonsignature.

简介：AbstractPancreatic cancer is an aggressive malignancy with a high recurrence rate even after curative-intent resection. Improvements in survival have not been achieved in the last 25 years thus highlighting the need for effective multimodal treatment strategies. The role of radiation therapy for pancreatic cancer remains ill-defined due to historical lack of a standard definition of resectability, and the use of antiquated radiation delivery techniques and chemotherapy regimens. Current level I data regarding neoadjuvant chemoradiotherapy for resectable and borderline resectable pancreatic adenocarcinoma (PDAC) are limited to 2 randomized controlled trials and several retrospective studies and suggest that it may lead to an increased likelihood of a margin-negative resection and certainly allows for improved patient selection for pancreaticoduodenectomy when compared to upfront surgery. In the adjuvant setting, data are similarly lacking but suggest that chemoradiotherapy may be beneficial for patients at high risk of locoregional recurrence. Here we review existing data regarding the role of radiation in PDAC.

简介：Treatmentofpancreaticcancerismultimodalandsurgeryisanessentialpart,mandatoryforcurativepotential.Alsochemotherapyisessential,andseriouspostoperativecomplicationsorrapiddiseaseprogressionmayprecludecompletionofmultimodaltreatment.Thesequenceoftreatmentinterventionshasthereforebecomeanimportantconcern,andnumerousongoingrandomizedcontrolledtrialscompareclinicaloutcomeafterupfrontsurgeryandneoadjuvanttreatmentwithsubsequentresection.Inpreviousyears,borderlineresectableandlocallyadvancedpancreaticcancerwasmostoftenconsideredunresectable.Moreeffectivechemotherapytogetherwiththelatestimprovementsinsurgicalexpertisehasresultedinextendedoperations,pushingthebordersofresectability.Multivisceralresectionswithorwithoutresectionofmajormesen-tericvesselsarenowperformedinnumerouspatients,resultinginbetteroutcome,recordedasoverallsurvivaland/orpatientreportedoutcome.Butpostoperativemorbidityincreasesconcurrently,andclinicalbenefitmustbecarefullyevaluatedagainstriskofpotentialharm,associatedwithnewcomprehensivemultimodaltreatmentsequences.Eventhoughcost/utilityanalysesaredeficient,extendedsurgeryhasresultedinsignifi-cantlylongerandbetterlifeformanypatientswithnoothertreatmentalternative.Improvedselectionofpatientstosurgeryand/orchemotherapywillinthenearfuturebepossible,basedonbettertumorbiologyinsight.Clinicallyavailablebiomarkersenablingpersonalizedtreatmentareforthcoming,buttheseoptionsarestilllimited.Theimportanceofsurgicalresectionforeachpatient’sprognosisispresentlyincreasing,justifyingsustainedexpansionofthesurgicaltreatmentmodality.

简介：胰腺的癌症继续是有仍然高的死亡和差的幸存的致命的恶意。尽管有重要进展，很少进步在理解，诊断，和常规、新奇的治疗的存取在先进胰腺的癌症的治疗上被取得了。损害的分子的病理是我们位于这癌症的发展下面的机制的理解的钥匙并且将可能在更早的诊断和更好治疗学的结果帮助我们。新治疗策略和创新治疗的更小心的评估清楚地为这疾病被需要。鉴于许多调查结果，胰腺的癌症应该被认为是全身的疾病，并且在最后几年，调查者获得了导致恶意的发展的分子的生物学和事件的更好的理解。我们这里在在胰腺的癌症的为通常变异的基因的全身的探索考察新奇开发。

简介：AbstractPancreatic ductal adenocarcinoma (PDAC) is a lethal, aggressive, and incurable disease. The patients with PDAC are often diagnosed at the advanced stage, leading to poor overall survival because of no current effective treatment. Further exploration of the mechanism is needed urgently to provide insights on the prevention, detection, or intervention of pancreatic cancer. Oncogenic KRAS and mutated tumor suppressor genes serve essential roles in PDAC tumorigenesis. Different groups of scientists indicated that yes-associated protein and transcriptional coactivator with PDZ-binding motif, which are the main effectors of the Hippo pathway, are the center in the development of PDAC. Here, we will focus on the recent advances of the molecular mechanisms of core components in the Hippo kinases cascade and discuss their clinical implications.

简介：AbstractBackground:It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed.Methods:Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion.Results:Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84-1.00, P < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46-2.78) mmHg/mL to 1.83 (1.34-2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59-0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33-0.67, P = 0.086).Conclusion:In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness. Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness.Trial registration:ClinicalTrials.gov, NCT04515511

简介：Abundantfluid-meltinclusionsarefoundintheaegirine-augite-baritepegmatiteandcarbonatiteveinsintheMianningREEdeposit,Sichuan,Theyweretrappedinearlystagefluoriteandquartzfromasalt-meltsystemattemperatureshigherthan5000℃,Meanwhile,fluidinclusionsarealsopresentinalrgeamountsinbastnaesite.Homogenizedbetween150and270℃,theseinclusionsarethoughttoberepresentativeofthephysico-chemicalconditionsofREEmineralization.TheseresultsshowthattheMianningREEdepositisoftypicalhydrothermalorigindevelopedfromasalt-meltsystem.

简介：AbstractPancreatic cancer is one of the most aggressive malignancies. The poor prognosis of pancreatic cancer patients is mainly attributed to low diagnostic rate at the early stage, highly aggressive nature coupled with the inadequate efficacy of current chemotherapeutic regimens. Novel therapeutic strategies are urgently needed for pancreatic cancer. MicroRNAs (miRNAs) play an important regulatory role in key processes of cancer development. The aberrant expression of miRNAs is often involved in the initiation, progression, and metastasis of pancreatic cancer. The discovery of tumor suppressor miRNAs provides prospects for the development of a novel treatment strategy for pancreatic cancer. We reviewed recent progress on the understanding of the role of miRNAs in pancreatic cancer, highlighted the efficient application of miRNAs-based therapies for pancreatic cancer in animal models and clinical trials, and proposed future prospects. This review focuses on the promise of integrating miRNAs into the treatment of pancreatic cancer and provides guidance for the development of precision medicine for pancreatic cancer.

简介：AbstractThe management of pancreatic cancer has dramatically changed since the first major randomized trial published in 2001 by the European Study Group for Pancreatic Cancer (ESPAC) stimulated the development of multimodality oncosurgical therapies. ESPAC-1 demonstrated a survival improvement from upfront surgery of only 8%, increasing to 21% 5-year survival for 5-fluorouracil/folinic acid but only 10.8% for chemoradiotherapy. ESPAC-4 has shown a 5-year survival rate of 30% for all patients without restriction of 30% using a combination of gemcitabine and capecitabine, rising to 40% in those with an R0 resection margin, or nearly 50% in those with N0 lymph node status. In selected patients with favorable prognostic features mFOLFIRINOX can produce a 50% 5-year survival rate but with added toxicity. While a positive resection margin is associated with an increased likelihood of local recurrence, this of itself is not the contributor to reduced survival, but rather reflects the increased probability of systemic disease. Thus, strategies aimed at local control, may reduce subsequent local progression, but will not improve overall survival. Neoadjuvant chemotherapy is increasingly utilized in cases of borderline resectable or locally advanced pancreatic cancer, but there is still a lack of proof of concept studies. High-quality evidence from randomized controlled trials to identify the indications and benefits of neoadjuvant therapy in pancreatic cancer are required. The use of patient-derived tumor organoids may predict response to chemotherapy which could open a new opportunity in pancreatic cancer treatment, stratifying patients into treatment groups based on their response to these therapies in the laboratory.

简介：作为高度恶意的癌症和在世界上的癌症相关的死亡的第四个原因，胰腺的癌症被忧郁的预后描绘，由于到化疗的快速的疾病前进，高度侵略的瘤显型，和抵抗。尽管有在疾病的治疗的重要进展在过去的十年期间，幸存率几乎没被改进。到差的结果的一个贡献因素是为早诊断的适当敏感、特定的biomarkers的缺乏。而且，为指向，指导并且估计治疗学的干预，以及为剩余或周期性的癌症的察觉的biomarkers也被需要。因此，在胰腺的癌症的足够的biomarkers的鉴定具有极端重要性。最近，伴随proteomic技术和设备的发展，越来越潜在的biomarkers出现了并且被报导。在这评论，我们在胰腺的癌症提供基于proteome的biomarkers的角色的概述，包括织物，浆液，果汁，尿和房间线。我们以后也讨论可能的机制和前景。那个信息可能希望对这块地里的进一步的研究有用。

简介：Laminarheattransferproblemisanalyzedforadiskrotatingwiththeangularspeedωinaco-rotatingfluid(withtheangularspeedΩ).Thefluidisswirledinaccordancewithaforced-vortexlaw,itrotatesasasolidbodyatβ=Ω/ω=const.Radialvariationofthedisk’ssurfacetemperaturefollowsapowerlaw.Anexactnumericalsolutionoftheproblemisobtainedbasingontheself-similarprofilesofthelocaltemperatureoffluid,itsstaticpressureandvelocitycomponents.NumericalcomputationsweredoneatthePrandtlnumbersPr=1(?)0.71.Itisshownthatwithincreasingβbothradialandtangentialcomponentsofshearstressesdecrease,andtozerovalueatβ=1.Nusseltnumberispracticallyconstantatβ=0(?)0.3(andevenhasapointofamaximuminthisregion);Nudecreasenoticeablyforlargerβvalues.

简介：AbstractPancreatic ductal adenocarcinoma is the main cause of cancer-related mortality, with a lack of effective treatments and overall survival rates far lower than other solid cancers. This clinical challenge is related to late diagnosis as well as primary or acquired resistance to therapy-induced apoptosis. Targeting nonapoptotic cell death pathways may provide alternative therapeutic strategies to overcome drug resistance. In particular, recent studies have suggested that ferroptosis, a type of iron-dependent nonapoptotic cell death, is a promising target for pancreatic ductal adenocarcinoma. Ferroptosis can be triggered by inhibiting or activating the redox or iron metabolism-related pathways, mediated by extrinsic/membrane transports (e.g., solute carrier family 7 member 11) or intrinsic/enzymes (e.g., glutathione peroxidase 4). Although the exact effector molecule remains obscure, reactive oxygen species-induced lipid peroxidation and subsequent plasma membrane damage appears to play a central role in mediating ferroptotic death. While treatment-induced ferroptosis is beneficial to suppress tumor growth, inflammation-related immunosuppression caused by ferroptotic damage may promote the occurrence of pancreatic ductal adenocarcinoma. In this review, we outline the latest knowledge about the regulation and function of ferroptosis in pancreatic tumorigenesis and therapy.

简介：AbstractThe 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.

简介：AbstractPancreatic neuroendocrine tumors (pNET) are heterogenous tumors originated from the diffuse neuroendocrine cells of pancreas, which show the function of synthesis, storage and secretion of peptide hormones and biomimetic amines. Biomarkers play a crucial role in the diagnosing, evaluating prognosis and predicting treatment response for pNET patients. Traditional NET markers such as chromogranin A and Neuron Specific Enolase, as a diagnostic biomarker, have relatively low sensitivity and specificity in pNET patients. The emergence of new types of biomarkers provides more reliable indicators for diagnosis and prognosis evaluation. Among them, NETest score is a promising biomarker with the highest diagnostic sensitivity (80%) and specificity (94%). In addition, this molecule can be also used as a prognostic biomarker, which can predict disease progression and shorter overall survival. Biomarkers related to therapeutic targets, such as vascular endothelial growth factor, vascular endothelial growth factor receptor, and key molecules of mTOR signaling pathway, have capability to predict response of treatment. With the development of next-generation sequencing, chip array, and digital droplet PCR, novel biomarkers such as circulating tumor cells, tumor-derived exosomes, and circulating tumor DNA and mRNA are expected to provide more accurate diagnosis, prognostic information, and prospective therapeutic targets. In this paper, biomarkers of pancreatic neuroendocrine tumor and their role in diagnosis, prognosis, diagnosis, treatment and monitoring are systematically introduced. Our conclusions can provide new basis for clinicians in the diagnosis and treatment process.