Surgical management of Zollinger-Ellison syndrome: Classical considerations and current controversies

Zollinger-Ellison syndrome(ZES)is characterized by gastric acid hypersecretion causing severe recurrent acid-related peptic disease.Excessive secretion of gastrin can now be effectively controlled with powerful proton pump inhibitors,but surgical management to control gastrinoma itself remains controversial.Based on a thorough literature review,we design a surgical algorithm for ZES and list some significant consensus findings and recommendations:(1)For sporadic ZES,surgery should be routinely undertaken as early as possible not only for patients with a precisely localized diagnosis but also for those with negative imaging findings.The surgical approach for sporadic ZES depends on the lesion location(including the duodenum,pancreas,lymph nodes,hepatobiliary tract,stomach,and some extremely rare sites such as the ovaries,heart,omentum,and jejunum).Intraoperative liver exploration and lymphadenectomy should be routinely performed;(2)For multiple endocrine neoplasia type 1-related ZES(MEN1/ZES),surgery should not be performed routinely except for lesions>2 cm.An attempt to perform radical resection(pancreaticoduodenectomy followed by lymphadenectomy)can be made.The ameliorating effect of parathyroid surgery should be considered,and parathyroidectomy should be performed first before any abdominal surgery for ZES;and(3)For hepatic metastatic disease,hepatic resection should be routinely performed.Currently,liver transplantation is still considered an investigational therapeutic approach for ZES.Well-designed prospective studies are desperately needed to further verify and modify the current considerations.

Progress in Fluorene-based Wide-bandgap Steric Semiconductors

Molecular bulks are favorable for the thermal and morphological stability in organic wide-bandgap semiconducting polymers with potential applications in both information and energy electronics. In this review, we present our progress in the design of fluorene-based bulky semiconductors with a fractal four-element pattern. Firstly, we established one-pot methods to spirofluorenes, especially spiro[fluorene-9,9＇-xanthene] （SFX） serving as the next-generation spiro-based semiconductors. Secondly, we observed the supramolecular forces at the bulky groups and discovered the supramolecular steric hindrance （SSH） effect on polymorphisms, nanocrystals as well as device performance. Thus, a synergistically molecular attractor-repulsor theory （SMART） was proposed for the control of nanocrystal morphology, thin film phase and morphology. Thirdly, the third possible type of defects has been identified to generate green band （g-band） emission in wide- bandgap semiconductors by the introduction of molecular strain design of cyclofluorene. Finally, the first bulky polydiarylfluorene with highly crystalline and β conformation was achieved by an attractor-repulsor design of tadpole-shape monomer, which offered an effective platform to fabricate stable wide-bandgap semiconducting devices. All the discoveries offer the solid basis to break through bottlenecks of organic/polymer wide-bandgap semiconductors by the improvements of overall performances.