Survey on the current status of the diagnosis and treatment of pancreatic cancer in public tertiary hospitals in China:a cross-sectional questionnaire-based,observational study

Objective:Pancreatic cancer is one of the most aggressive digestive system malignant tumors,and its clinical diagnosis and treatment are still challenging.To further understand the current status and improve the multidisciplinary collaboration for diagnosis and treatment of pancreatic cancer in China,we conducted an online questionnaire survey on the diagnosis and treatment status of pancreatic cancer in public tertiary hospitals of China in 2021.Methods:In this cross-sectional questionnaire-based,observational study,online questionnaires with real-name authentication were used to gather data from 500 clinicians,50 pharmacists,and 1000 pancreatic cancer patients in tertiary general hospitals or cancer hospitals nationwide.Results:A total of 485 valid questionnaires were obtained from the clinicians,majority of whom were from economically better developed regions or cities of China.There were multi-disciplinary team treatment(MDT)clinics for pancreatic cancer patients in 60%of the hospitals.Minimally invasive surgeries could be performed in all the surveyed hospitals.However,open surgery was still the mainstream choice in most cases.Gemcitabine-based chemotherapy was the most popular first-line adjuvant regimen for pancreatic cancer.A total of 50 valid questionnaires were collected from pharmacists,48%of them are not satisfactory with the efficacy of the chemotherapeutic drugs,and myelosuppression,liver,and renal damage were the most concerning side effects.In total,1011 valid questionnaires were collected from the patients.Approximately,48.4%of the patients did not know about pancreatic cancer before becoming ill.Over 80%of pancreatic cancer patients reported poor to very poor health-related quality of life,and the estimated overall medical expenses were within<400,000($58823.53)in 80%of the patients.Clinicians,pharmacists,and patients believe that popularizing scientific knowledge of pancreatic cancer,constructing MDT clinics and fast-lane system,and conducting clinical research will help further improve the diagnosis and treatment of pancreatic cancer.Conclusions:The MDT clinics for pancreatic cancer have been well developed in most of the public tertiary hospitals.Minimally invasive pancreatic surgery has developed rapidly in China;however,open surgery is still the mainstream choice for pancreatic cancer.The proportion of adjuvant treatment has been significantly improved,and the gemcitabine-based regimen is the most commonly used first-line regimen.Most of the public still lacks the general knowledge of pancreatic cancer,needing further popularization.The construction of a fast-lane treatment system and conducting of high-level clinical studies are the warm expectations of the clinicians and patients.The real-world situation of the diagnosis and treatment of pancreatic cancer in the other types of hospitals of China needs further exploration.

Reconstruction of phytoplankton productivity and community structure in the South Yellow Sea

The sedimentary environment and ecological system in the South Yellow Sea (SYS) changed dramatically due to sea level change caused by glacial-interglacial cycles. The authors report the use of marine biomarkers (brassicasterol, dinosterol and C37 alkenones) and terrigenous biomarkers (C28+C30+C32 nalkanols) in core DLC70-3 from the SYS to reconstruct the variation in the phytoplankton productivity and community structure and possible mechanisms during the middle Pleistocene. The results show that the primary productivity and that of single algae presented a consistent trend for the whole core during the middle Pleistocene, which was high during interglacial periods and low during glacial periods, with the highest being in marine isotope stage (MIS) 5–9 and MIS 19–21. The main reason is that the Yellow Sea Warm Current (YSWC) carried much of high temperature, high salinity water into the SYS, causing upwelling and vertical mixing and stirring, which increased the nutrient supply in the photosynthetic layer. The phytoplankton community structure mainly showed an increase in the relative content of haptophytes in MIS 5–9 and MIS 19–21, while the relative content of diatoms and dinoflagellates decreased;there was no evidence for a haptophyte content in other stages. The results reveal a shift from a coccolitho-phoriddominated community during MIS 5 –9 and MIS 19 –21 to a diatom-dominated community during the other stages, mainly as a result of surface salinity variation, attributed to the invasion of the YSWC during high sea level periods.