Pancreatic neuroendocrine tumors(PNETs) are a rare and diverse group of tumors; nonfunctional(NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentatio...Pancreatic neuroendocrine tumors(PNETs) are a rare and diverse group of tumors; nonfunctional(NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentation. A variety of treatment modalities exist, including medical, liver directed, and surgical treatments. Aggressive surgical management is associated with prolonged survival, however available data are limited by selection bias and the frequent combination of PNETs with carcinoid tumors. Although few patients with metastatic disease will be cured, application of currently available therapies in a multidisciplinary setting can lead to excellent outcomes with prolonged patient survival.展开更多
As the pancreas only occupies a small region in the whole abdominal computed tomography(CT)scans and has high variability in shape,location and size,deep neural networks in automatic pancreas segmentation task can be ...As the pancreas only occupies a small region in the whole abdominal computed tomography(CT)scans and has high variability in shape,location and size,deep neural networks in automatic pancreas segmentation task can be easily confused by the complex and variable background.To alleviate these issues,this paper proposes a novel pancreas segmentation optimization based on the coarse-to-fine structure,in which the coarse stage is responsible for increasing the proportion of the target region in the input image through the minimum bounding box,and the fine is for improving the accuracy of pancreas segmentation by enhancing the data diversity and by introducing a new segmentation model,and reducing the running time by adding a total weights constraint.This optimization is evaluated on the public pancreas segmentation dataset and achieves 87.87%average Dice-Sørensen coefficient(DSC)accuracy,which is 0.94%higher than 86.93%,result of the state-of-the-art pancreas segmentation methods.Moreover,this method has strong generalization that it can be easily applied to other coarse-to-fine or one step organ segmentation tasks.展开更多
AIM:To evaluate the effects of disease severity and necrosis on organ dysfunctions in acute pancreatitis(AP).METHODS:One hundred and nine patients treated as AP between March 2003 and September 2007 with at least 6 mo...AIM:To evaluate the effects of disease severity and necrosis on organ dysfunctions in acute pancreatitis(AP).METHODS:One hundred and nine patients treated as AP between March 2003 and September 2007 with at least 6 mo follow-up were included.Patients were classified according to severity of the disease,necrosis ratio and localization.Subjective clinical evaluation and fecal pancreatic elastase-Ⅰ(FPE-Ⅰ)were used for exocrine dysfunction evaluation,and oral glucose tolerance test was completed for endocrine dysfunction.The correlation of disease severity,necrosis ratio and localization with exocrine and endocrine dysfunction were investigated.RESULTS:There were 58 male and 51 female patients,and mean age was 56.5±15.7.Of the patients,35.8%had severe AP(SAP)and 27.5%had pancreatic necrosis.Exocrine dysfunction was identified in 13.7%of the patients[17.9%were in SAP,11.4%were in mild AP(MAP)]and 34.7%of all of the patients had endocrine dysfunction(56.4%in SAP and 23.2%in MAP).In patients with SAP and necrotizing AP(NAP),FPE-Ⅰlevels were lower than the others(P<0.05 and0.001 respectively)and in patients having pancreatic head necrosis or near total necrosis,FPE-1 levels were lower than 200μg/g stool.Forty percent of the patients who had undergone necrosectomy developed exocrine dysfunction.Endocrine dysfunction was more significant in patients with SAP and NAP(P<0.001).All of the patients in the necrosectomy group had endocrine dysfunction.CONCLUSION:Patients with SAP,NAP,pancreatic head necrosis and necrosectomy should be followed for pancreatic functions.展开更多
Objective:To mainly explore the effect of thalidomide combined with CHOP chemotherapy regimen on immunoglobulin,VEGF,lactate dehydrogenase,inflammatory factors and other related factors in patients with diffuse large ...Objective:To mainly explore the effect of thalidomide combined with CHOP chemotherapy regimen on immunoglobulin,VEGF,lactate dehydrogenase,inflammatory factors and other related factors in patients with diffuse large B-cell lymphoma.Methods:A total of 83 patients with diffuse large B-cell lymphoma admitted to the Department of Hematology and Oncology in our hospital from December 2012 to December 2018 were collected.CHOP chemotherapy was given to 40 patients in the chemotherapy group.And 43 patients in the thalidomide group were treated with thalidomide combined with CHOP chemotherapy.Immunoglobulin IgG,IgA,IgM,vascular endothelial growth factor(VEGF),tumor necrosis factor(TNF-α),lactate dehydrogenase(LDH),β2 microglobulin(β2-MG),Th17 cell ratio and natural killer cell(NK)ratio were measured before and after treatment.Results:There were no significant differences in immunoglobulin,inflammatory cytokines and other related factors between the two groups before treatment(P>0.05).After 6 cycles of treatment,the levels of immunoglobulin IgG,IgA,IgM,VEGF,LDH,β2-MG and the ratio of NK cells in the chemotherapy group were significantly lower than those before treatment(P<0.05);TNF-αand the ratio of Th17 cells were significantly higher than that those before treatment.The levels of IgG,IgA,IgM,VEGF,LDH andβ2-MG in the thalidomide group were significantly lower than those before treatment(P<0.05).The levels of TNF-α,Th17 cells and NK cell rates were significantly higher than those before treatment(P<0.05).In addition,the levels of IgG,IgA,IgM,VEGF,LDH andβ2-MG in the thalidomide group were significantly lower than those in the chemotherapy group(P<0.05),and the level of TNF-α,the rates of Th17 cells and NK cells were significantly higher than those in the chemotherapy group(P<0.05).Conclusion:Thalidomide combined with CHOP chemotherapy has a significant therapeutic effect on diffuse large B-cell lymphoma.Thalidomide combined with CHOP chemotherapy can significantly reduce the levels of angiogenesis VEGF,lactate dehydrogenase andβ2-MG in patients,significantly regulate the immune function of patients,and improve the Th17 cell rate and natural killer cell rate and the level of TNF-αin the body.This article provides the basis for the treatment of clinical diffuse large B cell lymphoma.展开更多
Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex...Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex nature and pathophysiological behaviour,surgical management continues to evolve.Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours,while lymphadenectomy remains a controversial subject.Different techniques,such as pancreas-preserving and minimally invasive approaches,continue to evolve and offer the same overall outcomes as open surgery.This comprehensive review describes in detail the current and most up-todate classification and staging of pancreatic neuroendocrine tumours,explores the rationale for nonsurgical and surgical management,and focuses on surgical treatment and more specifically,on minimally invasive approaches.展开更多
Type 2 diabetes(T2D)is a multifactorial metabolic disorder affecting more than 450 million people across the globe.With the increasing prevalence of T2D and obesity,the role of fat accumulation at sites other than sub...Type 2 diabetes(T2D)is a multifactorial metabolic disorder affecting more than 450 million people across the globe.With the increasing prevalence of T2D and obesity,the role of fat accumulation at sites other than subcutaneous adipose tissue has received significant attention in the pathophysiology of T2D.Over the past decade and a half,a pressing concern has emerged on investigating the association of pancreatic fat accumulation or pancreatic steatosis with the development of disease.While a few reports have suggested a possible association between pancreatic fat and T2D and/or impaired glucose metabolism,a few reports suggest a lack of such association.Pancreatic fat has also been linked with genetic risk of developing T2D,prediabetes,reduced insulin secretion,and beta cell dysfunction albeit some confounding factors such as age and ethnicity may affect the outcome.With the technological advancements in clinical imaging and progress in assessment of pancreatic beta cell function,our understanding of the role of pancreatic fat in causing insulin resistance and development of various etiologies of T2D has significantly improved.This review summarizes various findings on the possible association of pancreatic fat accumulation with the pathophysiology of T2D.展开更多
Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetu...Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.展开更多
文摘Pancreatic neuroendocrine tumors(PNETs) are a rare and diverse group of tumors; nonfunctional(NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentation. A variety of treatment modalities exist, including medical, liver directed, and surgical treatments. Aggressive surgical management is associated with prolonged survival, however available data are limited by selection bias and the frequent combination of PNETs with carcinoid tumors. Although few patients with metastatic disease will be cured, application of currently available therapies in a multidisciplinary setting can lead to excellent outcomes with prolonged patient survival.
基金supported by the National Natural Science Foundation of China[61772242,61976106,61572239]the China Postdoctoral Science Foundation[2017M611737]+3 种基金the Six Talent Peaks Project in Jiangsu Province[DZXX-122]the Jiangsu Province EmergencyManagement Science and Technology Project[YJGL-TG-2020-8]the Key Research and Development Plan of Zhenjiang City[SH2020011]Postgraduate Innovation Fund of Jiangsu Province[KYCX18_2257].
文摘As the pancreas only occupies a small region in the whole abdominal computed tomography(CT)scans and has high variability in shape,location and size,deep neural networks in automatic pancreas segmentation task can be easily confused by the complex and variable background.To alleviate these issues,this paper proposes a novel pancreas segmentation optimization based on the coarse-to-fine structure,in which the coarse stage is responsible for increasing the proportion of the target region in the input image through the minimum bounding box,and the fine is for improving the accuracy of pancreas segmentation by enhancing the data diversity and by introducing a new segmentation model,and reducing the running time by adding a total weights constraint.This optimization is evaluated on the public pancreas segmentation dataset and achieves 87.87%average Dice-Sørensen coefficient(DSC)accuracy,which is 0.94%higher than 86.93%,result of the state-of-the-art pancreas segmentation methods.Moreover,this method has strong generalization that it can be easily applied to other coarse-to-fine or one step organ segmentation tasks.
基金Supported by Uludag University Resources Committee
文摘AIM:To evaluate the effects of disease severity and necrosis on organ dysfunctions in acute pancreatitis(AP).METHODS:One hundred and nine patients treated as AP between March 2003 and September 2007 with at least 6 mo follow-up were included.Patients were classified according to severity of the disease,necrosis ratio and localization.Subjective clinical evaluation and fecal pancreatic elastase-Ⅰ(FPE-Ⅰ)were used for exocrine dysfunction evaluation,and oral glucose tolerance test was completed for endocrine dysfunction.The correlation of disease severity,necrosis ratio and localization with exocrine and endocrine dysfunction were investigated.RESULTS:There were 58 male and 51 female patients,and mean age was 56.5±15.7.Of the patients,35.8%had severe AP(SAP)and 27.5%had pancreatic necrosis.Exocrine dysfunction was identified in 13.7%of the patients[17.9%were in SAP,11.4%were in mild AP(MAP)]and 34.7%of all of the patients had endocrine dysfunction(56.4%in SAP and 23.2%in MAP).In patients with SAP and necrotizing AP(NAP),FPE-Ⅰlevels were lower than the others(P<0.05 and0.001 respectively)and in patients having pancreatic head necrosis or near total necrosis,FPE-1 levels were lower than 200μg/g stool.Forty percent of the patients who had undergone necrosectomy developed exocrine dysfunction.Endocrine dysfunction was more significant in patients with SAP and NAP(P<0.001).All of the patients in the necrosectomy group had endocrine dysfunction.CONCLUSION:Patients with SAP,NAP,pancreatic head necrosis and necrosectomy should be followed for pancreatic functions.
基金This study was supported by the China International Medical Exchange Foundation(Grant No.Z-2014-06-19405).
文摘Objective:To mainly explore the effect of thalidomide combined with CHOP chemotherapy regimen on immunoglobulin,VEGF,lactate dehydrogenase,inflammatory factors and other related factors in patients with diffuse large B-cell lymphoma.Methods:A total of 83 patients with diffuse large B-cell lymphoma admitted to the Department of Hematology and Oncology in our hospital from December 2012 to December 2018 were collected.CHOP chemotherapy was given to 40 patients in the chemotherapy group.And 43 patients in the thalidomide group were treated with thalidomide combined with CHOP chemotherapy.Immunoglobulin IgG,IgA,IgM,vascular endothelial growth factor(VEGF),tumor necrosis factor(TNF-α),lactate dehydrogenase(LDH),β2 microglobulin(β2-MG),Th17 cell ratio and natural killer cell(NK)ratio were measured before and after treatment.Results:There were no significant differences in immunoglobulin,inflammatory cytokines and other related factors between the two groups before treatment(P>0.05).After 6 cycles of treatment,the levels of immunoglobulin IgG,IgA,IgM,VEGF,LDH,β2-MG and the ratio of NK cells in the chemotherapy group were significantly lower than those before treatment(P<0.05);TNF-αand the ratio of Th17 cells were significantly higher than that those before treatment.The levels of IgG,IgA,IgM,VEGF,LDH andβ2-MG in the thalidomide group were significantly lower than those before treatment(P<0.05).The levels of TNF-α,Th17 cells and NK cell rates were significantly higher than those before treatment(P<0.05).In addition,the levels of IgG,IgA,IgM,VEGF,LDH andβ2-MG in the thalidomide group were significantly lower than those in the chemotherapy group(P<0.05),and the level of TNF-α,the rates of Th17 cells and NK cells were significantly higher than those in the chemotherapy group(P<0.05).Conclusion:Thalidomide combined with CHOP chemotherapy has a significant therapeutic effect on diffuse large B-cell lymphoma.Thalidomide combined with CHOP chemotherapy can significantly reduce the levels of angiogenesis VEGF,lactate dehydrogenase andβ2-MG in patients,significantly regulate the immune function of patients,and improve the Th17 cell rate and natural killer cell rate and the level of TNF-αin the body.This article provides the basis for the treatment of clinical diffuse large B cell lymphoma.
文摘Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex nature and pathophysiological behaviour,surgical management continues to evolve.Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours,while lymphadenectomy remains a controversial subject.Different techniques,such as pancreas-preserving and minimally invasive approaches,continue to evolve and offer the same overall outcomes as open surgery.This comprehensive review describes in detail the current and most up-todate classification and staging of pancreatic neuroendocrine tumours,explores the rationale for nonsurgical and surgical management,and focuses on surgical treatment and more specifically,on minimally invasive approaches.
文摘Type 2 diabetes(T2D)is a multifactorial metabolic disorder affecting more than 450 million people across the globe.With the increasing prevalence of T2D and obesity,the role of fat accumulation at sites other than subcutaneous adipose tissue has received significant attention in the pathophysiology of T2D.Over the past decade and a half,a pressing concern has emerged on investigating the association of pancreatic fat accumulation or pancreatic steatosis with the development of disease.While a few reports have suggested a possible association between pancreatic fat and T2D and/or impaired glucose metabolism,a few reports suggest a lack of such association.Pancreatic fat has also been linked with genetic risk of developing T2D,prediabetes,reduced insulin secretion,and beta cell dysfunction albeit some confounding factors such as age and ethnicity may affect the outcome.With the technological advancements in clinical imaging and progress in assessment of pancreatic beta cell function,our understanding of the role of pancreatic fat in causing insulin resistance and development of various etiologies of T2D has significantly improved.This review summarizes various findings on the possible association of pancreatic fat accumulation with the pathophysiology of T2D.
基金supported by the National Key R&D Program of China (grant no.2019YFC1005105).
文摘Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.
