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Management of Pancreatic Cystic Lesions.

胰腺囊性病变的处理。

  • 影响因子:1.94
  • DOI:10.1159/000496509
  • 作者列表:"Perri G","Marchegiani G","Frigerio I","Dervenis CG","Conlon KC","Bassi C","Salvia R
  • 发表时间:2020-01-01
Abstract

BACKGROUND:The prevalence of undefined pancreatic cystic neoplasms (PCNs) is high in the general population, increasing with patient age. PCNs account for different biological entities with different potential for malignant transformation. The clinician must balance his or her practice between the risk of surgical overtreatment and the error of keeping a malignant lesion under surveillance. METHODS:We review and discuss the clinical management of PCNs. Specifically, we analyze the main features of PCNs from the surgeon's point of view, as they present in the outpatient clinic. We also review the different consensus guidelines, address recent controversies in the literature, and present the current clinical practice at 4 different European Centers for pancreatic surgery. RESULTS:The main features of PCNs were analyzed from the surgeon's point of view as they present in the outpatient clinic. All aspects of surgical management were discussed, from indications for surgery to intraoperative management and surveillance strategies. CONCLUSIONS:Management of PCNs requires a selective approach with the aim of minimizing clinically relevant diagnostic mistakes. Through the evaluation of clinical and radiological features of a PCN, the surgeon can elaborate on a diagnostic hypothesis and assess malignancy risk, but the final decision should be tailored to the individual patient's need.

摘要

背景: 非特异性胰腺囊性肿瘤 (PCNs) 在普通人群中的患病率较高,随着患者年龄的增长而增加。PCNs解释了具有不同恶性转化潜力的不同生物实体。临床医生必须在手术过度治疗的风险和将恶性病变保持在监视下的错误之间平衡他或她的实践。 方法: 回顾并讨论PCNs的临床管理。具体来说,我们从外科医生的角度分析了PCNs的主要特征,因为它们存在于门诊中。我们还回顾了不同的共识指南,解决了最近文献中的争议,并介绍了4个不同欧洲胰腺外科中心的当前临床实践。 结果: 从外科医生的角度分析了PCNs在门诊中存在的主要特征。讨论了手术管理的各个方面,从手术指征到术中管理和监测策略。 结论: PCNs的管理需要选择性的方法,目的是最大限度地减少临床相关的诊断错误。通过对PCN的临床和放射学特征的评估,外科医生可以详细阐述诊断假设并评估恶性肿瘤风险,但最终的决定应根据个体患者的需要进行调整。

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DOI:10.1097/MCD.0000000000000272
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影响因子:2.42
发表时间:2020-02-01
DOI:10.1007/s12011-019-01715-5
作者列表:["Heidar Z","Hamzepour N","Zadeh Modarres S","Mirzamoradi M","Aghadavod E","Pourhanifeh MH","Asemi Z"]

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影响因子:2.42
发表时间:2020-02-01
DOI:10.1007/s12011-019-01720-8
作者列表:["Jamilian M","Foroozanfard F","Kavossian E","Kia M","Aghadavod E","Amirani E","Asemi Z"]

METHODS::The primary aim of our study was to determine the influence of taking chromium plus carnitine on insulin resistance, with a secondary objective of evaluating the influences on lipid profiles and weight loss in overweight subjects with polycystic ovary syndrome (PCOS). In a 12-week randomized, double-blind, placebo-controlled clinical trial, 54 overweight women were randomly assigned to receive either supplements (200 μg/day chromium picolinate plus 1000 mg/day carnitine) or placebo (27/each group). Chromium and carnitine co-supplementation decreased weight (- 3.6 ± 1.8 vs. - 1.0 ± 0.7 kg, P < 0.001), BMI (- 1.3 ± 0.7 vs. - 0.3 ± 0.3 kg/m2, P < 0.001), fasting plasma glucose (FPG) (- 5.1 ± 6.0 vs. - 1.1 ± 4.9 mg/dL, P = 0.01), insulin (- 2.0 ± 1.4 vs. - 0.2 ± 1.2 μIU/mL, P < 0.001), insulin resistance (- 0.5 ± 0.4 vs. - 0.04 ± 0.3, P < 0.001), triglycerides (- 18.0 ± 25.2 vs. + 5.5 ± 14.4 mg/dL, P < 0.001), total (- 17.0 ± 20.3 vs. + 3.6 ± 12.0 mg/dL, P < 0.001), and LDL cholesterol (- 13.3 ± 19.2 vs. + 1.4 ± 13.3 mg/dL, P = 0.002), and elevated insulin sensitivity (+ 0.007 ± 0.005 vs. + 0.002 ± 0.005, P < 0.001). In addition, co-supplementation upregulated peroxisome proliferator-activated receptor gamma (P = 0.02) and low-density lipoprotein receptor expression (P = 0.02). Overall, chromium and carnitine co-supplementation for 12 weeks to overweight women with PCOS had beneficial effects on body weight, glycemic control, lipid profiles except HDL cholesterol levels, and gene expression of PPAR-γ and LDLR. Clinical trial registration number: http://www.irct.ir: IRCT20170513033941N38.

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囊肿方向

囊肿是一种良性疾病,它可以长在人体表面,也可以长在内脏里;囊肿就是长在体内某一脏器、囊状的良性包块,其内容物的性质是液态的。

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