Diabetes and insulinoma represent opposing alterations in pancreatic β-cell mass,with diabetes resulting from irreversible β-cells damage and insulinoma arising from abnormal proliferation.Early diagnosis of both co...Diabetes and insulinoma represent opposing alterations in pancreatic β-cell mass,with diabetes resulting from irreversible β-cells damage and insulinoma arising from abnormal proliferation.Early diagnosis of both conditions necessitates effectiveβ-cell mass detection.Current detection methods are limited in diagnosing each condition individually or lacking timely and accurate detection.Diabetes is typically identified only after significantβ-cell loss,while insulinoma can evade conventional imaging due to their small size.Positron emission tomography/computed tomography(PET/CT)imaging,combining anatomical and functional data,enhances diagnostic accuracy but faces challenges in specificity.This study employed two RNA aptamers(m12–3773 and 1–717)modified to enhance RNase resistance and conjugated with68Ga to create ^(68)Ga-NOTA-Ap.^(68)Ga-NOTA-Ap was administered to rats with pancreaticβ-cell damage and mice with insulinoma to evaluate its ability to image islets,detect changes in pancreatic β-cell mass(BCM),and identify insulinoma.Modified with methoxy and fluoro,RNA aptamers exhibited enhanced stability and RNases resistance while retaining their dissociation constants(K_(d)).Furthermore,^(68)Ga-NOTA-Ap effectively detected changes of BCM in rats with pancreatic β-cell damage and imaged insulinoma in mice through recognition of abnormalβ-cell proliferation by recognizing clusterin and transmembrane p24 trafficking protein 6(TMED6)on pancreaticβ-cell.The developed ^(68)Ga-NOTA-Ap shows promise for early screening of diabetes and insulinoma due to its high sensitivity,specificity,and non-invasive nature.It has potential clinical applications for monitoring pancreatic β-cell function and diagnosing insulinoma.展开更多
Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:...Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.展开更多
Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplem...Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively,and analyzed the therapeutic effects of the RCS intervention on blood glucose control,weight change,and its adverse events.Results The study population consisted of 24 cases of insulinoma patients,7 males and 17 females,aged 46.08±14.15 years.Before RCS-supplemented diet,all patients had frequent hypoglycemic episodes(2.51±3.88 times/week),concurrent with neuroglycopenia(in 83.3% of patients)and autonomic manifestations(in 75.0% of patients),with the median fasting blood glucose(FBG)of 2.70(interquartile range[IQR]:2.50-2.90)mmol/L.The patients'weight increased by 0.38(IQR:0.05-0.65)kg per month,with 8(33.3%)cases developing overweight and 7(29.2%)cases developing obesity.All patients maintained the RCS-supplemented diet until they underwent tumor resection(23 cases)and transarterial chemoembolization for liver metastases(1 case).For 19 patients receiving RCS throughout the day,the median FBG within one week of nutritional management was 4.30(IQR:3.30-5.70)mmol/L,which was a significant increase compared to pre-nutritional level[2.25(IQR:1.60-2.90)mmol/L;P<0.001].Of them,10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment[3.20(IQR:2.60-3.95)mmol/L vs.2.15(IQR:1.83-2.33)mmol/L;P<0.001].Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management[3.50(IQR:2.50-3.65)mmol/L vs.2.20(IQR:1.80-2.60)mmol/L;P<0.001],but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG.No improvement in weight gain was observed upon RCS supplementation.Mild diarrhea(2 cases)and flatulence(1 case)occurred,and were relieved by reduction of RCS dose.Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.展开更多
基金supported by National Natural Science Foundation of China(No.82002241)National Key Research and Development Program of China(No.2020YFA0909000)“Clinic Plus”Outstanding Project(No.2024ZY012)from Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine。
文摘Diabetes and insulinoma represent opposing alterations in pancreatic β-cell mass,with diabetes resulting from irreversible β-cells damage and insulinoma arising from abnormal proliferation.Early diagnosis of both conditions necessitates effectiveβ-cell mass detection.Current detection methods are limited in diagnosing each condition individually or lacking timely and accurate detection.Diabetes is typically identified only after significantβ-cell loss,while insulinoma can evade conventional imaging due to their small size.Positron emission tomography/computed tomography(PET/CT)imaging,combining anatomical and functional data,enhances diagnostic accuracy but faces challenges in specificity.This study employed two RNA aptamers(m12–3773 and 1–717)modified to enhance RNase resistance and conjugated with68Ga to create ^(68)Ga-NOTA-Ap.^(68)Ga-NOTA-Ap was administered to rats with pancreaticβ-cell damage and mice with insulinoma to evaluate its ability to image islets,detect changes in pancreatic β-cell mass(BCM),and identify insulinoma.Modified with methoxy and fluoro,RNA aptamers exhibited enhanced stability and RNases resistance while retaining their dissociation constants(K_(d)).Furthermore,^(68)Ga-NOTA-Ap effectively detected changes of BCM in rats with pancreatic β-cell damage and imaged insulinoma in mice through recognition of abnormalβ-cell proliferation by recognizing clusterin and transmembrane p24 trafficking protein 6(TMED6)on pancreaticβ-cell.The developed ^(68)Ga-NOTA-Ap shows promise for early screening of diabetes and insulinoma due to its high sensitivity,specificity,and non-invasive nature.It has potential clinical applications for monitoring pancreatic β-cell function and diagnosing insulinoma.
文摘Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.
基金supported by the National High Level Hospital Clinical Research Fund(2022-PUMCH-A-146)the National Natural Science Foundation of China(72074222)the Na-tional Key Research and Development Program of China(2020YFC2005005).
文摘Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively,and analyzed the therapeutic effects of the RCS intervention on blood glucose control,weight change,and its adverse events.Results The study population consisted of 24 cases of insulinoma patients,7 males and 17 females,aged 46.08±14.15 years.Before RCS-supplemented diet,all patients had frequent hypoglycemic episodes(2.51±3.88 times/week),concurrent with neuroglycopenia(in 83.3% of patients)and autonomic manifestations(in 75.0% of patients),with the median fasting blood glucose(FBG)of 2.70(interquartile range[IQR]:2.50-2.90)mmol/L.The patients'weight increased by 0.38(IQR:0.05-0.65)kg per month,with 8(33.3%)cases developing overweight and 7(29.2%)cases developing obesity.All patients maintained the RCS-supplemented diet until they underwent tumor resection(23 cases)and transarterial chemoembolization for liver metastases(1 case).For 19 patients receiving RCS throughout the day,the median FBG within one week of nutritional management was 4.30(IQR:3.30-5.70)mmol/L,which was a significant increase compared to pre-nutritional level[2.25(IQR:1.60-2.90)mmol/L;P<0.001].Of them,10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment[3.20(IQR:2.60-3.95)mmol/L vs.2.15(IQR:1.83-2.33)mmol/L;P<0.001].Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management[3.50(IQR:2.50-3.65)mmol/L vs.2.20(IQR:1.80-2.60)mmol/L;P<0.001],but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG.No improvement in weight gain was observed upon RCS supplementation.Mild diarrhea(2 cases)and flatulence(1 case)occurred,and were relieved by reduction of RCS dose.Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.
