Int. J. Med. Sci. 2010, 7 http://www.medsci.org 309 IInntteerrnnaattiioonnaall JJoouurrnnaall ooff MMeeddiiccaall SScciieenncceess 2010; 7(5):309-313 © Ivyspring International Publisher. All rights reserved Research Paper Clinical Strategy for the Management of Solid Pseudopapillary Tumor of the Pancreas: Aggressive or Less? Hong Chang1, Yi Gong2, Jian Xu1, Zhongxue Su1, Chengkun Qin1, Zhenhai Zhang1 1. Department of General Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan Shandong, China; 2. Department of Rehabilitation, Shandong Provincial Hospital affiliated to Shandong University, Jinan Shandong, China. Corresponding author: Hong Chang, Department of General Surgery, Shandong Provincial Hospital, Shandong Univer -sity, 324, Jing5Wei7 Road, Jinan Shandong, China. Tel: 531-85186363. Email: changhong@sdu.edu.cn Received: 2010.05.14; Accepted: 2010.08.27; Published: 2010.09.01 Abstract Objective: To further delineate the clinicopathological and radiological features of solid pseudopapillary tumor (SPT) of the pancreas and s u m m a r i z e t h e s u r g i c a l t h e r a p y s t r a t e g y f o r t h i s t u m o r . M e t h o d s : A r e t r o s p e c t i v e r e v i e w o f 1 8 p a t h o l o g i c a l l y c o n f i r m e d c a s e s o f S P T w a s performed and the clinical and pathological features, radiological findings and surgical inter-ventions were analyzed. Results: The patients included 17 females and 1 male with a median age of 23 years. The median diameter of the lesions was 8.0 cm. Abdominal pain was the predominant complaint (8/18). The rest of the patients were asymptomatic and presented with a pancreatic mass detected incidentally. Radiological study revealed a well-demarcated mass which was composed of a solid-cystic portion. On post-contrast CT, the solid portions could be enhanced whereas the cystic parts remained unenhanced. With the preoperative diagnosis of SPT in 11 patients and pancreatic cyst, benign or malignant pancreatic tumor in the rest, pancreatic tumor resection was successfully completed. Surgical exploration findings, pathological characteristics and good prognosis of the patients with SPT, indicated its low-grade malignant potential. Conclusion: In combination with clinical findings, radiological features of SPT may help to make the correct diagnosis and differentiation from other pan-creatic neoplasms. Once diagnosed, given the excellent prognosis and low-grade malignancy, less aggressive surgical resection of the primary lesion is proposed. Key words: Diagnosis, Pancreas, Solid pseudopapillary tumor, Surgery Introduction Solid Pseudopapillary T um o r (SPT) of the pan-creas is a very rare entity with a reported incidence of 0.13% to 2.7% of all pancreatic tumors,1 whi ch w as once described in many other terms, such as Frantz’s tumor, solid and cystic tumor, papillary cy st ic neop -lasm, a n d solid and papillary epithelial neo p l a s m .2 From 1996, the term of SPT was recommended by the WHO pancreatic working group a nd is being widely accepted in medical p ra ct ice .3 Of note, in recent re-ports it has been concluded gradually that Solid Pseudopapillary Neoplasm of the pancreas (SPN) is the correct description regarding the terminology.4,5,6 Despite the increases in recognition of characteristics of this tumor, which include Vitamin D for the management of asthma Dr Nguyen Thuy Doan Trang General Pediatric Department Background Asthma is a chronic inflammatory condition of the airways, characterised by recurrent attacks of breathlessness, wheezing, cough, and chest tightness, commonly termed 'exacerbations' 'exacerbations Vitamin D is a fat-soluble micronutrient: micronutrient cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2) Background Cholecalciferol (D3) is synthesised in human skin by sunlight;or supplied by diet diet Ergocalciferol (D2) is ingested in the diet diet Inadequate vitamin D status has been reported to be common among people with asthma asthma Vitamin D to prevent asthma attacks Review question Does vitamin D prevent asthma attacks or improve control of asthma symptoms or both? Background Low blood levels of vitamin D linked to an increased risk of asthma attacks in children and adults Results from several studies about the benefit of vitamin D in asthma have not been evaluated as a group Cochrane decided to synthetize all the studies and gave the conclusions Why it is important to this review Potential of administration of vitamin D to reduce exacerbation risk and improve asthma symptom control Several published trials of vitamin D in children with asthma have reported the reductions in exacerbation rates among children randomised Why it is important to this review Meta-analysis analysis of these trials has the potential to increase statistical power to detect effects of administering vitamin D on exacerbation risk We conducted a meta-analysis analysis that was restricted to double-blind, blind, placebo-controlled placebo trials of at least 12 weeks' duration to determine the effect of vitamin D on the primary outcome of exacerbation Search methods We searched the Cochrane Airways Group Trial Register and reference lists of articles Date of last search: January 2016 Selection criteria Double-blind, randomised,, placebo-controlled placebo trials of vitamin D in children and adults with asthma Data collection and analysis Two review authors independently applied study inclusion criteria, extracted the data, and assessed risk of bias Participants 7RCT involved 435 children RCT involved 658 adults Participants were ethnically diverse The majority of participants had mild/moderate asthma, and a minority had severe asthma Median baseline serum 25(OH)D concentration ranged from 48 nmol/L to 89nmol/L Intervention All studies administered oral vitamin D3 (cholecalciferol) studies used daily dosing ranging from 500 IU/day to 1200IU/day used weekly dosing (Majak 2009) 2009 used monthly dosing (Yadav 2014) 2014 used two-monthly dosing (Martineau Martineau 2015) 2015 gave a bolus dose, followed by daily dosing (Castro 2014; Jensen 2016) Outcomes Asthma exacerbation treated with systemic corticosteroids Reduction in the rate of asthma exacerbations treated with systemic corticosteroids (RR 0.63, 95% confidence interval (CI) 0.45 to 0.88; 680 participants; studies; high-quality evidence;) Benefit of vitamin D for the outcomes of time to first exacerbation (HR 0.69, 95% CI 0.48 to 1.00; 658 participants; studies; moderate-quality quality evidence) Outcomes Benefit of vitamin D for proportion of participants experiencing one or more exacerbation (OR 0.74, 95% CI 0.49 to 1.10; 933 participants; studies; moderate-quality moderate evidence) Asthma exacerbation precipitating emergency department or requiring hospitalisation Reduction in the proportion of participants experiencing an asthma exacerbation precipitating an emergency department visit or hospital admission or both (OR 0.39, 95% CI 0.19 to 0.78; NNTB 27, 95% CI 20 to 76; 963 participants; studies; high-quality evidence) Outcomes Adverse reaction to vitamin D Two participants in one trial experienced hypercalciuria (Jensen 2016) ) No other study reported episodes of hypercalciuria or any other adverse events potentially attributable to administration of vitamin D Outcomes Costs from healthcare providers No effect on total costs associated with asthma/upper respiratory infection over 12 months (adjusted mean difference GBP 66.78, 95% CI GBP -263.47 to GBP 397.03) Use of inhaled beta2-agonists agonists One trial investigated the effects of vitamin D on the number of uses of inhaled relief medication per 24 hours (Martineau 2015) Allocation to vitamin D did not influence this outcome at 12 months (adjusted ratio of geometric means 1.00, 95% CI 0.77 to 1.28) Conclusion Reduction in the rate of asthma exacerbations requiring treatment with systemic corticosteroids Reduction in the risk of asthma exacerbations resulting in emergency department attendance or hospitalisation No effect of vitamin D on ACT score Conclusion Vitamin D did not influence the risk of any serious adverse event No fatal asthma exacerbations were reported in any trial included in this meta-analysis ...This publication has been produced by the IBD Working Group of BSPGHAN with the financial support of CICRA – Crohn’s in Childhood Research Association and NACC – National Association for Colitis & Crohn’s Disease County Print & Design ຜ 01622 605368 13416/BS registered charity number 278212 registered charity number 1117148 Guidelines for the Management of Inflammatory Bowel Disease (IBD) in Children in the United Kingdom UK IBD Working Group on behalf of the British Society of Paediatric Gastroenterology Hepatology and Nutrition (BSPGHAN) October 2008 1 Guidelines for the Management of Inflammatory Bowel Disease (IBD) in Children in the United Kingdom Authors ≥ B K Sandhu, J M E Fell, R M Beattie, S G Mitton Authors’ affiliations ≥ Prof. Bhupinder K Sandhu. Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children; and Centre for Child and Adolescent Health Bristol University and the University of West of England (UWE). ≥ Dr John ME Fell. Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London. ≥ Dr R Mark Beattie. Department of Paediatric Gastroenterology, Southampton General Hospital, Southampton. ≥ Dr Sally G Mitton. Department of Paediatric Gastroenterology, St. Georges University London, Cranmer Terrace, London. Correspondence to Chair of UK Paediatric IBD Working Group ≥ Dr Sally G Mitton MD FRCPCH Consultant Paediatric Gastroenterologist Dept Child Health St. Georges University London, Cranmer Terrace, London SW17 0RE Email s.mitton@sgul.ac.uk Guidelines for the Management of Inflammatory Bowel Disease (IBD) in Children in the United Kingdom 2 1. Introduction 2. Inflammatory Bowel Disease 3. Management of Crohn’s Disease 4. Management of Ulcerative Colitis 5. Associated aspects of IBD 6. Service Delivery Index Guidelines for the Management of Inflammatory Bowel Disease (IBD) in Children in the United Kingdom 3 Inflammatory bowel disease (IBD) encompasses two related but distinct disorders of as yet unknown aetiology. Crohn’s disease (CD) is a chronic, idiopathic transmural inflammation which can affect one or several segments of the digestive tract. Ulcerative colitis (UC) is a chronic idiopathic inflammation of the rectum extending continuously over a variable length of the colon from the distal to the proximal end. Indeterminate colitis (IC) is reserved for cases of colitis in which findings are not sufficient to allow differentiation between CD and UC [1]. 1.1 Development of guidelines [2-4] These guidelines are the work of the IBD working group of the British Society of Paediatric Gastroenterology Hepatology and Nutrition (BSPGHAN) and are for use by clinicians and allied professionals caring for children with IBD in the United Kingdom (UK). There is paucity of paediatric trials of high methodological quality to provide a comprehensive evidence based document. Thus these clinical guidelines have had to be consensus based, informed by the best available evidence from the paediatric literature and high quality data from adult IBD literature, together with the clinical expertise and multidisciplinary experience of IBD experts comprising paediatric gastroenterologists represented by BSPGHAN. They provide an evidence and Two million U.S. residents die each year; it is estimated that half of these deaths are "premature" and attributable to lifestyle and environmental factors (UC Berkley Wellness Letter 1997). Advances in biomedical sciences, mass immunization, and sanitation have resulted in a decrease in the incidence of infectious diseases (Matarazzo 1984), so that the health status of the population in economically developed countries now has less to do with acute illness than with lifestyle issues such as excessive drinking, unhealthy diet, or the use of tobacco products (Walsh et al.1993). Influencing lifestyle can do more to increase the health of the population and lower the cost of health care than can treatment of illness. In this article, a conceptual framework is proposed for the management of public health and social issue behaviors. The article relies on education, marketing, and law as its three primary classes of strategic tools. These tools will be considered with respect to specific targets and specific public health or social issues for which the targets may or may not have any motivation, opportunity, and/or ability to cooperate but that nevertheless have been selected for management (e.g. keeping preteen girls from beginning to smoke). The tools are considered with respect to targets who are prone, resistant, or unable to comply with the manager's goals. 1 The relative appropriateness of the use of various Michael L. Rothschild Carrots, Sticks, and Promises: A Conceptual Framework for the Management of Public Health and Social Issue Behaviors The author presents a framework that considers public health and social issue behaviors and is based on self-interest, exchange, competition, free choice, and externalities. Targets that are prone, resistant, or unable to respond to the manager's goal behave on the basis of their motivation, opportunity, and ability and on a manager's use of the strategies and tactics inherent in education, marketing, and law. _ __________________________________________________________ _ ______________ 1 Manager used here as a generic term that includes, but is not limited to, various persons such as civil servants, nonprofit administrators, legislators, and/or private sector managers who attempt to direct the behavior of individuals for the good of society (as defined by the managers, the leaders, and/or the constituents of the society) ______________________________________________________ __ Michael L. Rothschild is Professor, School of Business, University of Wisconsin, Madison. The author gratefully acknowledges the financial support of the Rennebohm Foundation, the Robert Wood Johnson Foundation, and the Comprehensive Cancer Center, School of Medicine, University of Wisconsin. The author gratefully acknowledges the intellectual contributions of Alan Andreasen, Gary Bamossy, Jan Willem Bol, Robert Drane, Jan Heide, Marvin Goldberg, Amy Marks, Daniel Wikler, the reviewers, and many, many others whose input made this article better. Ultimately, any errors in fact or logic are the author's. 24 / Journal of Marketing, October 1999 combinations of education, marketing, and law will be determined by these states for the purpose of assisting managers in dealing with ENDORSED 18 SEPTEMBER 2003 Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults © Commonwealth of Australia 2003 Paper-based publications This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth available from the Department of Communications, Information Technology and the Arts. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Intellectual Property Branch, Department of Communications, Information Technology and the Arts, GPO Box 2154, Canberra ACT 2601 or posted at http://www.dcita.gov.au/cca. © Commonwealth of Australia 2003 Electronic documents This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests for further authorisation should be directed to the Commonwealth Copyright Administration, Intellectual Property Branch, Department of Communications, Information Technology and the Arts, GPO Box 2154, CanberraACT 2601, or posted at http://www.dcita.gov.au/cca. ISBN Print: 1 864961 90 2 ISBN Online: 1 864961 96 1 Disclaimer This document is a general guide to appropriate practice, to be followed only subject to the clinician’s judgement in each individual case. The guidelines are designed to provide information to assist decision-making and are based on the best information available at the date of compilation. It is planned to review this Guideline in 2006. For further information regarding the status of this document, please refer to the NHMRC web address: http://www.nhmrc.gov.au For copies of this document contact: Phone: 1800 020 103 extension 8654 (toll free number) Email: phd.publications@health.gov.au Website: www.obesityguidelines.gov.au C O N T E N T S Preface vii Summary ix Evidence-based statements and recommendations xv 1 Setting the scene 1 1.1 The obesity epidemic 1 1.2 The health burden 2 1.3 The nancial burden 7 1.4 The benets of weight loss 7 1.5 Possible detrimental effects of weight loss 8 1.6 Normal regulation of body weight 8 1.7 Abnormal regulation of body weight and the 10 aetiology of obesity 1.8 At-risk groups 11 1.9 Obesity and eating disorders 12 2 Assessment 21 2.1 How is energy balance disturbed? 21 2.2 Why is energy balance disturbed? 22 2.3 Other considerations 31 3 Measuring overweight and obesity 43 3.1 'Gold standard' measures 43 3.2 Anthropometric measures 44 4 Treatment: general 53 4.1 A global approach to treatment and prevention 53 4.2 A treatment model 54 4.3 Treatment expectations 55 4.4 Treatment goals 56 4.5 Treatment duration 58 4.6 Treatment providers 58 4.7 Treatment emphasis 59 4.8 Selection of patients for treatment 60 4.9 The quality of obesity treatment studies 60 CONTENTS Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults iii CONTENTS Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults iv CONTENTS Clinical Practice Guidelines for the Management of Overweight ESC GUIDELINES Guidelines for the management of a trial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) † Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) Authors/Task Force Members: A. John Camm (Chairperson) (UK) * , Paulus Kirchhof (Germany), Gregory Y.H. Lip (UK), Ulrich Schotten (The Netherlands), Irene Savelieva (UK), Sabine Ernst (UK), Isabelle C. Van Gelder (The Netherlands), Nawwar Al-Attar (France), Gerhard Hindricks (Germany), Bernard Prendergast (UK), Hein Heidbuchel (Belgium), Ottavio Alfieri (Italy), Annalisa Angelini (Italy), Dan Atar (Norway), Paolo Colonna (Italy), Raffaele De Caterina (Italy), Johan De Sutter (Belgium), Andreas Goette (Germany), Bulent Gorenek (Turkey), Magnus He ldal (Norway), Stefan H. Hohloser (Germany), Philippe Kolh (Belgium), Jean-Yves Le Heuzey (France), Piotr Ponikowski (Poland), Frans H. Rutten (The Netherlands). ESC Committee for Practice Guidelines (CPG): Alec Vahanian (Chairperson) (France), Angelo Auricchio (Switzerland), Jeroen Bax (The Netherl ands), Claudio Ceconi (Italy), Veronica Dean (France), Gerasimos Filippatos (Greece), Christian Funck-Brentano (France), Richard Hobbs (UK), Peter Kearney (Ireland), Theresa McDonagh (UK), Bogdan A. Popescu (Romania), Zeljko Reiner (Croatia), Udo Sechtem (Germany), Per Anton Sirnes (Norway), Michal Tendera (Poland), Panos E. Vardas (Greece), Petr Widimsky (Czech Republic). Document Reviewers: Panos E. Vardas (CPG Review Coordinator) (Greece), Vazha Agladze (Georgia), EtienneAliot (France), ToshoBalabanski (Bulgaria), CarinaBlomstrom-Lundqvist (Sweden), AlessandroCapucci (Italy), HarryCrijns (The Netherlands), Bjo ¨ rn Dahlo ¨ f (Sweden), Thierry Folliguet (France), Michael Glikson (Israel), MarnixGoethals (Belgium), Dietrich C. Gulba (Germany), Siew YenHo (UK), Robert J. M. Klautz (The Netherlands), Sedat Kose (Turkey), John McMurray (UK), Pasquale Perrone Filardi (Italy), PekkaRaatikainen (Finland), Maria Jesus Salvador (Spain), Martin J. Schalij (The Netherlands), AlexanderShpektor (Russian Federation), Joa ˜ o Sousa (Portugal), Janina Stepinska (Poland), Hasso Uuetoa (Estonia), Jose Luis Zamorano (Spain), IgorZupan (Slovenia). The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines † Other ESC entities having participated in the development of this document: Associations: European Association of Echocardiography (EAE), European Association for Cardiovascular Prevention & Rehabilitation (EACPR), Heart Failure Association (HFA). Working Groups: Cardiovascular Surgery, Developmental Anatomy and Pathology, Cardiovascular Pharmacology and Drug Therapy, Thrombosis, Acute Cardiac Care, Valvular Heart Disease. Councils: Cardiovascular Imaging, Cardiology Practice, Cardiovascular Primary Care. * Corresponding author. A. John Camm, St George’s University of London, Cranmer Terrace, London SW17 ORE, UK. Tel: +44 20 8725 3414, Fax: +44 20 8725 3416, Email: jcamm@sgul.ac.uk The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC. Disclaimer. The ESC Guidelines represent the views of ... supplied by diet diet Ergocalciferol (D2 ) is ingested in the diet diet Inadequate vitamin D status has been reported to be common among people with asthma asthma Vitamin D to prevent asthma. .. Does vitamin D prevent asthma attacks or improve control of asthma symptoms or both? Background Low blood levels of vitamin D linked to an increased risk of asthma attacks in children and... Potential of administration of vitamin D to reduce exacerbation risk and improve asthma symptom control Several published trials of vitamin D in children with asthma have reported the reductions