Pancreatic cystic neoplasms(PCNs) are a diverse group of neoplasms in the pancreas,and are more increasingly encountered with widespread abdominal screening and improved imaging techniques.The most common types of PCNs are serous cystic neoplasms(SCNs),mucinous cystic neoplasms(MCNs),and intraductal papillary mucinous neoplasms(IPMNs).Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas,which may lead to overtreatment or delayed treatment.The current review provides recent developments in the understanding of the three most common types of PCNs,the latest modalities used in preoperative diagnosis and differential diagnosis,as well as the most up to date management.Suggestions for diagnosis and differential diagnosis of SCNs,MCNs,and IPMNs are also provided for young surgeons.Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.
AIM:To evaluate the efficacy of autologous bone marrow mononuclear cell transplantation in decompensated liver disease.METHODS:Medline,EMBASE,PubMed,Science Direct,and the Cochrane Library were searched for relevant studies.Retrospective case-control studies were included along with randomized clinical trials.Metaanalysis was performed in line with recommendations from the Cochrane Collaboration software review manager.Heterogeneity was assessed using a randomeffects model.RESULTS:Four randomized controlled trials and four retrospective studies were included.Cell transplantation increased serum albumin level by 1.96 g/L(95%CI:0.74-3.17;P = 0.002],2.55 g/L(95%CI:0.32-4.79;P= 0.03),and 3.65 g/L(95%CI:0.76-6.54;P = 0.01)after 1,3,and 6 mo,respectively.Patients who had undergone cell transplantation also had a lower level of total bilirubin[mean difference(MD):-1.37 mg/dL;95%CI:-2.68-(-0.06);P = 0.04]after 6 mo.This decreased after 1 year when compared to standard treatment(MD:-1.26;95%CI:-2.48-(-0.03);P =0.04].A temporary decrease in alanine transaminase and aspartate transaminase were significant in the cell transplantation group.However,after 6 mo treatment,patients who had undergone cell transplantation had a slightly longer prothrombin time(MD:5.66 s,95%CI:0.04-11.28;P = 0.05).Changes in the model for endstage liver disease score and Child-Pugh score were not statistically significant.CONCLUSION:Autologous bone marrow transplantation showed some benefits in patients with decompensated liver disease.However,further studies are still needed to verify its role in clinical treatment for end-stage liver disease.
