Pancreatic acinar cell carcinoma (PACC) is a rare exocrine tumor of the pancreas with distinct clinical and pathological features. In recent years, advancements in molecular biology techniques have led to a deeper understanding of the molecular mechanisms underlying PACC. Progress in imaging, endoscopic, and molecular diagnostic technologies has improved the early detection rate of PACC. The primary treatment modalities for PACC include surgical resection, chemotherapy, targeted therapy and immunotherapy; however, the therapeutic efficacy still requires further improvement. This article reviews the current research status of PACC, covering its epidemiology, pathological characteristics, molecular alterations, diagnostic methods, and treatment strategies, and discusses the controversies and future directions in PACC research.

Objective To investigate the feasibility and safety of transradial approach(TRA)for carotid artery stenting(CAS)using single-layer braided carotid stents with a microporous dense mesh design.Methods A retrospective consecutive series of patients with carotid artery stenosis who underwent CAS via TRA using single-layer braided microporous dense mesh stents admitted to the Department of Neurology,Linyi People's Hospital,Shandong Second Medical University were included from December 2022 to April 2023.General and clinical data,lesion characteristics,procedural metrics,periprocedural conditions,and follow-up outcomes were collected from the patients.General and clinical data including sex,age,medical history(hypertension,diabetes,coronary artery disease),and preoperative modified Rankin scale(mRS)score.Lesion characteristics included stenosis location,normal lumen diameters distal and proximal to the stenosis,stenosis rate,lesion length,and aortic arch type.Procedural metrics included successfully guided catheter placement,stent deployment,retrieval of the embolic protection device and residual stenosis rate.Periprocedural conditions included periprocedural complications(within 72 hours included puncture site bleeding,symptomatic radial artery occlusion,new cerebral infarctions on diffusion-weighted imaging,and cardio-cerebrovascular events[angina,acute myocardial infarction,cerebral infarction,cerebral hemorrhage])and length of hospital stay.The mRS scores at 1 and 6 months after surgery were recorded via telephone follow-ups.At 12 months after surgery,outpatient carotid color Doppler ultrasound was performed to evaluate in-stent restenosis.Results(1)Ten patients(9 male,1 female)aged 57-72 years,with a median age of 70(62,71)years were included.Among them,9 had hypertension,2 had diabetes,and 1 had coronary artery disease.Four patients had symptomatic carotid stenosis:2 presented with hemiparesis,1 with mild dysarthria,and 1 with transient ischemic attack.Preoperative mRS scores among symptomatic patients were 0(1 patient),1(2 patients),and 2(1 patient).The remaining 6 patients had asymptomatic stenosis,all with preoperative mRS scores of 0.(2)Two patients had left internal carotid artery(ICA)stenosis,and 8 had right ICA stenosis.The mean stenosis degree was(79.9±7.1)％,and the mean lesion length was(16.8±5.7)mm.The mean normal distal and proximal lumen diameter of the stenosed blood vessel were(5.1±0.5)mm and(8.1±0.8)mm,respectively.One patient had a type Ⅰ aortic arch,8 patients had type Ⅱ,and 1 patient had type Ⅲ.Among the 8 patients with right ICA stenosis,4 underwent direct catheterization of the right common carotid artery using a glidewire,while the other 4 required exchange technique for guide catheter placement.Both left-sided lesions were treated using exchange technique.Guide catheter placement and stent deployment were successful in all cases.No difficulties were encountered in embolic protection device retrieval.The mean residual stenosis rate was(21.6±6.7)％.(3)The mean postoperative hospital stay was(1.8±0.9)days.No puncture site bleeding or symptomatic radial artery occlusion occurred.One patient experienced a cerebrovascular event due to a pontine perforator artery infarction,presenting with diplopia and impaired left eye adduction,likely caused by postoperative hypotension and hypoperfusion.This patient had an immediate postoperative mRS score of 2 at discharge,which improved to 0 at 6 months.The other 9 patients showed no change in mRS scores compared to preoperative assessments,and no new cerebral infarctions were detected within 72 hours after surgery.At 12-month follow-up,carotid color Doppler ultrasound revealed no in-stent restenosis in any patient.Conclusions CAS performed via TRA using single-layer braided microporous dense mesh stents appears to be feasible and safe.However,this study is a single-center,retrospective analysis with a small sample size.Larger prospective randomized controlled trials are needed to validate these findings.

Objective To investigate the feasibility and safety of transradial approach(TRA)for carotid artery stenting(CAS)using single-layer braided carotid stents with a microporous dense mesh design.Methods A retrospective consecutive series of patients with carotid artery stenosis who underwent CAS via TRA using single-layer braided microporous dense mesh stents admitted to the Department of Neurology,Linyi People's Hospital,Shandong Second Medical University were included from December 2022 to April 2023.General and clinical data,lesion characteristics,procedural metrics,periprocedural conditions,and follow-up outcomes were collected from the patients.General and clinical data including sex,age,medical history(hypertension,diabetes,coronary artery disease),and preoperative modified Rankin scale(mRS)score.Lesion characteristics included stenosis location,normal lumen diameters distal and proximal to the stenosis,stenosis rate,lesion length,and aortic arch type.Procedural metrics included successfully guided catheter placement,stent deployment,retrieval of the embolic protection device and residual stenosis rate.Periprocedural conditions included periprocedural complications(within 72 hours included puncture site bleeding,symptomatic radial artery occlusion,new cerebral infarctions on diffusion-weighted imaging,and cardio-cerebrovascular events[angina,acute myocardial infarction,cerebral infarction,cerebral hemorrhage])and length of hospital stay.The mRS scores at 1 and 6 months after surgery were recorded via telephone follow-ups.At 12 months after surgery,outpatient carotid color Doppler ultrasound was performed to evaluate in-stent restenosis.Results(1)Ten patients(9 male,1 female)aged 57-72 years,with a median age of 70(62,71)years were included.Among them,9 had hypertension,2 had diabetes,and 1 had coronary artery disease.Four patients had symptomatic carotid stenosis:2 presented with hemiparesis,1 with mild dysarthria,and 1 with transient ischemic attack.Preoperative mRS scores among symptomatic patients were 0(1 patient),1(2 patients),and 2(1 patient).The remaining 6 patients had asymptomatic stenosis,all with preoperative mRS scores of 0.(2)Two patients had left internal carotid artery(ICA)stenosis,and 8 had right ICA stenosis.The mean stenosis degree was(79.9±7.1)％,and the mean lesion length was(16.8±5.7)mm.The mean normal distal and proximal lumen diameter of the stenosed blood vessel were(5.1±0.5)mm and(8.1±0.8)mm,respectively.One patient had a type Ⅰ aortic arch,8 patients had type Ⅱ,and 1 patient had type Ⅲ.Among the 8 patients with right ICA stenosis,4 underwent direct catheterization of the right common carotid artery using a glidewire,while the other 4 required exchange technique for guide catheter placement.Both left-sided lesions were treated using exchange technique.Guide catheter placement and stent deployment were successful in all cases.No difficulties were encountered in embolic protection device retrieval.The mean residual stenosis rate was(21.6±6.7)％.(3)The mean postoperative hospital stay was(1.8±0.9)days.No puncture site bleeding or symptomatic radial artery occlusion occurred.One patient experienced a cerebrovascular event due to a pontine perforator artery infarction,presenting with diplopia and impaired left eye adduction,likely caused by postoperative hypotension and hypoperfusion.This patient had an immediate postoperative mRS score of 2 at discharge,which improved to 0 at 6 months.The other 9 patients showed no change in mRS scores compared to preoperative assessments,and no new cerebral infarctions were detected within 72 hours after surgery.At 12-month follow-up,carotid color Doppler ultrasound revealed no in-stent restenosis in any patient.Conclusions CAS performed via TRA using single-layer braided microporous dense mesh stents appears to be feasible and safe.However,this study is a single-center,retrospective analysis with a small sample size.Larger prospective randomized controlled trials are needed to validate these findings.

Objective To compare the safety and efficacy of endovascular treatment(EVT)transradial approach and transfemoral approach in patients with acute ischemic stroke with large vessel occlusion in the posterior circulation.Methods Patients with acute ischemic stroke with large vessel occlusion in the posterior circulation admitted to the Stroke Center of Linyi People's Hospital,Shandong Second Medical University from February 2022 to April 2024 were retrospectively recruited.The baseline and clinical data were collected,including age,sex,past medical history(hypertension,diabetes mellitus,hyperlipidemia,atrial fibrillation,coronary artery disease,myocardial infarction and stroke),smoking,blood pressure at admission,National Institutes of Health stroke scale(NIHSS)score at admission,modified Rankin scale(mRS)score before the onset of stroke,Alberta stroke program early CT score(ASPECTS),whether intravenous thrombolysis was performed,volume of core infarct zone,volume of hypoperfused zone,occlusion location,etiology of stroke,time indexes(including time from onset to door,time from door to arterial puncture,arterial puncture to recanalization,and time from onset to revascularization),anesthesia modality,EVT first-line strategy,number of passes and whether with vascular access conversion.Clinical data included 90-day postoperative mRS scores,postoperative puncture site complications in 24 hours,symptomatic intracranial hemorrhage at 72 hours postoperatively,modified thrombolysis in cerebral infarction(mTICI)grade at the last angiography introperative and length of stay.The groups were categorized into transradial(TRA)and transfemoral(TFA)groups according to the final access route for EVT.The baseline and clinical data of the two groups were compared.Results A total of 129 patients underwent EVT with acute ischemic stroke with large vessel occlusion in the posterior circulation were finally included,including 47 patients in TRA group and 82 patients in TFA group.The differences about sex,age,past medical history,smoking,blood pressure at admission,NIHSS score at admission,mRS score before the onset of the stroke,ASPECTS,whether intravenous thrombolysis was performed,volume of core infarct zone,volume of hypoperfused zone,occlusion location,etiology of stroke,anesthesia modality,EVT first-line strategy,number of passes,mTICI grade at the last angiography introperative and other aspects were not statistically significant(all P＞0.05).The good prognosis rate at 90 d after surgery(53.2％[25/47]vs.48.8％[40/82],P=0.630),distribution of mRS scores at 90d postoperatively(P=0.991),all-cause mortality at 90 days after surgery(27.7％[13/47]vs.28.0％[23/82],P=1.000),rate of good recanalization(mTICI grade≥2b)on intraoperative last angiogram(97.9％[46/47]vs.95.1％[78/82],P=0.436),rate of complication of puncture site(4.3％[2/47]vs.12.2％[10/82],P=0.209)between the two groups were not statistically significant.The time from door to arterial puncture was significantly longer in the TRA group than in the TFA group,and the difference between the two groups was statistically significant(122.00[95.00,153.00]min vs.105.00[80.25,118.00]min,Z=-2.937,P=0.03);average length of stay in the TFA group was significantly longer than that of the TRA group,and the difference between the two groups was statistically significant(6.00[4.95,7.05]d vs.7.00[6.95,8.88]d,Z=-2.573,P=0.010).Conclusions Patients who underwent EVT via radial or femoral artery approach with acute ischemic stroke with large vessel occlusion in the posterior circulation had similar safety and efficacy,and the number of days of hospitalization was shorter via the TRA.However,more large prospective randomized controlled clinical trials are needed to validate the results of this study.

Objective To study application of Chinese general practice assessment questionnaire (GPAQ)consultation version 2.0 in evaluating patients' satisfaction with community health-care service (CHS).Methods First,origihal GPAQ consultation version 2.0 in English was translated into Chinese language by three experts in general practice/family medicine field,then translated it back into English,finally a Chinese version of GPAQ was formed.Ten medical doctors who were on duty on 25 April,2008 at each out-patient clinic from CHS of Daxing,Nancaiyuan,Yongning and Hancunhe were selected randomly as targets for evaluation of service satisfaction.A sample of the first 30 patients(1200 in total)aged more than 16 years who visited the clinic on that day were selected to fill out the Chinese GPAQ consultation version 2.0 to express their satisfaction with the medical doctors they visited,and reliability and validity of the questionnaire was then evaluated.Results Cronbach's alpha ranged 0.734 to 0.813 for each domain of the Chinese version of GPAQ2.0.and cumulated contribution of three common factors with the eigen-value more than one reached 58.722%.Scores of patients' satisfaction withreceptionists,access,continuity,doctor's communication skills andpatient enablement were significantly lower,as compared to those of national bench-mark in the United Kingdom,with t-values of -6.397,-11.729,-6.328,-59.871 and -2.210,and all P＜0.05.respectively.Conclusions The Chinese version of GPAO 2.0 achieves good reliability and modcrate validity,and can be used as an instrument for evaluating patient's satisfaction with quality of CHS in China as further revision in the future studies.