LSG is a safe and effective procedure with good five year results. Weight regain remains a concern two years post surgery. Standardization of LSG is important to reduce major complications.

Abstract. Necrolytic migratory erythema (NME), diabetes mellitus and glucagon-secreting tumors form the hallmarks of glucagonoma syndrome, and represent the major clinical manifestations of glucagonoma. NME is usually presented as the initial complaint of patients. Due to the rare incidence of glucagonoma, its diagnosis is often delayed, which leads to its progression. Here, we report a case of NME with a typical skin rash, which was misdiagnosed and treated with corticosteroids for two years. Removal of the tumor in the pancreatic body led to the rapid relief of the symptoms. The aim of the present study is to demonstrate the typical characteristics of glucagonoma syndrome to clinicians in order to improve its diagnosis and treatment. IntroductionGlucagonoma is an uncommon neoplasm of the pancreatic neuroendocrine islet α-cells, whereby the islet cells secrete abundant glucagon (1). The estimated annual incidence of glucagonoma is ~1 case per 20,000,000 individuals (2). Due to the rarity of the disease, mortality rates remain unclear. In a study of 21 glucagonoma patients, Wermers et al (3) reported that nine patients succumbed to the diease after a mean duration of 4.91 years following diagnosis (3). Complete tumor resection may cure glucagonoma, with a 10-year survival rate of 64.3% following surgery, however, liver and lymph node metastasis are major risk factors that contribute to tumor-associated mortality (4). For patients with unresectable advanced disease, tumor debulking, chemotherapy or somatostatin may also be considered to reduce the tumor-associated symptoms, however, the survival benefit of such treatments is limited (2,3). Glucagonoma induces various manifestations, which are characterized by necrolytic migratory erythema (NME), diabetes mellitus (DM), weight loss, anemia and neuropsychiatric disturbances (1). NME represents the most specific manifestation of glucagonoma syndrome and has therefore provided the most valuable indications for diagnosis in the majority of previous cases (5). Early recognition of NME is likely to lead to a more rapid diagnosis of glucagonoma, thereby allowing surgical resection and achieving a promising therapeutic outcome. This study presents the case of a glucagonoma patient who recovered following spleen-preserving distal pancreatectomy. Case reportIn November 2010, a 50-year-old female presented to The Pancreas Center of Nanjing Medical University (Nanjing, China) with a 2-year history of a pruritic and ulcerating skin rash, which initially appeared at the waist and slowly progressed to the entire body within three months (Fig. 1A). Phacoscotasmus, cheilitis and glossitis were also present (Fig. 1B). The patient also complained of blurred vision and weight loss of 5 kg. The patient was initially diagnosed with pemphigus and treated with prednisone without relief of the skin rash prior to her admission to our clinic. Physical examination revealed that the skin lesions were erythematous macules with erosions, serous exudate and crusting (Fig. 1C). A skin biopsy reve...

Long noncoding RNA(lncRNA)s are new regulators governing the metabolism in adipose tissue. In this study, we aimed to understand how lncRNAs respond to insulin signalling and explore whether lncRNAs have a functional role in insulin signalling pathway. We treated primary adipocyte cultures with insulin and collected RNA for RNA-sequencing to profile the non-coding transcriptome changes, through which we identified a top Adipose Specific Insulin Responsive LncRNA (LncASIR). To determine its biological function, we knocked down LncASIR using dcas9-KRAB, followed by RNA-seq to examine the effect on insulin-induced gene expression program. We identified a set of lncRNAs regulated by insulin signalling pathway. LncASIR is transcribed from a super enhancer region and responds robustly to insulin treatment. Silencing LncASIR resulted in an impaired global insulin-responsive gene program. LncASIR is a novel and integral component in the insulin signalling pathway in adipocytes.