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Moreover, GH signaling to elicit IGF1 gene transcription is blocked in the absence of appropriate insulin signaling, a phenomenon also known as un-coupling, and resulting in growth arrest (60, 61, 63, 64) (Figure 3)

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The strength of this study lies in the very homogenous sample (only patients with pylorus preserving pancreatic resection were included), the rigorous sampling that comes along with conducting a RCT, and the long-term follow-up of 12 months

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