Background: The pancreatic reconstruction technique decides the incidence of postoperative pancreatic fistulas (POPF) in pancreaticoduodenectomy (PD). This study aims to evaluate the safety of modified single-needle continuous suture (SNCS) of duct-to-mucosa and compare the efficacy with double-layer continuous suture (DLCS) of duct-mucosa pancreaticojejunostomy (PJ) in open PD (OPD). Methods: A total of 266 patients that received PD between January 2019 and May 2023 were retrospectively analyzed. Among them, 130 patients underwent DLCS, and 136 patients underwent SNCS [73 OPD and 63 laparoscopic PD (LPD)]. The primary outcome was clinically relevant POPF (CR-POPF) according to the definition of the revised 2016 International Study Group of Pancreatic Fistula (ISGPF). Propensity score matching (PSM) was conducted to reduce confounding bias. Results: A total of 66 pairs were successfully matched using PSM in OPD. No significant difference was observed in the occurrence of CR-POPF between the two groups (9.1% vs. 21.2%, P=0.052). However, the median duration of operation and PJ was shorter in the SNCS group. The incidence of CR-POPF in LPD was 9.5%. Furthermore, regarding the alternative fistula risk score (a-FRS), the CR-POPF rate were 2.1%, 10.5%, and 15.6% in low-, intermediate-, and high-risk groups (P=0.067). Conclusions: The SNCS is a facile, safe, and effective PJ technique and does not increase the incidence of POPF, regardless of a-FRS stratification, pancreatic texture, and main pancreatic duct (MPD) size.
Pancreaticoduodenectomy (PD) nowadays serves as a standard treatment for patients with disorders of the pancreas, intestine, and bile duct. Although the mortality rate of patients undergoing PD has decreased significantly, postoperative complication rates remain high. Dexamethasone, a synthetic glucocorticoid with potent anti-inflammatory and metabolic effects, has been proven to have a favorable effect on certain complications. However, the role it plays in post-pancreatectomy patients has not been systematically evaluated. The aim of this study is to assess the effect of dexamethasone on postoperative complications after PD.The PANDEX trial is an investigator-initiated, multicentric, prospective, randomized, double-blinded, placebo-control, pragmatic study. The trial is designed to enroll 300 patients who are going to receive elective PD. Patients will be randomized to receive 0.2 mg/kg dexamethasone or saline placebo, administered as an intravenous bolus within 5 min after induction of anesthesia. The primary outcome is the Comprehensive Complication Index (CCI) score within 30 days after the operation. The secondary outcomes include postoperative major complications (Clavien-Dindo≥3), postoperative pancreatic fistula (POPF), post-pancreatectomy acute pancreatitis (PPAP), infection, and unexpected relaparotomy, as well as postoperative length of stay, 30-day mortality, and 90-day mortality.The PANDEX trial is the first randomized controlled trial concerning the effect of dexamethasone on postoperative complications of patients undergoing PD, with the hypothesis that the intraoperative use of dexamethasone can reduce the incidence of postoperative complications and improve short-term outcomes after PD. The results of the present study will guide the perioperative use of dexamethasone and help improve the clinical management of post-pancreatectomy patients.ClinicalTrials.gov NCT05567094. Registered on 30 September 30 2022.
The term cell-in-cell, morphologically, refers to the presence of one cell within another. This phenomenon can occur in tumors but also among non-tumor cells. The cell-in-cell phenomenon was first observed 100 years ago, and it has since been found in a variety of tumor types. Recently, increasing attention has been paid to this phenomenon and the underlying mechanism has gradually been elucidated. There are three main related process: cannibalism, emperipolesis, and entosis. These processes are affected by many factors, including the tumor microenvironment, mitosis, and genetic factors. There is considerable evidence to suggest that the cell-in-cell phenomenon is associated with the prognosis of cancers, and it promotes tumor progression in most situations. Notably, in pancreatic cancer, the cell-in-cell phenomenon is associated with reduced metastasis, which is the opposite of what happens in other tumor types. Thus, it can also inhibit tumor progression. Studies show that cell-in-cell structure formation is affected by the tumor microenvironment, and that it may lead to changes in cellular characteristics. In this review, we summarize the different cell-in-cell processes and discuss their role in tumor progression and how they are regulated by different mechanisms.
Objective: To evaluate the effect of perioperative dexamethasone on postoperative complications after pancreaticoduodenectomy. Background: The glucocorticoid dexamethasone has been shown to improve postoperative outcomes in surgical patients, but its effects on postoperative complications after pancreaticoduodenectomy are unclear. Methods: This multicenter, double-blind, randomized controlled trial was conducted in four Chinese high-volume pancreatic centers. Adults undergoing elective pancreaticoduodenectomy were randomized to receive either 0.2 mg/kg dexamethasone or a saline placebo as an intravenous bolus within 5 minutes after anesthesia induction. The primary outcome was the Comprehensive Complication Index (CCI) score within 30 days after the operation, analyzed using the modified intention-to-treat principle. Results: Among 428 patients for eligibility, 300 participants were randomized and 265 were included in the modified intention-to-treat analyses. One hundred thirty-four patients received dexamethasone and 131 patients received a placebo. The mean (SD) CCI score was 14.0 (17.5) in the dexamethasone group and 17.9 (20.3) in the placebo group (mean difference: −3.8; 95% CI: −8.4 to 0.7; P = 0.100). The incidence of major complications (Clavien-Dindo grade ≥III; 12.7% vs 16.0%, risk ratio: 0.79; 95% CI: 0.44 to 1.43; P = 0.439) and postoperative pancreatic fistula (25.4% vs 31.3%, risk ratio: 0.81; 95% CI: 0.55 to 1.19; P = 0.286) were not significantly different between the two groups. In the stratum of participants with a main pancreatic duct ≤3 mm (n = 202), the CCI score was significantly lower in the dexamethasone group (mean difference: −6.4; 95% CI: −11.2 to −1.6; P = 0.009). Conclusions: Perioperative dexamethasone did not significantly reduce postoperative complications within 30 days after pancreaticoduodenectomy.
OBJECTIVE To discuss the application of Beckman Coulter LH750 blood corpuscle analyzer in analyzing stability of the related parameter.METHODS When the traceability of blood analyzer determination data was guaranteed,fluctuation average value analysis system provided by the analyzer software(X-B) analysis system) was applied.The MCV,MCH and MCHC,of the clinical specimen was examined,whose fluctuation average value tendency was determined.RESULTS When X-B was applied,many influencing factors which the material controls 5CPlus could not prompt may be discovered.On the other hand,when instrument was in good state,the average value of RBC,Hb,MCH,MCHC and MCV changes in the small scope,the XB analytic method quality control chart was basically consistent with the quality control chart change tendency of blood traceability quality control sample.CONCLUSION This method can be used as another approach to monitor the stability of traceability analyzed by LH750 blood corpuscle.
OBJECTIVE To establish the normal reference range of red blood cells parameters(RBC,HGB,MCV,MCH,MCHC and HCT) of healthy adults in Wuxi by analyzing the data measured by Beckman Coulter LH750 hematology analyzer.METHODS The healthy adults of male and female 1,000 in each group.The venous blood specimens were detected by using Beckman Coulter LH750 hematology analyzer.The reference rage was investigated.RESULTS All data was analyzed by the SPSS10.0 software,The parameters of red blood cells were RBC: the male(5.04±0.42)×1012/L,the female(4.40±0.38)×1012/L;HGB:the male(149.00±10.00)g/L,the female(130.2±11.2)g/L:MCV:the male(90.1±4.10)fL,the female(90.00±4.50)fL,HCT:the male(0.45±0.03)%,the female(0.38±0.04)%.CONCLUSION There are certain differences between the result and the reference range provided by the National Rules of Operation of Clinical Laboratory.Therefore,it is necessary to establish the local reference range of red blood cell in laboratories.
Objective To discuss the prevention and best care for thyroidal patients with postoperative bleeding. Methods Thirty-eight cases of thyroidal patients with postoperative bleeding were received in our hospital, which were randomly divided into treatment group and control group with 19 cases respectively. Both groups were given routine care and treatment, according to the actual conditions, we developed the specified care program for treatment group on the basis of routine care. By observing the improved syndrome and recording the daily life of the patients, we analyzed the method of prevention against bleeding. Results Treatment group had the total effective rate of 89.47% while the control group was 78.95%, which be compared the life quality of two groups, we concluded that the former enjoyed significantly better conditions than the latter. Conclusion The care with personalized measures will work well in preventing the thyroidal patients with postoperative bleeding.
Abstract Background Currently, there are no effective tools to accurately assess acute biliary pancreatitis (ABP) risk in patients with gallstones. This study aimed to develop an ABP risk nomogram in patients with gallstones. Methods Data on 2102 patients with gallstones admitted to the Department of General Surgery of The First Affiliated Hospital of Harbin Medical University between January 6, 2009 and January 22, 2018 were retrospectively collected. Some patients were randomly divided into the training cohort (n=1470) for nomogram development; the others formed the validation cohort (n=632) to confirm the model’s performance. The chi-square test was used to optimize feature selection, and logistic regression analysis was applied to build a prediction model incorporating the selected features. The area under the curve (AUC), Hosmer-Lemeshow test, calibration curve, decision curve analysis (DCA) and internal validation were used to validate the model’s accuracy, calibration and clinical effectiveness. Results Predictors included sex (male), diabetes, gallbladder wall thickness ≤3 mm, gallbladder stone diameter <3 mm, coexisting CBD stone, CBD diameter ≤10 mm, AST≥53.6 U/L, GGT≥150 U/L, DBIL≥1.0 mg/dL, WBC≥10Í10 9 , and GRAN%≥80%. The model displayed good predictive power with AUCs of 0.850 (95% CI: 0.825~0.875) and 0.844 (95% CI: 0.825~0.875) in the training and validation cohorts, respectively. The DCA showed a 10-100% risk threshold. The Hosmer-Lemeshow test and calibration curve demonstrated the accuracy and effectiveness of this model, which could be applied in clinical practice. Conclusions The ABP risk nomogram incorporating 11 features is useful to predict ABP risk in gallstone patients.
Background/Purpose Currently, there are no effective tools to accurately assess acute biliary pancreatitis (ABP) risk in patients with gallstones. This study aimed to develop an ABP risk nomogram in patients with symptomatic gallstones. Methods We conducted a retrospective nested case-control study and data on 816 conservatively treated patients with symptomatic gallstones admitted to The First Affiliated Hospital of Harbin Medical University between January 6, 2007 and January 22, 2016 were retrospectively collected. We conducted a propensity-score matched (PSM) analysis based on follow-up time in a ratio of 1:4 between ABP group (n=65) and non-ABP group (n=260). These matched patients were randomly divided into study cohort (n=229) and validation cohort (n=96) according to a ratio of 7:3. In the study cohort, independent risk factors for ABP occurrence identified using Cox regression were included in nomogram. Nomogram performance and discrimination were assessed using the concordance index (C-index), area under the curve (AUC), calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC). The model was also validated in the validation cohort. Results Nomogram was based on 7 independent risk factors: age, diabetes history, gallbladder wall thickness, gallstone diameter, coexisting common bile duct (CBD) stones, direct bilirubin (DBIL), and white blood cell count (WBC). The C-index of nomogram was 0.888, and the 10-year AUCs of nomogram was 0.955. In the validation cohort, nomogram still had good discrimination (C-index, 0.857; 10-year AUC, 0.814). The calibration curve showed good homogeneity between the prediction by nomogram and the actual observation. DCA and CIC demonstrated that nomogram was clinically useful. Conclusions The ABP risk nomogram incorporating 7 features is useful to predict ABP risk in symptomatic gallstone patients.
Despite improvements in surgical procedures and comprehensive therapies, pancreatic cancer remains one of the most aggressive and deadly human malignancies. It is therefore necessary to determine which cellular mediators associate with prognosis in pancreatic cancer so as to improve the treatment of this disease. In the present study, mRNA array and immunohistochemical analyses showed that KLF5 is highly expressed in tissue samples from three short-surviving patients with pancreatic cancer. Survival analysis using data from The Cancer Genome Atlas showed that patients highly expressing KLF5 exhibited shorter overall and tumor-free survival times. Mechanistically, KLF5 promoted expression of E2F1, cyclin D1 and Rad51, while inhibiting expression of p16 in pancreatic cancer cells. Finally, flow cytometric analyses verified that KLF5 promotes G1/S progression of the cell cycle in pancreatic cancer cells. Collectively, these findings demonstrate that KLF5 is an important prognostic biomarker in pancreatic cancer patients, and they shed light on the molecular mechanism by which KLF5 stimulates cell cycle progression in pancreatic cancer.
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