Effect of six-stitch pancreaticojejunostomy on pancreatic fistula:A propensity score-matched comparative cohort study

Background:Clinically relevant postoperative pancreatic fistula(CR-POPF)is the most common and severe complication after pancreaticoduodenectomy(PD).Despite the development of numerous anastomotic surgical techniques to minimize CR-POPF,more than 30%of patients who undergo PD develop CR-POPF.Herein,we propose a novel pancreaticojejunostomy(PJ)technique and evaluate its efficacy and safety compared to traditional PJ.Methods:This retrospective study enrolled 164 consecutive patients who underwent PJ after PD between January 2012 and June 2017.Of them,78(47.6%)underwent traditional PJ and 86(52.4%)underwent sixstitch PJ.The primary outcome was CR-POPF at 1-month follow-up defined according to the revised 2016 International Study Group on Pancreatic Fistula definition.To adjust for baseline differences and selection bias,patients were matched by propensity scores,which left 63 patients with traditional PJ and 63 with six-stitch PJ.Results:Compared to patients who underwent traditional PJ(mean age 56.2±9.4 years),patients who underwent six-stitch PJ(mean age 57.4±11.4 years)had a lower CR-POPF rate.The risk of CR-POPF among patients who underwent six-stitch PJ was decreased by 81.7%after adjustment for age,sex,body mass index,and disease severity compared to patients who underwent traditional PJ.Additionally,the surgery time was reduced from 29 min for traditional PJ to 15 min for six-stitch PJ(P<0.001).Adverse effects such as abdominal fluid collection,abdominal bleeding,and wound infection were similar between two groups.Conclusion:Six-stitch PJ may be an effective and efficient PJ technique for patients who undergo PD surgery.

Ant sting-induced whole-body pustules in an inebriated male:A case report

BACKGROUND Many ant species can harm humans;however,only a few cause life-threatening allergic reactions.Normally,reactions caused by ants occur in patients who come into contact with ant venom.Venom contains various biologically active peptides and protein components,of which acids and alkaloids tend to cause anaphylaxis.Ant venom can cause both immediate and delayed reactions.The main histopathological changes observed in ant hypersensitivity are eosinophil recruitment and Th2 cytokine production.CASE SUMMARY A 70-year-old man was bitten by a large number of ants when he was in a drunken stupor and was hospitalized at a local hospital.Five days later,because of severe symptoms,the patient was transferred to our hospital for treatment.Numerous pustules were observed interspersed throughout the body,with itching and pain reported.He had experienced fever,vomiting,hematochezia,mania,soliloquy,sleep disturbances,and elevated levels of myocardial enzymes since the onset of illness.The patient had a history of hypertension for more than 1 year,and his blood pressure was within the normal range after hypotensive drug treatment.He had no other relevant medical history.Based on the clinical history of an ant bite and its clinical manifestations,the patient was diagnosed with an ant venom allergy.The patient was treated with 60 mg methylprednisolone for 2 d,40 mg methylprednisolone for 3 d,and 20 mg methylprednisolone for 2 d.Oral antihistamines and diazepam were administered for 12 d and 8 d,respectively.Cold compresses were used to treat the swelling during the process.After 12 d of treatment,most pustules became crusts,whereas some had faded away.No symptoms of pain,itching,or psychological disturbances were reported during the follow-up visits within 6 mo.CONCLUSION This case report emphasizes the dangers of ant stings.

Mesenchymal stem cell-derived extracellular vesicles:a possible therapeutic strategy for orthopaedic diseases:a narrative review

Accumulating evidence suggests that the therapeutic role of mesenchymal stem cells(MSCs)in bone diseases is closely related to paracrine-generated extracellular vesicles(EVs).MSC-derived EVs(MSC-EVs)carry proteins,nucleic acids,and lipids to the extracellular space and affect the bone microenvironment.They have similar biological functions to MSCs,such as the ability to repair organ and tissue damage.In addition,MSC-EVs also have the advantages of long half-life,low immunogenicity,attractive stability,ability to pass through the blood-brain barrier,and demonstrate excellent performance with potential practical applications in bone diseases.In this review,we summarise the current applications and mechanisms of MSC-EVs in osteoporosis,osteoarthritis,bone tumours,osteonecrosis of the femoral head,and fractures,as well as the development of MSC-EVs combined with materials science in the field of orthopaedics.Additionally,we explore the critical challenges involved in the clinical application of MSC-EVs in orthopaedic diseases.

Toxic Shock Syndrome Due to Streptococcus pyogenes Presenting with Purpura Fulminans inan Older Adult

Introduction Purpura fulminans(PF)was first described in 18861 and is characterized as a rare syndrome with a rapidly progressive course of hemorrhagic infarction of the skin and soft tissue necrosis.It mainly occurs in children and rarely in adults.1 PF is a life-threatening disease that can be a clinical presentation of toxic shock syndrome(TSS).2 The most common infectious etiology is cocci,and routine use of antibiotics for this disease is well recognized.However,another etiology,influenza virus,is often neglected.We herein report a case involving an older patient with TSS presenting with PF,in which Streptococcus pyogenes(S.pyogenes)accompanied by influenza virus might have played an important role,in order to arise the attention of clinician to the infection of the influenza virus in the pathogenesis of TSS.