Comparison of outcomes with stapler versus hand-sewn closure of the pancreatic stump following minimally invasive distal pancreatectomy:a retrospective cohort study

Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remains unclear.Methods:Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected.The outcomes of MDP with stapler and hand-sewn closure were compared.The primary outcome was clinically relevant postoperative pancreatic fistula(CR-POPF)per the International Study Group of Pancreatic Surgery definition.Results:Of the 384 patients(stapler closure,339;hand-sewn closure,45)enrolled,249 developed CR-POPF(grades B and C:242 and 7 patients,respectively).The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group(64.6%and 1.5%vs 51.1%and 4.4%,P=.078 and P=.223,respectively).No differences between the stapler and hand-sewn groups were observed regarding the median operation time(207 vs 222 minutes,P=.139),incidence of major complications(16.5%vs 20.0%,P=.559),and mortality(0.2%vs 0%,P=1.000).The independent risk factors of CR-POPF were abdominal abscess,prolonged operation time,and transection site(P=.004,.006,and.001,respectively).Conclusion:The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort.Randomized controlled trials are needed to verify this finding.

Highly transmitted silver nanowires-SWCNTs conductive flexible film by nested density structure and aluminum-doped zinc oxide capping layer for flexible amorphous silicon solar cells

Indium tin oxide(ITO)is widely used in transparent conductive films(TCFs);however,several disadvan-tages,such as high cost and toxicity of indium,limit its applications.Therefore,it is necessary to develop other materials that can replace ITO.Silver nanowires or single walled carbon nanotubes(SWCNTs)have attracted considerable interest owing to their unique electrical,optical,and thermal stabilities,and thus,they are ideal for transparent electrodes for flexible or stretchable devices.In this study,we develop a novel architecture of composite TCFs on a polyethylene naphthalate(PEN)flexible substrate.Herein,the silver nanowires-SWCNTs films with nested density structure were fabricated through ultrasonic spraying technology by varying the spraying width.For achieving enhanced transmittance,we combined the larger irregular grids and holes with fewer nanowires stacked in the longitudinal direction,more optical chan-nels,and good carrier transport.Thereafter,aluminum-doped zinc oxide(AZO)was used as capping to the structure for enhancing the optical properties of the TCFs.The silver nanowires-SWCNTs/AZO(ASA)bilayer was obtained in the optimized architecture,which showed superior optoelectronic performance to that shown by commercial ITO with a high optical transmittance of 92%at the wavelength of 550 nm and low sheet resistance of 17/sq.In the specially structured conductive film,the significant improvement in the transmittance and uniformity of the sheet resistance was attributed to the effective nanowire junc-tion contact compared to that in ordinary structure of silver nanowires,which reduced the mean density of small clusters of nanowires.Compared with the silver nanowires-SWCNTs films,the ASA bilayer film exhibited excellent resistance to boiling,mechanical bending(10,000 cycles),and CO_(2)plasma.Moreover,the sheet resistance of ASA changed slightly after the tape tests,thereby illustrating a strong adhesion to the PEN substrate after the enclosure of AZO.Meanwhile,the AZO capping layer can enhance the op-tical transmittance between 600 and 1500 nm.In addition,the amorphous silicon photovoltaic devices with flexible ASA TCFs exhibited a power conversion efficiency(PCE)of 8.67%.After bending for 3000 times,the PCE was decreased to 8.20%,thereby demonstrating the potential of developed films to replace traditional ITO.

Envafolimab plus lenvatinib and transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma:a prospective,single-arm,phase II study

Evidences regarding the feasibility of transcatheter arterial chemoembolization(TACE)-based therapy for unresectable hepatocellular carcinoma(uHCC)remains limited.This study aimed to investigate the efficacy and safety of TACE combined with envafolimab and lenvatinib for uHCC.Eligible patients with uHCC received envafolimab and lenvatinib after TACE until disease progression,conversion to surgery,intolerable toxicities,or death.The primary endpoint was the objective response rate(ORR)assessed according to Response Evaluation Criteria in Solid Tumors(RECIST)1.1 criteria.Between March 2022 and July 2022,38 patients were included for safety analysis,and 36 patients were included for efficacy analysis.As of the data cutoff(13 December 2023),the median follow-up was 16.9 months.The ORR was 50%,and disease control rate(DCR)was 83.3%per RECIST 1.1(ORR and DCR of both 83.3%per modified RECIST(mRECIST)).The median progression-free survival(PFS)was 7.58 months.Of 36 patients,17 patients were converted to resectable HCC with a surgical conversion rate of 47.2%,and 16 patients underwent surgery with R0 resection rate of 100%,pathologic complete response(pCR)rate of 31.3%.Overall incidences of treatment-related adverse events(TRAEs)of any grade was 97.4%.Grade≥3 TRAEs were observed in 52.6%patients.No treatment-related deaths occurred.Image mass cytometry(IMC)analysis revealed that combined treatment improved the immune status of the tumor microenvironment,and resident macrophages had the potential to predict efficacy of this treatment.Envafolimab plus lenvatinib and TACE yielded promising survival outcomes and conversion efficiency with a tolerable safety profile.Trial registration Clinical trials:NCT05213221.