Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

BACKGROUND Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidence. AIM To investigate and emphasize the clinical outcomes of Blumgart anastomosis compared with traditional anastomosis in reducing postoperative pancreatic fistula. METHODS In this observational study, a retrospective analysis of 291 patients who underwent pancreatoduodenectomy, including Blumgart anastomosis (201 patients) and traditional embedded pancreaticojejunostomy (90 patients), was performed in our hospital. The preoperative and perioperative courses and longterm follow-up status were analyzed to compare the advantages and disadvantages of the two methods. Moreover, 291 patients were then separated by the severity of postoperative pancreatic fistula, and two methods of pancreaticojejunostomy were compared to detect the features of different anastomosis. Six experienced surgeons were involved and all of them were proficient in both surgical techniques.RESULTS The characteristics of the patients in the two groups showed no significant differences, nor the preoperative information and pathological diagnoses. The operative time was significantly shorter in the Blumgart group (343.5 ± 23.0 vs 450.0 ± 40.1 min, P = 0.028), as well as the duration of pancreaticojejunostomy drainage tube placement and postoperative hospital stay (12.7 ± 0.9 d vs 17.4 ± 1.8 d, P = 0.031;and 21.9 ± 1.3 d vs 28.9 ± 1.3 d, P = 0.020, respectively). The overall complications after surgery were much less in the Blumgart group than in the embedded group (11.9% vs 26.7%, P = 0.002). Patients who underwent Blumgart anastomosis would suffer less from severe pancreatic fistula (71.9% vs 50.0%, P = 0.006), and this pancreaticojejunostomy procedure did not have worse influences on long-term complications and life quality. Thus, Blumgart anastomosis is a feasible pancreaticojejunostomy procedure in pancreatoduodenectomy surgery. It is safe in causing less postoperative complications, especially pancreatic fistula, and thus shortens the hospitalization duration. CONCLUSION Surgical method should be a key factor in reducing pancreatic fistula, and Blumgart anastomosis needs further promotion.

Diagnostic accuracy of K-ras mutation for pancreatic carcinoma:a meta-analysis

BACKGROUND:The conventional tests for the diagnosis of early stage pancreatic carcinoma are not acceptable.This metaanalysis is to evaluate the accuracy of K-ras mutation for the diagnosis of pancreatic carcinoma.DATA SOURCES:A systemic search of all relevant literature was performed in Web of Science,EMBASE,Cochrane Database,and MEDLINE(PubMed as the search engine) prior to June 1,2011.Thirty-four studies fulfilled the inclusion criteria and data were pooled for analysis.RESULTS:The pooled estimates for K-ras mutation in diagnosis of pancreatic carcinoma were as follows:sensitivity 0.68(95% CI:0.66-0.71),specificity 0.87(95% CI:0.85-0.88),positive likelihood ratio 4.54(95% CI:3.47-5.94),negative likelihood ratio 0.37(95% CI:0.30-0.44) and diagnostic odds ratio 14.90(95% CI:10.02-22.15).Summary receiver operating characteristic analysis demonstrated that the maximum joint sensitivity and specificity was 0.79,and the overall area under the curve was 0.86.CONCLUSIONS:Diagnostic accuracy of K-ras mutation was not superior to that of conventional tests.Therefore,K-ras mutation analysis alone is not recommended for the diagnosis of pancreatic carcinoma.

Prognostic significance of epidermal growth factor-like domain 7 in pancreatic cancer

BACKGROUND： Recent studies have shown the clinical significance of epidermal growth factor-like domain 7（EGFL7）in a variety of cancers. However, the relationship between EGFL7 and the prognosis of pancreatic cancer（PC） remains unclear. The present study was undertaken to investigate the role of EGFL7 in the prognosis of PC.METHODS： The expression of EGFL7 in nine PC cell lines was first determined by Western blotting analysis. Tissue microarray-based immunohistochemical staining was performed in paired formalin-fixed paraffin-embedded tumor and non-tumor samples from 83 patients with PC. Finally,correlations between EGFL7 expression and clinicopathological variables as well as overall survival were evaluated.RESULTS： EGFL7 was widely expressed in all PC cell lines tested.EGFL7 expression in tumor tissues was significantly higher than that in non-tumor tissues（P0.040）. In addition, univariate analysis revealed that high EGFL7 expression in tumor tissues was significantly associated with poor overall survival,accompanied by several conventional clinicopathological variables, such as gender, histological grade and lymph node metastasis. In a multivariate Cox regression test, EGFL7 expression was identified as an independent marker for longterm outcome of PC.CONCLUSION： Our data showed that EGFL7 is extensively expressed in PC and that EGFL7 is associated with poor prognosis.

Advances in understanding the molecular mechanism of pancreatic cancer metastasis

BACKGROUND： Pancreatic cancer（PC） is usually diagnosed at the late-stage and therefore, has widespread metastasis and a very high mortality rate. The mechanisms underlying PC metastasis are not well understood. Recent advances in genomic sequencing have identified groups of gene mutations that affect PC metastasis, but studies elucidating their roles are lacking. The present review was to investigate the molecular mechanisms of PC metastasis.DATA SOURCES： Relevant articles on PC metastasis were searched in MEDLINE via Pub Med prior to April 2015. The search was limited in English publications.RESULTS： PC metastatic cascades are multi-factorial events including both intrinsic and extrinsic elements. This review highlights the most important genetic alterations and other mechanisms that account for PC invasion and metastasis, with particular regard to epithelial-mesenchymal transition, inflammation, stress response, and circulating tumor cells.CONCLUSIONS： Analyses of relevant gene functions and signaling pathways are needed to establish the gene regulatory network and to define the pivotal modulators. Another promising area of study is the genotyping and phenotyping of circulating tumor cells, which could lead to a new era of personalized therapy by identifying specific markers and targets.

A novel polymer gel with high-temperature and high-salinity resistance for conformance control in carbonate reservoirs

Plugging agents have been widely used to enhance oil recovery in fractured-vuggy carbonate reservoirs.However,the harsh conditions of fractured-vuggy carbonate reservoirs yield a significant challenge in maintaining a long-term stabilization of plugging agents.In this work,we developed an anti-hightemperature and high-salinity polymer gel(APG)with excellent resistance to high temperature(140℃)and ultra-high salinity(240000 mg/L).The rheology and microstructure of APG were characterized before and after gelation.Core plugging tests on fractured cubic cores were conducted to quantify the plugging performance of the gel system.Experimental results showed that the Sclerglucan and Cobalt(Ⅱ)Chloride Hexahydrate filled the three-dimensional(3-D)network with various morphologies,providing extra protection to the cross-linking points of the 3D network structure of APG and thus,leading to a prolongation of the dehydration time.The dehydration rate of APG was only 5%within 30days,and the strength of APG could be maintained at a rigid or near-rigid level over 150 days.Moreover,APG exhibited satisfactory shear and scour resistance.Core plugging tests showed that APG could achieve a plugging rate of 90%and demonstrate ignorable minor damage to the substrate.Our results indicate that APG can serve as a great candidate in channel plugging in fractured-vuggy carbonate reservoirs where fractures are fully developed.

Clinical characteristics, treatments, and prognosis of patients with multiple primary carcinoma of head and neck

To the Editor: Multiple primary carcinoma (MPC) or secondary primary carcinoma refers to two or more malignant tumors occurring in the same organ or different organs of a patient. MPC is classified into synchronous MPC (time between diagnoses ≤6 months) and metachronous MPC (time between diagnoses >6 months).[1] Clinically, MPC was easily misdiagnosed as the recurrence and metastasis of malignant tumor. In head and neck MPC patients, the correct diagnosis and active treatments are important.

Layer-Wise Pre-Training Low-Rank NMF Model for Mammogram-Based Breast Tumor Classification

Image-based breast tumor classification is an active and challenging problem.In this paper,a robust breast tumor classification framework is presented based on deep feature representation learning and exploiting available information in existing samples.Feature representation learning of mammograms is fulfilled by a modified nonnegative matrix factorization model called LPML-LRNMF,which is motivated by hierarchical learning and layer-wise pre-training(LP)strategy in deep learning.Low-rank(LR)constraint is integrated into the feature representation learning model by considering the intrinsic characteristics of mammograms.Moreover,the proposed LPML-LRNMF model is optimized via alternating direction method of multipliers and the corresponding convergence is analyzed.For completing classification,an inverse projection sparse representation model is introduced to exploit information embedded in existing samples,especially in test ones.Experiments on the public dataset and actual clinical dataset show that the classification accuracy,specificity and sensitivity achieve the clinical acceptance level.

Efficacy of non-surgical larynx-preservation comprehensive treatment in advanced laryngeal carcinoma

In China,patients with advanced laryngeal cancer are treated either with radical surgery followed by adjuvant radiotherapy or with non-surgical comprehensive treatment for organ preservation.Although important clinical trials have confirmed the possibility of laryngeal organ preservation in the treatment of advanced laryngeal cancer,[1,2]the best larynx-preservation strategy continues to be debated.[3,4]Here,we evaluated the efficacy of non-surgical comprehensive treatment that sought to preserve laryngeal function for patients with advanced laryngeal carcinoma.