Correlation between metastatic lymph node ratio and prognosis in patients with extrahepatic cholangiocarcinoma

AIM: To investigate the prognostic value of metastaticlymph node ratio(MLNR) in extrahepatic cholangiocarcinoma(ECC) patients undergoing radical resection.METHODS: Seventy-eight patients with ECC were enrolled.Associations between various clinicopathologic factors and prognosis were investigated by KaplanMeier analyses.The Cox proportional-hazards model was used for multivariate survival analysis.RESULTS: The overall three- and five-year survival rates were 47.26% and 23.99%, respectively.MLNR of 0, 0-0.2, 0.2-0.5, and > 0.5 corresponded to fiveyear survival rates of 28.59%, 21.60%, 18.84%, and 10.03%, respectively.Univariate analysis showed that degree of tumor differentiation, lymph node metastasis, MLNR, tumor-node-metastasis(TNM) stage, and margin status were closely associated with postoperative survival in ECC patients(P < 0.05).Multivariate analysis showed that MLNR and TNM stage were independent prognostic factors after pancreaticoduodenectomy(HR = 2.13, 95%CI: 1.45-3.11; P < 0.01; and HR = 1.97, 95%CI: 1.17-3.31; P = 0.01, respectively).The median survival time for MLNR > 0.5, 0.2-0.5, 0-0.2, and 0 was 15 mo, 24 mo, 23 mo, and 35.5 mo, respectively.There were statistical differences in survival time between patients with different MLNR(χ2 = 15.38; P < 0.01).CONCLUSION: MLNR is an independent prognostic factor for ECC patients after radical resection and is useful for predicting postoperative survival.

Comment on“Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis”

The present letter to the editor is in response to the research“Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis”by Elshaarawy et al in World J Gastroenterol 2021;13(5):424–439.The preoperative assessment of the liver reserve function in hepatocellular carcinoma(HCC)patients with cirrhosis is crucial,and there is no universal consensus on how to assess it.Based on a retrospective study,Elshaarawy et al investigated the impact of various classical clinical indicators on liver failure and the prognosis after hepatectomy in HCC patients with cirrhosis.We recommend that we should strive to explore new appraisal indicators,such as the indocyanine green retention rate at 15 min.

Resection of the main trunk of the superior mesenteric vein without reconstruction during surgery for giant pancreatic mucinous cystadenoma:A case report

Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for complete resection of pancreatic tumors. However, the optimum surgical method for venous management is controversial. Resection of the SMV without reconstruction during surgery for pancreatic tumors is rarely reported. Here we present the case of a 58-year-old woman with a giant pancreatic mucinous cystadenoma adhering to the SMV, who underwent an en bloc tumor resection, including the main trunk of the SMV and the spleen. No venous reconstruction was performed during surgery. No ischemic changes occurred in the bowel. The presence of several welldeveloped collateral vessels was shown by 3-dimensional computed tomography examination. The patient had an uneventful postoperative period and was discharged. This case indicated that the main trunk of the SMV can be resected without venous reconstruction if adequate collateralization has formed.

Microarray analysis to explore the effect of CXCL12 isoforms in a pancreatic pre-tumor cell model

CXCL12 expression was significantly lower in tumor samples than in corresponding normal samples.CXCL12 expression was significantly positively related to the infiltration levels of T cells,dendritic cells(DCs),immature DCs,cytotoxic cells,Tfh cells,mast cells,B cells,Th1 cells,natural killer(NK)cells,pDCs,neutrophils,and T helper cells(Spearman correlation coefficient>0.5,P<0.001)and negatively correlated with the infiltration level of NK CD56bright cells.In addition,pancreatic hTERT-HPNE cells treated with three diverse CXCL12 isoforms exhibited changes mainly in the regulation of the epithelialmesenchymal transition activation pathway.

Prognostic role of expression of angiogenesis markers in hepatocellular carcinoma:A bioinformatics analysis

The expression of angiopoietin(ANGPT)1,ANGPT2,vascular endothelial growth factor(VEGF)A,VEGFB,VEGFC,VEGFD,and placental growth factor(PGF)is significantly higher in tumor tissues than in normal tissues in both unpaired and paired hepatocellular carcinoma(HCC)samples.ANGPT2,VEGFB,VEGFC,and PGF are primarily involved in regulating the activation of the epithelialmesenchymal transition pathway;ANGPT1 is primarily involved in regulating the activation of the RAS/mitogen-activated protein kinase and receptor tyrosine kinase(RTK)pathways;VEGFA is engaged in regulating the RTK activation pathway;and VEGFD is mainly involved in regulating the activation of the tuberous sclerosis protein/mammalian target of rapamycin pathway.There is a significant difference in overall survival between HCC patients with high and low expression of ANGPT2,PGF,VEGFA,and VEGFD.Disease free survival(DFS)is significantly shorter in HCC patients with high ANGPT2,PGF,and VEGFA expression than in those with low ANGPT2,PGF,and VEGFA expression.

Prevention of late complications of endoscopic resection of colorectal lesions with a coverage agent:Current status of gastrointestinal endoscopy

Endoscopic ectomy of large nonpedunculated colorectal lesions(≥20 mm)might cause significant adverse incidents,such as delayed perforation and delayed bleeding,despite the closure of mucosal lesions with clips.The conventional utilization of prophylactic clipping has not decreased the risk of postprocedural delayed adverse events,and additional outcomes and cost-effectiveness research is needed for patients with proximal lesions≥20 mm,in whom prophylactic clipping might be useful.Coverage of the wound after endoscopic excision offers shield protection against delayed concomitant diseases.

Optical properties of several ternary nanostructures

To investigate the optical properties of the ternary nanostructures, the nanodisk, core–shell, and three-sphere structures are constructed. The extinction coefficients and electric near-field distributions of these structures are calculated by the discrete dipole approximation(DDA) method. The result shows that the nanodisk structure has the best extinction efficiency in the three structures. Furthermore, several three-material combinations of the nanodisk structures are investigated. The ternary nanodisk structure composed of TiO_(2) and two noble metals(Au, Ag or Pt) has higher extinction coefficient and near-field intensity than the nanodisk consisting of Au, TiO_(2) and a semiconductor(Pb Se, Ge, MoS2, CdSe, CdS or TiO_(2)).Especially, TiO_(2)/Ag/Pt has the best extinction efficiency and the max electric near-field intensity. And the extinction spectra of TiO_(2)/Ag/Pt and TiO_(2)/Ag/Au structures are complementary in the visible range. This work conduces to the further research into ternary nanostructure and provides essential information about its performance in visible range.

Effects of ulinastatin on immune function, oxidative stress and related factors in patients with acute pancreatitis

Objective: To investigate the effects of ulinastatin on immune function, oxidative stress and related factors in patients with acute pancreatitis. Methods: 120 patients with acute pancreatitis admitted to digestive department of our hospital from May 2016 to May 2018 were randomly divided into control group and observation group, 60 cases in each group. Patients in the control group were given routine treatment, while patients in the observation group were given ulinastatin on the basis of the treatment of patients in the control group. The levels of Kim-1, Cys C, BUN, IgA, IgM, IgG, SOD, NO, TAC, PCT and CRP of patients in the two groups were detected and compared before and after treatment. Results: After treatment, the serum levels of Kim-1, Cys C, BUN, NO, PCT and CRP of patients in the control group and the observation group decreased significantly and the serum levels of IgA, IgG, IgM, SOD and TAC increased significantly. The change trend of these indexes in the serum of patients in the observation group was more obvious than those of patients in the control group (P<0.05). Conclusion: Ulinastatin in the treatment of acute pancreatitis can significantly alleviate kidney injury, enhance immune function and antioxidant capacity of patients, alleviate inflammation.