Validation and modification of the AJCC 8th TNM staging system for pancreatic ductal adenocarcinoma in a Chinese cohort:A nationwide pancreas data center analysis

Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refined staging system for PDAC.Methods:Data were collected from the China Pancreas Data Center(CPDC)for patients with resected PDAC in 2016 and 2017,and cancer-specific survival(CSS)was evaluated using the Kaplan-Meier method and log-rank test.Univariate and multivariate analyses based on Cox regression were performed to identify prognostic factors.The recursive partitioning analysis(RPA),Kaplan-Meier method,and log-rank test were performed on the training dataset to generate a proposed modification for the 8 th TNM staging system utilizing the preoperative carbohydrate antigen(CA)19-9 level.Validation was performed for both staging systems in the validation cohort.Results:A total of 1,676 PDAC patients were retrieved,and the median CSS was significantly different between the 8 th TNM groupings,with no significant difference in survival between stage IB and IIA.The analysis of T and N stages demonstrated a better prognostic value in the N category.Multivariate analysis showed that the preoperative serum CA19-9 level was the strongest prognostic indicator among all the independent risk factors.All patients with CA19-9>500 U/mL had similar survival,and we proposed a new staging system by combining IB and IIA and stratifying all patients with high CA19-9 into stage III.The modified staging system had a better performance for predicting CSS than the 8 th AJCC staging scheme.Conclusions:The 8 th AJCC staging system for PDAC is suitable for a Chinese cohort of resected patients,and the N category has a better prognostic value than the T category.Our modified staging system has superior accuracy in predicting survival than the 8 th AJCC TNM staging system.

Converting furfural residue wastes to carbon materials for high performance supercapacitor

Sustainable development based on the value-added utilization of furfural residues(FRs)is an effective way to achieve a profitable circular economy.This comprehensive work highlights the potential of FRs as precursor to prepare porous carbons for high performance supercapacitors(SCs).To improve the electrochemical performance of FR-based carbon materials,a facile route based on methanol pretreatment coupled with pre-carbonization and followed KOH activation is proposed.More defects could be obtained after methanol treatment,which is incline to optimize textural structure.The activated methanol treated FR-based carbon materials(AFRMs)possess high specific surface area(1753.5 m^(2) g^(-1)),large pore volume(0.85 cm^(3) g^(-1)),interconnected micro/mesoporous structure,which endow the AFRMs with good electrochemical performance in half-cell(326.1 F g^(-1) at 0.1 Ag^(-1),189.4 Fg^(-1) at 50 A g^(-1) in 6 mol L^(-1) KOH).The constructed symmetric SCs based on KOH,KOH–K_(3)Fe(CN)_(6) and KOH-KI electrolyte deliver energy density up to 8.9,9.9 and 10.6 Wh kg^(-1) with a capacitance retention of over 86%after 10,000 cycles.Furthermore,the self-discharge can be restrained by the addition of K_(3)Fe(CN)_(6) and KI in KOH electrolyte.This study provides an effective approach for high-valued utilization of FR waste.

Corrosion mechanism investigation of TiN/Ti coating and TC4 alloy for aircraft compressor application

It is imperative to develop multifunctional erosion and corrosion resistant coatings for compressor blades of aircraft engines in harsh environment.PVD(Physical Vapor Deposition)technology has the advances in processing erosion-resistant coatings;however,the performance of PVD coatings to combat corrosion depends on various coating defects.Determining and comparing the corrosion performances of PVD TiN/Ti coating and uncoated TC4 alloy was the main objective of present work.The 960 h salt spray corrosion and 116 h hot corrosion tests were conducted to simulate the grounding and working environments of the aircraft compressors.The corrosion mechanisms due to the coating defects such as pinhole,columnar boundary and large grain were analyzed based on the OM,Confocal microscope,electrochemical measurements,SEM,XRD and EDS results.Owing to the disordered state associated with the columnar boundary and the coating defect,nitrogen could be easily replaced by oxygen in the hot corrosion process,these structures were channels for fast diffusion of oxygen.Moreover,the Gibbs energy changes of Ti oxidation and TiN oxidation were thermodynamically calculated according to the working condition of aircraft compressors,and considerable research effort was focused on mapping out the phase diagram of Ti,TiN and high pressure gases.The findings of this research can provide insights into developing multifunctional coatings for future aircraft engines.

The Rapid Assessment and Early Warning Models for COVID-19

Human beings have experienced a serious public health event as the new pneumonia(COVID-19), caused by the severe acute respiratory syndrome coronavirus has killed more than 3000 people in China, most of them elderly or people with underlying chronic diseases or immunosuppressed states. Rapid assessment and early warning are essential for outbreak analysis in response to serious public health events. This paper reviews the current model analysis methods and conclusions from both micro and macro perspectives. The establishment of a comprehensive assessment model, and the use of model analysis prediction, is very efficient for the early warning of infectious diseases. This would significantly improve global surveillance capacity, particularly in developing regions, and improve basic training in infectious diseases and molecular epidemiology.

Re-isolation of Wuxiang Virus from Wild Sandflies Collected from Yangquan County, China

We previously isolated a new species of the genus Phlebovirus from wild sandflies collected from Wuxiang County in central China,which named the Wuxiang virus(WUXV).In this study,we re-isolated the WUXV from wild sandflies collected from two villages in Yangquan County,China in 2019.Four virus isolates that caused cytopathic effects in BHK-21 cells were successfully isolated from sandfly specimens collected from chicken pens and sheep pens.Phylogenetic analyses of the L,M and S gene segments of the viruses revealed that the four virus strains represented the previously isolated WUXV.The minimum infection rate(MIR)of the virus isolated from the sheep pen was 3.21,and the MIR of the virus isolated from the chicken pen was 3.45.The positive rates of Wuxiang virus neutralizing antibodies in serum samples of local healthy people and domestic chickens were 8.7%(4/46)and 100%(4/4),respectively,suggesting that Wuxiang virus can infect human and animal.In view of the fact that Wuxiang virus is infectious to humans and animals and has a relatively wide geographical distribution in China,it is of great public health significance to strengthen the investigation and study on the infection status of Wuxiang virus in humans and animals.

The self-assembled nanoparticle-based trimeric RBD mRNA vaccine elicits robust and durable protective immunity against SARS-CoV-2 in mice

As COVID-19 continues to spread rapidly worldwide and variants continue to emerge,the development and deployment of safe and effective vaccines are urgently needed.Here,we developed an mRNA vaccine based on the trimeric receptor-binding domain(RBD)of the SARS-CoV-2 spike(S)protein fused to ferritin-formed nanoparticles(TF-RBD).Compared to the trimeric form of the RBD mRNA vaccine(T-RBD),TF-RBD delivered intramuscularly elicited robust and durable humoral immunity as well as a Th 1-biased cellular response.After further challenge with live SARS-CoV-2,immunization with a two-shot low-dose regimen of TF-RBD provided adequate protection in hACE2-transduced mice.In addition,the mRNA template of TF-RBD was easily and quickly engineered into a variant vaccine to address SARS-CoV-2 mutations.The TF-RBD multivalent vaccine produced broad-spectrum neutralizing antibodies against Alpha(B.1.1.7)and Beta(B.1.351)variants.This mRNA vaccine based on the encoded self-assembled nanoparticle-based trimer RBD provides a referenee for the design of mRNA vaccines targeting SARS-CoV-2.

MicroRNAs as potential therapeutic targets for pancreatic cancer

Pancreatic cancer is one of the most aggressive malignancies. The poor prognosis of pancreatic cancer patients is mainly attributed to low diagnostic rate at the early stage, highly aggressive nature coupled with the inadequate efficacy of current chemotherapeutic regimens. Novel therapeutic strategies are urgently needed for pancreatic cancer. MicroRNAs (miRNAs) play an important regulatory role in key processes of cancer development. The aberrant expression of miRNAs is often involved in the initiation, progression, and metastasis of pancreatic cancer. The discovery of tumor suppressor miRNAs provides prospects for the development of a novel treatment strategy for pancreatic cancer. We reviewed recent progress on the understanding of the role of miRNAs in pancreatic cancer, highlighted the efficient application of miRNAs-based therapies for pancreatic cancer in animal models and clinical trials, and proposed future prospects. This review focuses on the promise of integrating miRNAs into the treatment of pancreatic cancer and provides guidance for the development of precision medicine for pancreatic cancer.

Flexible design of gradient multilayer nanofilms coated on carbon nanofibers by atomic layer deposition for enhanced microwave absorption performance

Impedance matching is important for achieving high-efficiency microwave absorbers. The high conductivity of dielectric loss materials such as pure metals and carbon nanomaterials generally results in poor absorption owing to the low impedance matching between the absorbers and air. Carbon nanostructures are very promising candidates for high-efficiency absorption because of their attractive features including low density, high surface area, and good stability. Herein, a new strategy is proposed to improve the impedance matching of dielectric loss materials using electrospun carbon nanofibers as an example. The carbon nanofibers are coated with specifically designed gradient multilayer nanofilms with gradually increasing electroconductibility synthesized by doping ZnO with different A1203 content （AZO） by atomic layer deposition. The gradient nanofilms are composed of five layers of dielectric films, namely, pure A1203, AZO （5：1, the pulse cycle ratio of ZnO to A1203）, pure ZnO, AZO （10：1）, and AZO （20：1）. The versatile gradient films serve as intermediate layers to tune the impedance matching between air and the carbon nanofiber surfaces. Therefore, the carbon nanofibers coated with gradient films of rationally selected thicknesses exhibit remarkably enhanced microwave absorption performance, and the optimal reflection loss reaches -58.5 dB at 16.2 GHz with a thickness of only 1.8 mm. This work can help further understand the contribution of impedance matching to microwave absorption. Our strategy is general and can be applied to improve the absorption properties of other dielectric loss materials and even for applications in other fields.

Molecular characterization of circulating tumor cells in pancreatic ductal adenocarcinoma:potential diagnostic and prognostic significance in clinical practice

Background:The clinical value of heterogeneous sub-populations of circulating tumor cells(CTCs)in pancreatic ductal adenocarcinoma(PDAC)remains unclear.Methods:Peripheral blood samples were obtained from 67 PDAC patients.CTCs were isolated by employing CD45 negative enrichment technique and further characterized for epithelial to mesenchymal transition(EMT)or human equilibrative nucleoside transporter-1(hENT-1).The relationships between CTCs sub-phenotypes with clinicopathological factors or post-operative recurrence in PDAC patients were analyzed.Results:EMT related CTCs could be isolated and identified from the 81%of patients(54/67),and both the total count(median:5 vs.17/mL,P<0.0001)and M-CTC percentage(median:0.2 vs.0.345,P=0.0244)of CTCs could differentiate local/regional with metastatic disease.Multivariate analysis showed that both AJCC stage(P=0.025)and M-CTC percentage(P=0.001)were independent prognostic indicators of recurrence free survival(RFS)in resected patients.Moreover,Kaplan-Meier survival analysis showed that M-CTC after 2 courses of chemotherapy was significantly associated with inferior RFS(49.5 weeks vs.undefined,P=0.0288).No significant correlation in hENT-1 expression was found between CTCs and matched tumor tissues,and further multivariate analysis suggested hENT-1 expression in CTCs as independent prognostic factor for RFS(P=0.016).Patients with low hENT-1 expression in CTCs had decreased RFS(32 weeks vs.undefined,P=0.0337).Conclusions:CTCs could be the promising diagnostic biomarkers in PDAC patients,and phenotypic profiling of CTCs based on EMT or hENT-1 could help establish novel prognostic biomarkers in resected patients undergoing adjuvant gemcitabine-based chemotherapy.

Co-delivery of Cisplatin and Chlorin e6 by Poly(phosphotyrosine)for Synergistic Chemotherapy and Photodynamic Therapy

Nanoscale drug delivery systems(NDDSs)have emerged as promising carriers for combinational therapy by co-delivery of multiple drugs and modalities.However,most co-delivery systems require the use of complicated materials and formulations.Herein,we report the single use of a polymeric material,namely mPEG-block-poly(phosphotyrosine)(mPEG-b-PpY),as a multi-functional carrier for the facile fabrication of NDDS Pt/Ce6@mPEG-b-PpY(PtCeNP)for the co-delivery of cisplatin and photosensitizer chlorin e6(Ce6)via phosphato-platinum coordination andπ-πstacking,respectively.PtCeNP improves the solubility,cellular uptake,and bioavailability of both parental drugs,and showed strong synergistic antitumor efficacy both in vitro and in vivo through combined chemo-photodynamic therapy.Our results indicate that PpY is a biocompatible,multifunctional,and promising carrier material suitable for a variety of drugs and may simplify the design for co-delivery systems.

Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021)

Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.

A recombinant receptor-binding domain in trimeric form generates protective immunity against SARSCoV-2 infection in nonhuman primates

A safe and effective vaccine is critical to combat the COVID-19 pandemic.Here,we developed a trimeric SARS-CoV-2 receptor-binding domain(RBD)subunit vaccine candidate that simulates the natural structure of the spike(S)trimer glycoprotein.Immunization with the RBD trimer-induced robust humoral and cellular immune responses,and a high level of neutralizing antibodies was maintained for at least 4.5 months.Moreover,the antibodies that were produced in response to the vaccine effectively cross-neutralized the SARS-CoV-2501Y.V2 variant(B.1.351).Of note,when the vaccine-induced antibodies dropped to a sufficiently low level,only one boost quickly activated the anamnestic immune response,conferring full protection against a SARSCoV-2 challenge in rhesus macaques without typical histopathological changes in the lung tissues.These results demonstrated that the SARS-CoV-2 RBD trimer vaccine candidate is highly immunogenic and safe,providing long-lasting,broad,and significant immunity protection in nonhuman primates,thereby offering an optimal vaccination strategy against COVID-19.

Prognostic factors for disease-free survival in patients with pancreatic ductal adenocarcinoma after surgery: a single center experience

Objective: To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification of the 8th edition American Joint Committee on Cancer (AJCC) staging system. Methods: A cohort of 185 patients with PDAC who underwent surgical resection in the General Surgery Department of Peking University First Hospital from January 2010 to December 2017 was enrolled retrospectively. The clinicopathological characteristics and survival data were analyzed to find out risk factors correlated to DFS. The survival curves were calculated according to the 8th edition of AJCC staging system. Results:Among the 185 PDAC patients, 125 (67.6%) with pancreatic head carcinoma underwent pancreatoduodenectomy or total pancreatectomy, and 60 (32.4%) with tumors located in the pancreatic body and tail underwent distal pancreatectomy and splenectomy. R0 resection was achieved in 97 patients (52.4%), and the R1 and R2 resections rate was 44.9% and 2.7%, respectively. One hundred five patients (56.8%) received postoperative adjuvant chemotherapy. The median overall survival (OS) was 21 (95% confidence interval [CI] 17.7–24.3) months, and median DFS was 15 (95% CI 13.6–16.5) months. Univariate analysis showed that AJCC T and N staging, status of resection margin, grade of tumor differentiation, perineural invasion, intravascular cancer embolus, combined vascular resection, neutrophil-to-lymphocyte ratio (NLR)≥2, carcinoembryonic antigen ≥5ng/mL, carbohydrate antigen 19-9 (CA 19-9)≥400U/mL, and without postoperative adjuvant chemotherapy were correlated with shorter DFS. Furthermore, AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy were independent risk factors for DFS. Both the DFS and OS curves were well separated by stage using the 8th staging classification. Conclusions: The 8th edition of AJCC T, primary tumor;N, regional lymph nodes;M, distant metastasis staging system could predict the prognosis of PDAC accurately. Patients with AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy, have a significantly higher risk of tumor recurrence and shorter DFS after surgery. R0 resection and adjuvant chemotherapy could significantly prolong the DFS of PDAC patients.

Exosomal miR-485-3p derived from pancreatic ductal epithelial cells inhibits pancreatic cancer metastasis through targeting PAK1

Background:Cell competition is an important feature in pancreatic cancer(PC)progression,but the underlying mechanism remains elusive.This study aims to explore the role of exosomes derived from normal pancreatic ductal epithelial cells involved in PC progression.Methods:PC cells and pancreatic stellate cells(PSCs)were treated with exosomes isolated from pancreatic ductal epithelial cells.Cell proliferation was assessed by CCK8 assays.Cell migration and invasion were assessed by Transwell assays.PC and matched adjacent non-tumor tissue specimens were obtained from 46 patients pathologically diagnosed with PC at Peking University First Hospital from 2013 to 2017.Tissue miR-485-3p and p21-activated kinase-1(PAK1)expression was examined by real-time polymerase chain reaction(RT-PCR),and the relationship of the two was analyzed using Pearman’s product-moment correlation.The clinical significance of miR-485-3p was analyzed using the Chi-square test,Wilcoxon rank-sum test,and Fisher exact probability,respectively.The binding of miR-485-3p to PAK15’-untranslated region(5’-UTR)was examined by luciferase assay.PC cells were xenografted into nude mice as a PC metastasis model.Results:Exosomes from pancreatic ductal epithelial cells suppressed PC cell migration and invasion as well as the secretion and migration of PSCs.MiR-485-3p was enriched in the exosomes of pancreatic ductal epithelial cells but deficient in those of PC cells and PSCs,in accordance with the lower level in PSCs and PC cells than that in pancreatic ductal cells.And the mature miR-485-3p could be delivered into these cells by the exosomes secreted by normal pancreatic duct cells,to inhibit PC cell migration and invasion.Clinical data analysis showed that miR-485-3p was significantly decreased in PC tissues(P<0.05)and was negatively associated with lymphovascular invasion(P=0.044).As a direct target of miR-485-3p,PAK1 was found to exert an inhibitory effect on PC cells,and there was a significantly negative correlation between the expression levels of miR-485-3p and PAK1(r=-0.6525,P<0.0001)in PC tissues.Moreover,miR-485-3p could suppress PC metastasisin vivo by targeting p21-activated kinase-1.Conclusions:Exosomal miR-485-3p delivered by normal pancreatic ductal epithelial cells into PC cells inhibits PC metastasis by directly targeting PAK1.The restoration of miR-485-3p by exosomes or some other vehicle might be a novel approach for PC treatment.

Porous CuCo_(2)O_(4) microtubes as a promising battery-type electrode material for high-performance hybrid supercapacitors

Hollow nanostructures of transition metal oxides(TMOs)with hollow interior,low density,large surface area and surface permeability have drawn significant interest as electrode materials for supercapacitors.However,it is still challenging to controllably prepare hollow nanostructures by a facile method.Herein,we report for the first time that CuCo_(2)O_(4 )microrod precursor obtained from a solvothermal method in ethanol media can be converted into porous CuCo_(2)O_(4 )microtubes(CuCo_(2)O_(4 )MTs)in the post annealing treatment.The results of electrochemical tests demonstrate that these MTs are categorized as the typical battery-grade electrode materials.They can deliver a high capacity up to 393.66 C g^(-1) at ^(-1) A g^(-1) and still hold 305.99 C g^(-1) at 10 A g^(-1).Additionally,an assembled hybrid supercapacitor(CuCo_(2)O_(4 )MTs//AC HSC)exhibits 78.23 F g^(-1),good cycling durability and high energy density(32.49 W h kg^(-1) at 912.10 W kg^(-1)).The present synthetic methodology may be further applicable to the preparation of other hollow structural TMOs with applications in high-performance energy storage and conversion devices.

Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)

The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China:a national questionnaire survey

Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method:A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results:A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)pancreatojejunostomy was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of gastrojejunostomy(GJ)cases,the distance between GJ and hepaticojejunostomy<30,30-50,and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion:Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)PJ was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of GJ cases,the distance between GJ and HJ<30 cm,30-50 cm and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.

The management strategy of pancreatic cancer in the era of systemic therapy-“Surgery First” or “Surgery Last”?

With the development of chemotherapy,targeted therapy and immunotherapy,the management of solid tumors has evolved from a single discipline to multi-disciplinary comprehensive treatment in recent years.The outcome of patients with malignant tumors,including several gastrointestinal cancers,has been continuously improved,along with a significant improvement in long-term survival rate.However,as a common malignant tumor of the digestive system,pancreatic cancer(PC)is still correlated with a very poor prognosis,characterized by the close parallel between incidence and mortality.