Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.

Combined hepatic segment color rendering technique improves the outcome of anatomical hepatectomy in patients with hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is the third most common cause for cancer-related death worldwide,especially in China[1].Hepatectomy is considered one of the most potentially curative therapies for HCC[2].As HCC is capable of vascular invasion and metastasis via the portal venous system,anatomical resection is often performed to reduce tumor recurrence.This process involves resecting the tumor-bearing portal branches and the corresponding hepatic parenchyma[3].Certain comparative studies have demonstrated better overall survival and disease-free survival with the use of anatomical resection when compared with nonanatomical resection[4–6].

The application of the extraglissonian approach for selective hepatic inflow occlusion during laparoscopic anatomical segmentectomy

Objective:Laparoscopic anatomical hepatectomy has been proven to be achievable for segmentectomy,subsegmentectomy and multi-segmentectomy.The extraglissonian approach in the context of selective hepatic inflow ocdlusion has been skilled under laparoscopy.This study aims to examine the suitability of the technique stated above for laparoscopic anatomical hepatectomy.Methods:This retrospective study analyzed the dinical data of 114 patients diagnosed with hepatocel-lular carcinoma who underwent laparoscopic anatomical hepatectomy using the extraglissonian hepatic inflow occlusion technique at the Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital between September 2020 and December 2022.Results:The success rate of achieving the ischemic area using the described methods was determined to be 74.6%.Out of the 85 cases that underwent laparoscopic anatomical hepatectomy,34 cases involved segmentectomy,5 cases involved subsegmentectomy,and 46 cases involved multi-segmentectomy.The average duration of the operation,blood loss volume,and postoperative hospi-tal stay were 229.0±85.0 min,133.0±112.0 mL,and 5.4±1.7 d,res pectively.Notably,no intraoperative blood transfusions were necessary,and no postoperative complications were observed.Conclusion:The extraglissonian hepatic inflow occlusion technique exhibits a notable advantage in terms of a high success rate,effectively guiding the selection process during laparoscopic parenchymal tran-section.Moreover,this technique has demonstrated safety,reproducibility,and significant potential for broader clinical adoption.

Safety and feasibility of irreversible electroporation for the pancreatic head in a porcine model

BACKGROUND Irreversible electroporation(IRE)is a local non-thermal ablative technique which has been suggested as a potential cancer therapy.However,the specific anatomic characteristics of the pancreatic head make it challenging to perform any local ablation in this region.Therefore,the safety and feasibility of IRE in the pancreatic head region should be further explored.AIM To evaluate the safety of IRE in pancreatic head region including its effects on pancreatic ducts,vessels,and adjacent gastrointestinal organs.METHODS Eight landrace miniature pigs underwent IRE of pancreatic head tissue successfully,with a total of 16 lesions created.Laboratory testing including white blood cell(WBC)count and serum amylase before IRE with follow-up laboratory analysis and pathological examination at 1,7,14,and 28 d postablation were performed.RESULTS All pigs tolerated the ablation procedure without serious perioperative complications.Transiently elevated WBC count and amylase were observed at 24 h post-IRE,suggesting an acute pancreatic tissue damage which was confirmed by pathological observations.Vascular endothelial cells and pancreatic duct epithelial cells in ablation zone were also positive in terminal deoxynucleotidyl transferase dUTP nick end labeling staining.There was extensive duodenum mucosa damage with local hemorrhage 24 h after ablation,while regeneration of new villous structures were observed at 7 and 28 d post-IRE.Masson’s trichromatic staining showed that the extracellular matrix was still intact in vessels and pancreatic ducts,and even in the duodenum.CONCLUSION IRE ablation to the pancreatic head may be safe and feasible without long-term damage to the surrounding vital structures.However,risks of stress injuries in acute phase should be taken into consideration to prevent severe perioperative complications.

Prognostic factors for patients with mass-forming intrahepatic cholangiocarcinoma:A case series of 68 patients

BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis.According to the Liver Cancer Study Group of Japan classification,ICC can be divided into three types:Mass-forming(MF)type,periductal-infiltrating(PI)type,and intraductal-growth type.The MF type is the most common,accounting for 57.1-83.6%of ICCs.Nevertheless,little is known about the epidemiology and treatment of MF ICC.AIM To examine the prognostic factors for patients with MF ICC.METHODS We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018.According to the treatment received,the patients were divided into either a resection group or an exploration group.RESULTS The pooled 1-,3-,and 5-year survival rates in the 68 patients with MF ICC were 66.5%,36.3%,and 9.3%,respectively.Univariate analysis revealed that surgical resection(P<0.001),nodal metastasis(P<0.001),tumor location(P=0.039),vascular invasion(P<0.001),ascites(P<0.001),and differentiation(P=0.009)were significantly associated with the prognosis and survival of MF ICC.Multivariate analysis revealed that ascites(hazard ratio[HR]=5.6,95%confidence interval[CI]:1.6-18.9,P=0.006)and vascular invasion(HR=2.5,95%CI:1.0-6.1,P=0.045)were independent risk factors for MF ICC.The pooled 1-,3-,and 5-year survival rates in the 19 patients of the exploration group were 5.3%,5.3%,and 0,respectively.Among the 49 patients who underwent surgical resection,the pooled 1-,3-,and 5-year survival rates were 93.5%,49.7%,and 14.4%,respectively.Univariate and multivariate analyses revealed that vascular invasion(HR=3.1,95%CI:1.2-8.5,P=0.024)and nodal metastasis(HR=3.2,95%CI:1.4-7.6,P=0.008)were independent prognostic risk factors for surgical resection patients.CONCLUSION The prognosis of MF ICC patients is dismal,especially those with ascites or vascular invasion.Surgical resection is a key factor in improving overall survival in patients with MF ICC,and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.

Feasibility and safety of “bridging” pancreaticogastrostomy for pancreatic trauma in Landrace pigs

BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length of surgery,low secondary trauma,rapid construction of shunts for pancreatic fluid,preventing second surgeries,and achieving good treatment outcomes in clinical practice.However,due to the limited number of clinical cases,there is a lack of strong evidence to support the feasibility and safety of this surgical procedure.Therefore,we carried out animal experiments to examine this procedure,which is reported here.AIM To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy,“bridging”pancreaticogastrostomy.METHODS Ten Landrace pigs were randomized into the experimental and control groups,with five pigs in each group.“Bridging”pancreaticogastrostomy was performed in the experimental group,while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.After surgery,the general condition,amylase levels in drainage fluid on Days 1,3,5,and 7,fasting and 2-h postprandial blood glucose 6 mo after surgery,fasting,2-h postprandial peripheral blood insulin,and portal vein blood insulin 6 mo after surgery were assessed.Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS After surgery,the general condition of the animals was good.One in the control group did not gain weight 6 mo after surgery,whereas significant weight gain was present in the others.There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7.There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups.One month after surgery,the sinus tract orifice/anastomosis was patent in the two groups.Six months after surgery,the sinus tract orifice/anastomosis was sealed,and pancreases in both groups presented with chronic pancreatitis.CONCLUSION“Bridging”pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.

Bile Acid Overload Induced by Bile Duct and Portal Vein Ligation Improves Survival after Staged Hepatectomy in Rats

Objective Compared to portal vein ligation(PVL),simultaneous bile duct and portal vein ligation(BPL)can significantly enhance hypertrophy of the intact liver.This study aimed to investigate whether BPL could improve survival after extended hepatectomy independently of an increased remnant liver.Methods We adopted rat models of 90%BPL or 90%PVL.To investigate the role of bile acids(BAs)the BA pools in the PVL and BPL groups were altered by the diet.Staged resection preserving 10%of the estimated liver weight was performed 3 days after BPL;PVL;or sham operation.Histology,canalicular network(CN)continuity;and hepatocyte polarity were evaluated.Results At 3 days after BPL;PVL;or sham operation when the volumetric difference of the intended liver remained insignificant,the survival rates after extended hepatectomy were 86.7%,47%,and 23.3%,respectively(P<0.01).BPL induced faster restoration of canalicular integrity along with an intensive but transient BA overload.Staged hepatectomy after BPL shortened the duration of the bile CN disturbance and limited BA retention.Decreasing the BA pools in the rats that underwent BPL could compromise these effects,whereas increasing the BA pools of rats that underwent PVL could induce similar effects.The changes in CN restoration were associated with activation of LKB1.Conclusion In addition to increasing the future remnant liver,BPL shortened the duration of the spatial disturbance of the CN and could significantly improve the tolerance of the hypertrophied liver to staged resection.BPL may be a safe and efficient future option for patients with an insufficient remnant liver.

Robotic versus laparoscopic surgery for sporadic benign insulinoma:Short-and long-term outcomes

Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.

In-Situ Annealed Ti_(3)C_(2)T_(x) MXene Based All-Solid-State Flexible Zn-Ion Hybrid Micro Supercapacitor Array with Enhanced Stability

Zn-ion hybrid supercapacitors(SCs)are considered as promising energy storage owing to their high energy density compared to traditional SCs.How to realize the miniaturization,patterning,and flexibility of the Zn-ion SCs without affecting the electrochemical performances has special meanings for expanding their applications in wearable integrated electronics.Ti_(3)C_(2)T_(x) cathode with outstanding conductivity,unique lamellar structure and good mechanical flexibility has been demonstrated tremen-dous potential in the design of Zn-ion SCs,but achieving long cycling stability and high rate stability is still big challenges.Here,we proposed a facile laser writing approach to fabricate patterned Ti_(3)C_(2)T_(x)-based Zn-ion micro-supercapacitors(MSCs),followed by the in-situ anneal treatment of the assembled MSCs to improve the long-term stability,which exhibits 80%of the capacitance retention even after 50,000 charge/discharge cycles and superior rate stability.The influence of the cathode thickness on the electrochemical performance of the MSCs is also studied.When the thickness reaches 0.851μm the maximum areal capacitance of 72.02 mF cm^(−2)at scan rate of 10 mV s^(−1),which is 1.77 times higher than that with a thickness of 0.329μm(35.6 mF cm^(−2)).Moreover,the fab-ricated Ti_(3)C_(2)T_(x) based Zn-ion MSCs have excellent flexibility,a digital timer can be driven by the single device even under bending state,a flexible LED displayer of“TiC”logo also can be easily lighted by the MSC arrays under twisting,crimping,and winding conditions,demonstrating the scalable fabrication and application of the fabricated MSCs in portable electronics.