Analysis of 300 consecutive cases of pancreatic adenocarcinoma in a single-center in China

BACKGROUND: Most of the reports on the prognostic indicators of patients with pancreatic adenocarcinoma are from developed countries. The present study focused on the prognostic indicators of Chinese patients with pancreatic adenocarcinoma. METHODS: A total of 300 patients with pancreatic adenocarcinoma who had undergone curative resection were included. The resection and R0/R1 resection rates for adenocarcinomas from different parts of the pancreas were calculated and clinical characteristics were analyzed.RESULTS: In 3427 patients diagnosed with pancreatic adenocarcinomas, only 300(8.8%) were eligible for radical resection. The total median survival of these patients was 19 months, and their 1-, 3-, and 5-year survival rates were 72.5%, 28.0% and 23.4%, respectively. The prognostic factors included socioeconomic status, smoking history, symptoms, high blood glucose, and various tumor characteristics, including perineural and vascular invasion, lymph node metastases, and CA19-9 levels before and after operation. Operation-associated prognostic indicators included operation time, blood loss and transfusions, pancreatic fistula, and complications. Independent predictors of mortality included poor socioeconomic status, smoking history, symptoms, CA19-9, perineural invasion and lymph node metastasis, grade of fistula and complications. Patient survival was not correlated with either resection margin or adjuvant chemotherapy in multivariate analysis.CONCLUSIONS: The survival rates of patients with curative resection for pancreatic adenocarcinoma in China are close to those in developed countries, but curative resection rate is far below. Socioeconomic status, symptoms, and CA19-9 are the three most prominent prognostic factors, which are helpful in patient selection and perioperative care.

Exploration of transmission chain and prevention of the recurrence of coronavirus disease 2019 in Heilongjiang Province due to inhospital transmission

The coronavirus disease 2019(COVID-19)epidemic is a major public health emergency characterized by fast spread,a wide range of infections,and enormous control difficulty.Since the end of December 2019,Wuhan has become the first core infection area of China's COVID-19 outbreak.Since March 2020,the domestic worst-hit areas have moved to the Heilongjiang Province due to the increased number of imported COVID-19 cases.Herein,we reported the major COVID-19 outbreak,which caused a rebound of the epidemic in Harbin,China.After the rebound,different levels of causes for the recurrence of COVID-19,including citylevel,hospital-level,and medical staff-level cause,were investigated.Meanwhile,corresponding countermeasures to prevent the recurrence of the epidemic were also carried out on the city level,hospital level,and medical staff level,which eventually showed the effect of infection control function in a pandemic.In this study,we described the complete transmission chain,analyzed the causes of the outbreak,and proposed corresponding countermeasures from our practical clinical experience,which can be used as a valuable reference for COVID-19 control.

Management of granulomatous lobular mastitis: an international multidisciplinary consensus(2021 edition)

Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

Pathogenesis and preventive measures of environment-related cardiovascular disease in northern China

Cardiovascular diseases(CVDs)have been the top-ranked cause of human death in the world for years,according to the World Health Organization.Accumulating evidence from epidemiological data supports the view that the risk of CVDs is higher in northern China than in southern area.There is no doubt that living environment has become a crucial factor contributing to the occurrence and progression of CVDs in northern region.However,there have not been any clinical guidelines for the prevention strategy of environment-related CVDs,especially for cold exposure.Thus,there is an urgent need for better understanding of the clinical characteristics and underlying mechanisms of cold-induced CVDs in order to formulate and implement proper and effective measures for minimizing the risk of CVDs for people residing in low-temperature area.Cold exposure,air pollution,lack of sunlight and irrational diet are believed to be crucial factors responsible for environment-related CVDs,and preventive measures might be carried out accordingly to decrease the high risk of CVDs in northern China.

Early postsurgical lethal outcome due to splenic littoral cell angioma:A case report

BACKGROUND Littoral cell angioma(LCA)is a rare benign vascular tumor of the spleen.Given its rarity,standard diagnostic and therapeutic recommendations have yet to be developed for reported cases.Splenectomy is the only method of obtaining a pathological diagnosis and providing treatment to obtain a favorable prognosis.CASE SUMMARY A 33-year-old female presented with abdominal pain for one month.Computed tomography and ultrasound revealed splenomegaly with multiple lesions and two accessory spleens.The patient underwent laparoscopic total splenectomy and accessory splenectomy,and splenic LCA was confirmed by pathology.Four months after surgery,the patient presented with acute liver failure,was readmitted,rapidly progressed to multiple organ dysfunction syndrome and died.CONCLUSION Preoperative diagnosis of LCA is challenging.We systematically reviewed online databases to identify the relevant literature and found a close relationship between malignancy and immunodysregulation.When a patient suffers from both splenic tumors and malignancy or immune-related disease,LCA is possible.Due to potential malignancy,total splenectomy(including accessory spleen)and regular follow-up after surgery are recommended.If LCA is diagnosed after surgery,a comprehensive postoperative examination is needed.

How to effectively manage the refractory coronary thrombus? A systemic mini-review

The main management principle for patients with coronary thrombus should be “more removal and less implantation”.Routine thrombus aspiration(TA) is ineffective for intracoronary thrombus or high residual thrombus burden after TA and may result in a refractory coronary thrombus.It is unwise to implant a stent in the vessel with high residual thrombus,which is associated with no-reflow,impaired microvascular perfusion,and consequently worse clinical outcomes.Therefore,increasing the efficiency of TA during percutaneous coronary intervention procedures,especially under some conditions of refractory coronary thrombus,is very important to restore myocardial reperfusion and improve microvascular dysfunction early.In the present work,we aimed to demonstrate the factors that may affect TA efficiency and introduce several highly effective approaches to treat refractory coronary thrombus.

The intricate relationship between cold exposure and gut microbiota

In order to advance microbiota-based therapies for cold-related diseases,it is crucial to fundamentally understand the intricate connections between cold exposure and the influence on gut microbiota composition.Identifying unique cold-related microbes and understanding their functionalities will be pivotal in developing effective treatments for cold-related diseases.

Chinese expert consensus on multidisciplinary diagnosis and treatment of pancreatic neuroendocrine liver metastases

Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.

Consensus of clinical diagnosis and treatment for non-functional pancreatic neuroendocrine neoplasms with diameter<2 cm

In clinical practice,pancreatic neuroendocrine neoplasms(pNENs)with a diameter smaller than 2 cm are commonly referred to as small pNENs.Due to their generally favorable biological characteristics,the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial.In response to this,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs,which is based on evidence-based medicine and expert opinions.This consensus covers various topics,including concepts,disease assessment,treatment selection,follow-up,and other relevant aspects.

Emergency strategies and trends in the management of liver trauma

The liver is the most frequently injured organ during abdominal trauma.The management of hepatic trauma has undergone a paradigm shift over the past several decades,with mandatory operation giving way to nonoperative treatment.Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy.Hemodynamically unstable patients should undergo focused abdominal sonography for trauma,whereas stable patients may undergo computed tomography,the standard examination protocol.The grade of liver injury alone does not accurately predict the need for operation,and nonoperative management is rapidly becoming popular for high-grade injuries.Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention.The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques.Although surgical intervention for hepatic trauma is not as common now as it was in the past,current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries,such as packing,Pringle maneuver,selective vessel ligation,resectional debridement,and parenchymal sutures.The present review presents emergency strategies and trends in the management of liver trauma.

Cytokine levels and pathological characteristics of a patient with severe coronavirus disease 2019:a case report

To the Editor:The clinical spectrum of coronavirus disease 2019(COVID-19)appears to be wide,ranging from asymptomatic to severe progressive pneumonia with respiratory failure,multiorgan failure,and even death.Here,we investigated the clinical and pathological characteristics of a patient who died from severe COVID-19.Our findings will facilitate a deeper understanding of the pathogenesis and progression of COVID-19 and improve clinical strategies to combat the disease.On January 23,2020,a 57-year-old man without relevant history presented with fatigue and fever after attending a family party 2 days prior.Among the members of the family party,one relative had traveled from Wuhan.Over 9 days,the fever and cough developed,and the patient visited the emergency department.A throat swab was positive for severe acute respiratory syndrome coronavirus 2(SARS-COV-2)on real-time reverse-transcription polymerase chain reaction.He was admitted to the local hospital and received supportive therapies,anti-viral agents,atomized inhalation of interferon-γ,and oxygen therapy.Cough,fever,and dyspnea further developed on February 8.He received non-invasive mechanical ventilation therapy.On February 18,he was transferred to a superior hospital with shortness of breath.

Acute necrotizing pancreatitis: challenges and interventions-a narrative review

Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.20%of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The CT-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.

Acute necrotizing pancreatitis:challenges and interventions—a narrative review

Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.Twenty percent of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The contrast-enhanced computed tomography(CECT)-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.

Prophylactic antibiotics and abdominal drainage in early recovery pathway for hepatectomy

Enhanced recovery after surgery(ERAS)protocols have been pioneered by Kehlet and include multimodal perioperative care to reduce complications rate,cost and hospital stay.The paper"Early recovery pathway for hepatectomy:data-driven liver resection care and recovery"by Warner and colleagues attempt to formulate a pathway for practice based on data to allow creation of rational order sets for efficient and superior practice(1).