Application of Neo-Pancreaticogastrostomy in Total Laparoscopic Pancreaticoduodenectomy.

Objective: To introduce laparoscopic neo-pancreaticogastrostomy (neo-PG) and investigate its application potential in total laparoscopic pancreaticoduodenectomy (TLPD). Materials and Methods: We performed a single-center prospective single-arm trial to evaluate the feasibility and safety of neo-PG for its initial application in TLPD. The first 50 patients who were operated by a single surgeon and who underwent TLPD with neo-PG at our institution were recruited. The pre/intra/postoperation data were collected and analyzed. Results: Twenty-nine male patients and 21 female patients from May 2022 to March 2023 were included. The mean operation time was 272.60 ± 47.30 minutes. The median PG time was 16 (15, 23) minutes. Six patients had delayed gastric emptying (DGE), and all underwent standard LPD. None of the patients had Grade B/C postoperative pancreatic fistula (POPF) or postoperative hemorrhage, or underwent reoperation. The median length of post-LPD hospital stay was 6 (6, 8) days. None of the patients died within 90 days after surgery. Nineteen cases were pathologically classified as pancreatic lesion, 6 cases as bile duct lesion, 18 cases as duodenal lesion, and 7 cases as ampullary lesion. Conclusion: The laparoscopic neo-PG is a simple, safe, and feasible pancreatic anastomosis that can be applied in TLPD. Pylorus-preserving LPD may decrease DGE rate. Further studies involving more surgeons are warranted to prove that our new technique may terminate POPF in TLPD.

Application of single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures in total laparoscopic pancreaticoduodenectomy.

INTRODUCTION: To investigate the application potential of single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures ("1 + 2" PJ) in total laparoscopic pancreaticoduodenectomy (TLPD). Explore the advantages of "1 + 2" PJ over the traditional double-layer interrupted duct-to-mucosa pancreaticojejunostomy (traditional PJ). METHODS: We retrospectively collected the clinical data of 184 patients who were admitted in our department from Oct 2019 to Oct 2022, including 95 cases who underwent TLPD with "1 + 2" PJ and 89 cases who underwent TLPD with traditional PJ. The pre/intra/postoperation data were analyzed and compared. RESULTS: The "1 + 2" PJ procedures were successfully performed in all the 95 cases. When compared with the traditional PJ group, there were no statistically significant variations between the pre-operative and pathological data. However, the "1 + 2" PJ group had a shorter operation time (235 (210, 300) minutes vs. 310 (270, 360) minutes in the traditional PJ group, P < 0.001), shorter pancreaticojejunostomy time (15 (10, 20) minutes vs. 50 (45, 55) minutes in the traditional PJ group, P < 0.001), lower pancreatic fistula (both grade B/C) rate (4.21% vs. 12.34% in the traditional group, P = 0.044), and abdominal infection rate (2.11% vs. 8.99% in the traditional group, P = 0.044), as well as reduced hospital stay (11 (9, 15) days vs. 13 (11, 15) days in the traditional PJ group, P = 0.013). In the "1 + 2" PJ group, the median diameter of the pancreatic duct was 3 (3, 4) mm; 82 cases (86.31%) had a normal pancreatic texture, while nine (9.47%) cases had a hard texture, and seven (7.37%) cases had a soft texture; the median intraoperative blood loss was 200 (100, 400) mL and 19 cases (20.00%) needed intraoperative transfusion; eight cases (8.4%) developed postoperative complications, including four cases (4.2%) of pancreatic fistula (including both grade B/C), one case (1.1%) of bile leakage, three cases (3.2%) of delayed gastric emptying, three cases (3.2%) of postoperative hemorrhage, two cases (2.1%) of abdominal infection, and one case (1.1%) of reoperation; the median hospital stay was 13 (8, 17) days; 25 cases were pathologically classified as pancreatic cancer, 35 cases as bile duct cancer, 23 cases as duodenal cancer, and 12 cases as ampullary cancer. CONCLUSION: Single-layer continuous duct-to-mucosa pancreaticojejunostomy with two figure-of-eight sutures is a feasible and safe procedure that can be applied in TLPD.

The Clinical Characteristics, Diagnostic Methods, Treatment, and Outcomes of Listeria monocytogenes Meningoencephalitis: A Case Series Study from China.

Background: Listeria monocytogenes meningoencephalitis (LMM) is a rare but dangerous infection of the nervous system. This study intends to summarize and discuss the clinical features, diagnostic methods, treatment, and outcomes. Methods: LMM patients treated in the First Affiliated Hospital of Zhengzhou University from June 2013 to December 2022 were retrospectively studied. The clinical data, magnetic resonance imaging (MRI), biochemical and hematological parameters, pathogen tests, treatments, and outcomes information were collected and summarized. Results: Ten LMM patients were enrolled in this study. Three were female and seven were male, with a mean age of 54.5 years old. Seven (70%) of the patients had chronic conditions that either affected the liver (1 case), heart (1 case), or immune system (5 cases). The main clinical manifestations were fever (100%), headache, (60%), and disturbance of consciousness (60%). Out of the nine patients taken MRI, enhanced magnetic resonance imaging was observed with cerebral parenchyma and meningeal enhancement in 3 patients, whereas six patients showed non-specific abnormal signals and brain edema. Seven (70%) patients were positive for L. monocytogenes by bacterial culture and five patients were positive by further next-generation sequencing (NGS) test in CSF. All patients were treated with antibiotics based on antibiotic sensitivity tests or experience, with seven (70%) improved but three (30%) died within one month. Conclusion: LMM patients have a high mortality rate. Considering the time and reliability of NGS reports, it would be better to identify L. monocytogenes infection in the CSF than bacterial culture. While, after diagnosis, giving timely and appropriate antibiotics would still be a challenge to achieve good outcomes.

Low-temperature in situ preparation of Eu3+/Tb3+-doped CaMoO4/SrMoO4 nanoparticle thin films and their application in anti-counterfeiting.

Rare earth-doped metal oxide thin films exhibit remarkable potential for application in anti-counterfeiting, owing to their exceptional fluorescent properties. However, the existing fabrication techniques for these rare earth-doped luminescent thin films are predominantly complex and necessitate high-temperature conditions. In light of this issue, we present a low-temperature method for in situ fabrication of luminescent Ca1-xMoO4:Eux3+ and Sr1-xMoO4:Tbx3+ nanocrystal thin films by a solution deposition process. The developed method has the advantages of simple operation, rapid and low-temperature synthesis. The optimal chemical compositions of molybdate-based luminescent films are Ca0.90MoO4:Eu0.103+ and Sr0.90MoO4:Tb0.103+. Moreover, we evaluate the practical feasibility of luminescent nanoparticle films in the field of anti-counterfeiting by combining the unique fluorescent properties of rare earth ions and designing customized fluorescent patterns.

Microplastics affect C, N, and P cycling in natural environments: Highlighting the driver of soil hydraulic properties.

As microplastics (MPs) are organic polymers with a carbon-based framework, they may affect nutrient cycling. Information regarding how MPs influence N, P, and C cycling and the underlying driving force remains lacking. N, P, and C cycling induced by soil hydraulic properties under MPs exposure (including polyethylene (PE), polyvinyl chloride (PVC), polystyrene (PS), polypropylene (PP)) in the natural environment were investigated in this study. MPs exposure increased the soil water content (11.2-84.5%) and reduced bulk density (11.4-42.8%); soil saturated hydraulic conductivity increased by 7.3-69.4% under PP and PE exposure. MPs exposure led to increases in available phosphorus, NO3--N, NH4+-N, and soil organic matter; the bacterial communities related to N and C cycling were significantly changed. Expression levels of soil N and C cycling-related genes were enhanced under low concentrations (0.5% and 2%) of MPs, except PVC; consequently, soil nitrogen storage and organic carbon storage increased by 12-75% and 6.7-93%, respectively. Correlation analyses among soil hydraulic properties, bacterial communities, and functional genes related to nutrient cycling revealed that soil hydraulic properties (including soil water content, saturated water capacity, and soil saturated hydraulic conductivity) were the dominant factors affecting soil N and C storage under MPs exposure.

Radical adducts formation mechanism of CH3CO2∙ and CH3CO3∙ realized decomposition of chitosan by plasma catalyzed peracetic acid.

High-molecular-weight chitosan has limited applications due to unsatisfactory solubility and hydrophilicity. Discharge plasma coupled with peracetic acid (PAA) oxidation ("plasma+PAA") realized fast depolymerization of high-molecular-weight chitosan in this study. The molecular weight of chitosan rapidly declined to 81.1 kDa from initial 682.5 kDa within 60 s of "plasma+PAA" treatment, and its reaction rate constant was 12-fold higher than single plasma oxidation. Compared with 1O2, ∙CH3, CH3O2·, and O2∙-, CH3CO2∙ and CH3CO3∙ played decisive roles in the chitosan depolymerization in the plasma+PAA system through mechanisms of radical adduct formation. The attacks of CH3CO2∙ and CH3CO3∙ destroyed the ß-(1,4) glycosidic bonds and hydrogen bonds of chitosan, leading to generation of low-molecular-weight chitosan; the main chain structure of chitosan was not changed during the depolymerization process. Furthermore, the generated low-molecular-weight chitosan exhibited greater antioxidant activities than original chitosan. Overall, this study revealed the radical adduct formation mechanisms of CH3CO2∙ and CH3CO3∙ for chitosan decomposition, providing an alternative for fast depolymerization of high-molecular-weight chitosan.

Free-ranging livestock affected the spatiotemporal behavior of the endangered snow leopard (Panthera uncia).

Long recognized as a threat to wildlife, particularly for large carnivores, livestock grazing in protected areas can potentially undermine conservation objectives. The interspecific interactions among livestock, snow leopards (Panthera uncia), and their wild prey in fragile Asian highland ecosystems have been a subject of debate. We strategically deployed 164 camera traps in the Wolong National Nature Reserve to systematically investigate the activities of snow leopards, their primary wild ungulate prey species, and free-ranging livestock. We found that snow leopard habitat use was influenced by both wild prey and livestock. Blue sheep served as the main wild prey that spatially attracted snow leopards and coexisted with yaks while free-ranging yaks significantly restricted snow leopard habitat use both temporally and spatially. This study challenges the conventional understanding that livestock indirectly impacts large carnivores by competing with and displacing wild prey. Our findings highlight that free-ranging yaks within the alpine canyon terrain could directly limit snow leopard habitat use, suggesting a potential risk of grazing in reducing apex predator distribution and jeopardizing their populations. Consequently, managing their coexistence in shared habitats requires a more nuanced approach. Furthermore, our research underscores the importance of further research efforts aimed at enhancing our comprehension of the complex interplay within animal communities and ecosystems. This knowledge will contribute to the development of informed, evidence-based conservation strategies and policies.

First assistant experience in total laparoscopic pancreaticoduodenectomy: accelerating the learning curve for an operator.

OBJECTIVE: Compare and analyze clinical data of total laparoscopic pancreaticoduodenectomy (TLPD) cases for surgeons with / without first assistant experience (FAE) in TLPD. Probe influence of FAE in TLPD on the learning curve for an operator. METHODS: The clinical data of 239 patients, that underwent TLPD performed by two surgeons between January 2017 and January 2022) in our department, were consecutively collected and divided into two groups (A and B). Group A cases were operated by Surgeon A, with FAE of 57 TLPDs in our department prior to initial TLPD as an operator. Group B cases were operated by Surgeon B with no FAE of TLPD. Cumulative sum (CUSUM) method developed learning curves. Clinical data and both surgeons' learning curves were statistically compared between both groups. RESULTS: Between both groups, no statistically significant variations were observed for pre-operative health conditions. Reduced surgical duration, blood loss and transfusion volume during surgery, together with reductions in major post-operative complication rates and reduced hospital/ICU stays were identified within Group A, having statistically significant variations. The technical plateau phases of the learning curves were approximately 25-41 cases and 35-51 cases, for Surgeon A and Surgeon B, respectively. CONCLUSION: FAE in TLPD can accelerate the learning curve of TLPD for an operator, with safer surgical procedures and enhanced post-operative recovery.

GLP-1 receptor agonists for the treatment of obesity: Role as a promising approach.

Obesity is a complex disease characterized by excessive fat accumulation which is caused by genetic, environmental and other factors. In recent years, there has been an increase in the morbidity, disability rate,and mortality due to obesity, making it great threat to people's health and lives, and increasing public health care expenses. Evidence from previous studies show that weight loss can significantly reduce the risk of obesity-related complications and chronic diseases. Diet control, moderate exercise, behavior modification programs, bariatric surgery and prescription drug treatment are the major interventions used to help people lose weight. Among them, anti-obesity drugs have high compliance rates and cause noticeable short-term effects in reducing obese levels. However, given the safety or effectiveness concerns of anti-obesity drugs, many of the currently used drugs have limited clinical use. Glucagon-like peptide-1 receptor (GLP-1R) agonists are a group of drugs that targets incretin hormone action, and its receptors are widely distributed in nerves, islets, heart, lung, skin, and other organs. Several animal experiments and clinical trials have demonstrated that GLP-1R agonists are more effective in treating or preventing obesity. Therefore, GLP-1R agonists are promising agents for the treatment of obese individuals. This review describes evidence from previous research on the effects of GLP-1R agonists on obesity. We anticipate that this review will generate data that will help biomedical researchers or clinical workers develop obesity treatments based on GLP-1R agonists.

Perioperative Outcomes and Long-Term Survival of Laparoscopic Pancreaticoduodenectomy: A Retrospective Study of 653 Cases in a Single Institution.

Introduction: Laparoscopic pancreaticoduodenectomy (LPD) is gaining wide acceptance within pancreatic surgery. However, longitudinal data are lacking. The aim of this study was to analyze and assess the short-term outcomes and long-term survival of LPD over a duration of 8 years. Methods: Patients who underwent LPD in our institution between November 2013 and September 2021 were included in this study. The perioperative outcomes were statistically analyzed. The long-term survival was studied over a median follow-up duration of 13 months. Results: In total, 653 consecutive patients treated at our institution were included, of which 617 cases underwent standard LPD and 36 cases underwent LPD with vascular resection. The rate of death in hospital, reoperation, postpancreatectomy hemorrhage, postoperative pancreatic fistula, and delayed gastric emptying were 4.4%, 10.3%, 11.9%, 12.9%, and 6.1% respectively. There were statistical differences in the intraoperative blood loss and transfusion, operation time, and the R0 resection rate between the LPD cases and LPD with vascular resection cases. A total of 526 cases were pathologically diagnosed of cancer. The 1-, 3-, and 5-year survival rates were 49.2%, 17.9%, and 17.9%, respectively, for pancreatic cancer with the median survival time of 12 months. The 1-, 3-, and 5-year survival rates were 76.9%, 60.8%, and 52.5%, respectively, for bile duct cancer with the median survival time of 35 months. The 1-, 3-, and 5-year survival rates were 80.2%, 62.2%, and 52.9%, respectively, for duodenal cancer with the median survival time of 53 months. The 1-, 3-, and 5-year survival rates were 72.5%, 54.5%, and 50%, respectively, for ampullary cancer with the median survival time of 55 months. Conclusion: LPD is a feasible and oncologically acceptable procedure with satisfying perioperative outcomes and long-term survival in a high-volume institution.

Patterns of biogenic amine during broad bean paste fermentation: microbial diversity and functionality via Bacillus bioaugmentation.

BACKGROUND: Broad bean paste is a high nitrogen and high salt traditional Chinese condiment, which triggers biosynthesis of nitrogen hazards like biogenic amines (BAs). Mechanisms of association and applied research of functional safety and community assembly within multiple-microbial fermentation are currently lacking. Here, bioaugmentation was performed based on the profiles of BAs accumulation and microbial succession to evaluate the functional variation within broad bean paste fermentation. RESULTS: Putrescine, spermine, and spermidine were the main BAs during traditional broad bean paste fermentation. Staphylococcus, Streptococcus, Lactococcus, Lactobacillus, Leuconostoc, and Bacillus were the predominant bacteria, whereas Aspergillus and Zygosaccharomyces dominated in fungal species, and community structure shifted upon salt exposure. PICRUSt software uncovered that Bacillus contributed significantly (>1%) to the amine oxidase gene family. Bacillus amyloliquefaciens 1-G6 and Bacillus licheniformis 2-B3 were screened to perform the bioaugmentation of broad bean paste, which achieved a 29% and 16% BA decrease respectively. Interaction network analysis showed that Cronobacter and Lactobacillus were significantly negatively correlated with Bacillus (ρ = -0.829 and ρ = -0.714, respectively, P < 0.05) in the B. amyloliquefaciens 1-G6 group, and Staphylococcus and Buttiauxella were inhibited by Bacillus (ρ = -0.657 and ρ = -0.543, respectively, P < 0.05) in the B. licheniformis 2-B3 group. CONCLUSION: The synergism of amine oxidase activity and microbial interactions led to the decline of BAs. Thus, this study improves our understanding of the underlying mechanisms of microbial succession and functional variation to further facilitate the optimization of the fermented food industry.

Hydroxyurea ameliorates atherosclerosis in ApoE-/- mice by potentially modulating Niemann-Pick C1-like 1 protein through the gut microbiota.

Rationale: The efficacy and mechanism of hydroxyurea in the treatment of atherosclerosis have rarely been reported. The goal of this study was to investigate the efficacy of hydroxyurea in high-fat diet-fed ApoE-/- mice against atherosclerosis and examine the possible mechanism underlying treatment outcomes. Methods: ApoE-/- mice were fed a high-fat diet for 1 month and then administered hydroxyurea by gavage continuously for 2 months. Aortic root hematoxylin-eosin (H&E) staining and oil red O staining were used to verify the efficacy of hydroxyurea; biochemical methods and ELISA were used to detect changes in relevant metabolites in serum. 16S rRNA was used to detect composition changes in the intestinal bacterial community of animals after treatment with hydroxyurea. Metabolomics methods were used to identify fecal metabolites and their changes. Immunohistochemical staining and ELISA were used for the localization and quantification of intestinal NPC1L1. Results: We showed that aortic root HE staining and oil red O staining determined the therapeutic efficacy of hydroxyurea in the treatment of atherosclerosis in high-fat diet-fed ApoE-/- mice. Serological tests verified the ability of hydroxyurea to lower total serum cholesterol and LDL cholesterol. The gut microbiota was significantly altered after HU treatment and was significantly different from that after antiplatelet and statin therapy. Meanwhile, a metabolomic study revealed that metabolites, including stearic acid, palmitic acid and cholesterol, were significantly enriched in mouse feces. Further histological and ELISAs verified that the protein responsible for intestinal absorption of cholesterol in mice, NPC1L1, was significantly reduced after hydroxyurea treatment. Conclusions: In high-fat diet-fed ApoE-/- mice, hydroxyurea effectively treated atherosclerosis, lowered serum cholesterol, modulated the gut microbiota at multiple levels and affected cholesterol absorption by reducing NPC1L1 in small intestinal epithelial cells.

Intraoperative navigation system with a multi-modality fusion of 3D virtual model and laparoscopic real-time images in laparoscopic pancreatic surgery: a preclinical study.

BACKGROUND: Laparoscopy is widely used in pancreatic surgeries nowadays. The efficient and correct judgment of the location of the anatomical structures is crucial for a safe laparoscopic pancreatic surgery. The technologies of 3-dimensional(3D) virtual model and image fusion are widely used for preoperative planning and intraoperative navigation in the medical field, but not in laparoscopic pancreatic surgery up to now. We aimed to develop an intraoperative navigation system with an accurate multi-modality fusion of 3D virtual model and laparoscopic real-time images for laparoscopic pancreatic surgery. METHODS: The software for the navigation system was developed ad hoc. The preclinical study included tests with the laparoscopic simulator and pilot cases. The 3D virtual models were built using preoperative Computed Tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data. Manual and automatic real-time image fusions were tested. The practicality of the navigation system was evaluated by the operators using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) method. RESULTS: The 3D virtual models were successfully built using the navigation system. The 3D model was correctly fused with the real-time laparoscopic images both manually and automatically optical orientation in the preclinical tests. The statistical comparative tests showed no statistically significant differences between the scores of the rigid model and those of the phantom model(P > 0.05). There was statistically significant difference between the total scores of automatic fusion function and those of manual fusion function (P = 0.026). In pilot cases, the 3D model was correctly fused with the real-time laparoscopic images manually. The Intraoperative navigation system was easy to use. The automatic fusion function brought more convenience to the user. CONCLUSIONS: The intraoperative navigation system applied in laparoscopic pancreatic surgery clearly and correctly showed the covered anatomical structures. It has the potentiality of helping achieve a more safe and efficient laparoscopic pancreatic surgery.

GP73 is a glucogenic hormone contributing to SARS-CoV-2-induced hyperglycemia.

Severe cases of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are associated with elevated blood glucose levels and metabolic complications. However, the molecular mechanisms for how SARS-CoV-2 infection alters glycometabolic control are incompletely understood. Here, we connect the circulating protein GP73 with enhanced hepatic gluconeogenesis during SARS-CoV-2 infection. We first demonstrate that GP73 secretion is induced in multiple tissues upon fasting and that GP73 stimulates hepatic gluconeogenesis through the cAMP/PKA signaling pathway. We further show that GP73 secretion is increased in cultured cells infected with SARS-CoV-2, after overexpression of SARS-CoV-2 nucleocapsid and spike proteins and in lungs and livers of mice infected with a mouse-adapted SARS-CoV-2 strain. GP73 blockade with an antibody inhibits excessive glucogenesis stimulated by SARS-CoV-2 in vitro and lowers elevated fasting blood glucose levels in infected mice. In patients with COVID-19, plasma GP73 levels are elevated and positively correlate with blood glucose levels. Our data suggest that GP73 is a glucogenic hormone that likely contributes to SARS-CoV-2-induced abnormalities in systemic glucose metabolism.

Persistent pain and numbness in the extremities of an adult due to paraneoplastic peripheral neuropathy caused by olfactory neuroblastoma: A case report.

Background: Paraneoplastic peripheral neuropathy (PPN) caused by olfactory neuroblastoma (ONB) has not yet been reported. Case report: We present a rare case of an adult who hospitalized repeatedly over the past 9 months for persistent pain and numbness in the limbs. This patient was initially diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) and treated accordingly, but neurological symptoms did not improve significantly. After this admission, FDG-PET/CT showed focal hypermetabolism of a soft-tissue mass in the nasal cavity, and further lesion biopsy suggested ONB. Combined with positive serum anti-Hu antibody, the diagnosis of PPN associated with ONB was eventually made. Furthermore, the patient's neurological symptoms were relieved after removal of the primary tumor, confirming the accuracy of the diagnosis. Conclusion: Our case not only expanded the clinical characteristics of ONB but also highlighted the importance of early and comprehensive tumor screening for the diagnosis of PPN.

GP73 is a TBC-domain Rab GTPase-activating protein contributing to the pathogenesis of non-alcoholic fatty liver disease without obesity.

The prevalence of non-obese nonalcoholic fatty liver disease (NAFLD) is increasing worldwide with unclear etiology and pathogenesis. Here, we show GP73, a Golgi protein upregulated in livers from patients with a variety of liver diseases, exhibits Rab GTPase-activating protein (GAP) activity regulating ApoB export. Upon regular-diet feeding, liver-GP73-high mice display non-obese NAFLD phenotype, characterized by reduced body weight, intrahepatic lipid accumulation, and gradual insulin resistance development, none of which can be recapitulated in liver-GAP inactive GP73-high mice. Common and specific gene expression signatures associated with GP73-induced non-obese NAFLD and high-fat diet (HFD)-induced obese NAFLD are revealed. Notably, metformin inactivates the GAP activity of GP73 and alleviates GP73-induced non-obese NAFLD. GP73 is pathologically elevated in NAFLD individuals without obesity, and GP73 blockade improves whole-body metabolism in non-obese NAFLD mouse model. These findings reveal a pathophysiological role of GP73 in triggering non-obese NAFLD and may offer an opportunity for clinical intervention.

Nomogram and a predictive model for postoperative hemorrhage in preoperative patients of laparoscopic pancreaticoduodectomy.

To develop a predictive model and a nomogram for predicting postoperative hemorrhage in preoperative patients undergoing laparoscopic pancreaticoduodenectomy (LPD). A total of 409 LPD patients that underwent LPD by the same surgical team between January 2014 and December 2020 were included as the training cohort. The preoperative data of patients were statistically compared and analyzed for exploring factors correlated with postoperative hemorrhage. The predictive model was developed by multivariate logistic regression and stepwise (stepAIC) selection. A nomogram based on the predictive model was developed. The discriminatory ability of the predictive model was validated using the receiver operating characteristic (ROC) curve and leave-one-out method. The statistical analysis was performed using R 3.5.1 ( www.r-project.org ). The predictive model including the risk-associated factors of postoperative hemorrhage was as follows: 2.695843 - 0.63056 × (Jaundice = 1) - 1.08368 × (DM = 1) - 2.10445 × (Hepatitis = 1) + 1.152354 × (Pancreatic tumor = 1) + 1.071354 × (Bile duct tumor = 1) - 0.01185 × CA125 - 0.04929 × TT - 0.08826 × APTT + 26.03383 × INR - 1.9442 × PT + 1.979563 × WBC - 2.26868 × NEU - 2.0789 × LYM - 0.02038 × CREA + 0.00459 × AST. A practical nomogram based on the model was obtained. The internal validation of ROC curve was statistically significant (AUC = 0.7758). The validation by leave-one-out method showed that the accuracy of the model and the F measure was 0.887 and 0.939, respectively. The predictive model and nomogram based on the preoperative data of patients undergoing LPD can be useful for predicting the risk degree of postoperative hemorrhage.