[Perioperative efficacy of laparoscopic duodenal-preserving pancreatic head resection].

Objective: To compare the perioperative outcomes of laparoscopic duodenal-preserving pancreatic head resection(LDPPHR) with laparoscopic pancreaticoduodenectomy(LPD) in the treatment of borderline and benign diseases of the pancreatic head. Methods: This is a retrospective cohort study. Perioperative data from 87 patients with non-malignant pancreatic head diseases who underwent LDPPHR or LPD were retrospectively collected in the Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to December 2022. There were 49 male and 38 female patients with an age (M(IQR)) of 57.0(16.5) years (range: 20 to 75 years). Forty patients underwent LDPPHR and 47 patients underwent LPD. Quantitative data following a normal distribution were compared using Student's t-test, while quantitative data not following a normal distribution were compared using the Mann-Whitney U test. Comparisons of categorical or ordinal variables were made using χ2 test or Fisher's exact test. Logistic regression analysis was used to estimate the risk factors associated with the rate of complications. Results: There were no statistically significant differences between the LDPPHR group and the LPD group in terms of reoperation rate,total hospital stay duration,postoperative hospital stay duration,90-day mortality rate,30-day and 90-day readmission rates,and 2-year tumor recurrence rate (all P>0.05). The complication rate was higher in the LDPPHR group compared to the LPD group (80.0%(32/40) vs. 51.1%(24/47), χ2=7.89,P=0.005),but there was no difference in the rate of Clavien-Dindo classification of surgical complications ≥Ⅲ between the two groups (10.0%(4/40) vs. 12.8%(6/47), χ2<0.01, P=0.947). Additionally,the rate of delayed gastric emptying (DGE) was higher in the LDPPHR group compared to the LPD group (χ2=10.79,P=0.001),but there was no statistically significant difference in the rate of B,C grade DGE between the two groups (χ2=0.48, P=0.487). There were no statistically significant differences in the rates of postoperative pancreatic fistula,bile leakage,post-pancreatectomy hemorrhage,intra-abdominal infection,and pulmonary infection between the two groups (all P>0.05). The results of the univariate logistic regression analysis showed that LDPPHR (compared to LPD, OR=3.83, 95%CI: 1.46 to 10.04, Z=2.73,P=0.006) and preoperative biliary stent placement (compared to non-use of biliary stent, OR=5.30, 95%CI: 1.13 to 25.00, Z=2.11, P=0.035) were risk factors for the complication rate,but neither was an independent risk factor for complication rate (all P>0.05). Conclusion: The preliminary results suggest that LDPPHR can achieve perioperative safety and effectiveness comparable to LPD.

[The value and controversy of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic cancer].

Pancreatic cancer was considered to be one of the contraindications of laparoscopic pancreaticoduodenectomy, but a large number of studies have shown that laparoscopic pancreaticoduodenectomy is safe and feasible for surgeons who have passed the learning curve in high-volume hospitals.Laparoscopic pancreaticoduodenectomy can provide high-resolution intraoperative exploration and unique operative perspective,which can help to reduce intraoperative and postoperative complications,dissect lymph nodes more thoroughly and reduce intraoperative metastasis of tumors,so as to promote the development of postoperative adjuvant therapy and improve patients' quality of life.However,due to the long learning curve and unclear survival outcome, the application of laparoscopic pancreaticoduodenectomy in patients with pancreatic cancer is still controversial.This article summarizes the existing literature and the experience of the author's team,exploring the value and controversy of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic cancer.Further,suggestions are put forward on how to improve the laparoscopic pancreaticoduodenectomy in China.

Biofunctionalization of titanium surface with multilayer films modified by heparin-VEGF-fibronectin complex to improve endothelial cell proliferation and blood compatibility.

In-stent restenosis and subsequent thrombosis remain a significant complication following the implantation of coronary stents. Different approaches have been used in developing novel coronary stents to protect against thrombosis and minimize restenosis. In the present study, we designed a biomacromolecular layer-by-layer coating with heparin, vascular endothelial growth factor (VEGF), and fibronectin onto nickel-free titanium surface to improve blood compatibility and endothelial cell proliferation. The multilayer assembling process was monitored by water contact angle and surface plasmon resonance, respectively. With increasing the number of layers, the deposition of polyelectrolyte as self-assembled ultrathin multilayer films showed linear growth of absorbance. In vitro blood compatibility results revealed that the fabricated layers prolonged activated partial thrombin time and prothrombin time, reduced platelets activation and aggregation, and reduced blood hemolysis rate. Cell adhesion and growth results showed that the assembled multilayer films significantly promoted cell attachment and growth, and the endothelialization property of the multilayer films was preferable compared with the untreated titanium disk. In conclusion, these results suggest that titanium surface modification using biofunctional multilayer films composed of heparin, VEGF, and fibronectin may serve as a potential approach to inhibit thrombosis and promote re-endothelialization of cardiovascular stents.

Layer-by-layer assembly of chitosan and platelet monoclonal antibody to improve biocompatibility and release character of PLLA coated stent.

The aim of this study is to construct a biocompatible coating of a drug-eluting stent through the incorporation of chitosan with monoclonal antibody (mAb) to a platelet glycoprotein (GP) IIIa receptor, by electrostatic layer-by-layer (LBL) adsorption of oppositely charged polyelectrolytes and proteins. The platelet maximum aggregation rate and aggregation inhibition rate tests confirm the bioactivity of mAb in different pH assembly environments. The fluorescence spectra test and confocal laser scanning microscopy observation were used to monitor the LBL assembly process of the mAb/chitosan multilayer on the surface of the aminolyzed Poly-L-lactic acid (PLLA) membrane, when using Rhodamine B isothiocyanate-labeled mAb and Fluorescein isothiocyanate-labeled chitosan. The in vitro platelet adhesion experiment demonstrated the amicable blood compatibility of the mAb/chitosan multilayer. The endothelial cell adhesion and migration test revealed that the multilayer could improve the cytocompatibility of the PLLA matrix in terms of cell attachment, proliferation, and migration. An in vitro perfusion circuit was designed to evaluate the release rates measured by a radioisotope technique with ¹²5I-labeled GP IIIa mAb. The different eluting curves of the mAb/chitosan-assembled stent and mAb physically absorbed stent showed the improvement of mAb's release character when using LBL self-assembly technology. Our method to prepare a biocompatible stent surface with mAb/chitosan multilayers has proved to be favorable and effective in vitro, thus justifying further evaluation to improve the biocompatibility in an animal model test.

Ultrasonic atomization and subsequent desolvation for monoclonal antibody (mAb) to the glycoprotein (GP) IIIa receptor into drug eluting stent.

An eluting-stent system with mAb dispersed in the PLLA (poly (L-lactic acid)) was validated in vitro. Specifically designed spray equipment based on the principle of ultrasonic atomization was used to produce a thin continuous PLLA (poly (L-lactic acid)) polymer coating incorporating monoclonal antibody (mAb). This PLLA coating was observed in light microscopy (LM) and scanning electron microscopy (SEM). The concentration of the monoclonal antibody (mAb) to the platelet glycoprotein (GP) IIIa receptor and the eluting rate were then measured by a radioisotope technique with (125)I-labelled GP IIIa mAb. An in vitro perfusion circuit was designed to evaluate the release rates at different velocities (10 or 20 ml min(-1)). The PLLA coating was thin and transparent, uniformly distributed on the surface of the stent. Three factors influenced its thickness: PLLA concentration, duration and gas pressure. The concentration of mAb was influenced by the duration of absorption and the concentration of the mAb solution; the maximum was 1662.23 + or - 38.83 ng. The eluting rate was fast for the first 2 h, then decreased slowly and attained 80% after 2 weeks. This ultrasonic atomization spray equipment and technological process to prepare protein eluting-stents were proved to be effective and reliable.

Eluting characteristics of a platelet glycoprotein receptor antibody using a PLLA-coated stent.

Drug-eluting stents (DES) have emerged as a recognized alternative to treat stent restenosis but many questions remain regarding the optimal type and eluting characteristics of both drug and stent. The first component of the study examines the extent of surface coating of PLLA (poly(L-lactic acid)) on a Nitinol stent. The second characterizes the adsorption and elution rates of monoclonal mouse anti-human platelet glycoprotein (GP) IIIa antibody SZ-21 from a PLLA-coated surface. The PLLA coating was examined by fluorescence staining and image analysis using the Image Processing Box of MATLAB. Stents exposed to the monoclonal mouse anti-human platelet GP IIIa antibody were tested for their adsorption characteristics by radioisotope technique with (125)I-labelled SZ-21. The elution rates were then measured in looped circuits at different velocities (10 or 20 ml/min) and durations (30 min up to 312 h). Results showed that the fluorescence staining and image analysis showed a striking difference in the extent of coating between PLLA-coated stents and SZ-21 eluting stents on the gray-scale distribution of Nitinol surfaces. The amount of SZ-21 adsorbed onto the PLLA-coated stents was dependent on the concentration and duration of immersion in the solution. The method of preparation the mAb eluting stent significantly influenced the elution characteristics for a continuous perfusion of more than 300 h. The eluting curve was biphasic with initial rapid elution for the first 24 h followed by a gradual slow elution. These results indicate that the Image Processing Box of MATLAB appears to be a useful method for semi-quantitative analysis of fluorescence images. Furthermore, SZ-21 can be passively adsorbed onto PLLA-coated stents and predictably influenced by the concentration and duration of immersion. These studies may pave the way to developing stent-based delivery of a potent anti-platelet agent.

[Pathological and virological studies of the liver tissues from the patients with sporadic hepatitis E].

OBJECTIVE: To study the pathological feature, viral distribution and replication in the liver tissue of sporadic hepatitis E(HE), and to explore the mechanism of the liver injury induced by hepatitis E virus(HEV). METHODS: The total bioptic liver tissues (n=54) were obtained from the patients with sporadic hepatitis E, including the clinical acute stage (n=20), the convalescent stage (n=16), and the chronic hepatitis B (CHB) overlapped with HEV infection recently (n=18). The pathological changes in the liver tissues were observed under the light and the electron microscope. HEV RNA was detected by in situ hybridization, and Kupffer cells were marked with immunohistochemistry. RESULTS: The HE liver tissues showed the pathological features in the clinical acute stage, presenting frequently with feathery degeneration of hepatocytes (100%), cholangiolar cholestasis (75.0%), and double nuclei and multinuclei hepatocytes (65.0%). The apoptotic body of hepatocyte was larger and irregular, and the proliferation of Kupffer cells was prominent. HEV RNA was distributed in hepatocyte cytoplasm near the nuclei. The positive rate of HEV RNA in acute stage was evidently higher than that in convalescent stage (100% vs 12.5%,P < 0.001), and the HEV RNA positive hepatocytes and the viral copies in acute stage were also more than in convalescent stage, in which the liver tissues were becoming normal. The liver tissue changes of the CBH overlapped with HEV infection were more severe compared with the single CHB. CONCLUSIONS: Sporadic HE had histopathological characteristics. HEV infection and replication in hepatocytes occurred mainly during clinical acute stage and regressed in convalescent stage, which suggested sporadic acute HE may have a good result. The immune-mediated liver injury by lymphocytes might be a main pathogenesis of HE,but the liver injury induced directly by HEV might not be excluded.

[Relationship between coronary angiography and syndrome differentiation type of TCM].

OBJECTIVE: To understand the relationship between the coronary Angiography (CA) reflected degree of coronary artery lesion and the TCM Syndrome Differentiation-type (TCM-SDT). METHODS: Patients TCM-SDT were differentiated adopting the standard of Syndrome Differentiation for coronary artery diseases revised in 1990, and the comparison of TCM-SDT with the findings in CA was carried out. RESULTS: CA examination showed that 29 patients (39.73%) were of one-artery lesion, 9 patients (12.33%) two-artery lesion and 35 patients (47.95%) three-artery lesion; the stenosis degree of them were: 54 arteries were mild stenosis, 38 moderate stenosis and 31 severe stenosis; 29 arteries were completely occluded, the sum total of affected artery was 152 (69.41%), and the other 67 arteries (30.59%) had no lesion. TCM-SDT showed that all the 73 patients had secondary Excess Syndrome, among them 73 patients (100%) with blood stasis Syndrome, 39 patients (53.4%) with Phlegm-Turbid Syndrome, 16 (21.0%) with Qi-stagnation Syndrome and 7 (9.6%) with Cold condensation Syndrome. 63 patients (86.3%) with obvious primary Deficiency Syndrome, among them, 57 (78.1%) were Qi-Deficiency, 18 (24.7%) Yang-Deficiency, 28 (38.4%) Yin-Deficiency and 5 (6.8%) Yang collapse. All patients had blood stasis of various degrees, manifesting on tongue proper prominently. In the 80.8% patients who had angina pectoris, 74.0% had their mouth, lips and gum dark red, dark purple or light dark in color. The comparison between TCM-SDT and Blood-Stasis score revealed that patients of Cold condensation-blood stasis Syndrome and Yang collapse-blood stasis Syndrome were serious. Patients of Qi stagnation-blood stasis Syndrome and Yin Deficiency-blood stasis Syndrome were mild cases, while patients of Phlegm Turbid-blood stasis Syndrome and Qi Deficiency-blood stasis Syndrome were moderate severity cases. The number of affected artery in Cold condensation patients was the most, and in Yin-Deficiency patients was the least. The coronary artery stenosis degree in patients of Qi-stagnation and Yin-Deficiency were milder than in those of Yang-collapse and Yang-Deficiency patients. CONCLUSION: The more the number of arterial lesion, the severer the degree of stenosis and the higher the blood stasis score, then the more serious the degree of stasis.

[Development and application of hybridoma secreting monoclonal antibody against poly-human serum albumin].

Two hybridomas which secrete monoclonal antibody (McAb) against polymerized human serum albumin (PHSA) were obtained by the fusion of SP2/0 myeloma cell with immune murine spleen cells. One of the McAb was identified as mouse IgG1, the other was IgM. The titers of these purified McAb was 1:16 364 with passive hemagglutination assay (PHA). After labelling with 125I by chloramine-T method, a solid phase radioimmune assay for detecting the PHSA has yielded in 21 positive results, out of 126 HBsAg positive sera, but 53 HBsAg negative sera were all negative. At present we have not seen any report of PHSA present in circulation. PHSA may be as a bridge bind receptor between HBV and hepatocytes and then initiate infection. The appearance of PHSA in HBsAg positive sera could be the result of the damage of the liver during virus infection. More work should be done for this explanation.