[Minimally invasive enucleation for benign and low-grade malignant pancreatic tumors: an analysis of 60 cases].

Objective: To investigate the safety and feasibility of minimally invasive pancreatic tumor enucleation. Methods: The clinicopathological data of 60 patients with minimally invasive pancreatic tumor enucleation admitted to the Department of Pancreatic Surgery of Fudan University Cancer Center from November 2019 to August 2021 were retrospectively analyzed. There were 17 males and 43 females,with age of (50.0±13.2)years(range: 23 to 73 years). Tumors were located in the head of pancreas in 40 cases(66.7%),neck and tail of pancreas in 20 cases(33.3%). Patients were divided into robotic group(n=25) and laparoscopic group(n=35) according to surgical methods. The measurement data were compared by t-test or Mann-Whitney U test, and the categorical data were compared by χ2 test or Fisher exact probability method. The influencing factors of postoperative pancreatic fistula were analyzed by univariate and multivariate Logistic regression. Results: All patients successfully completed tumor enucleation without conversion to laparotomy. The operation time was (183.5±67.3)minutes(range:90 to 410 minutes). Twelve patients(20.0%) underwent stent placement and pancreatic duct repair during operation. The removal time of abdominal drainage tube after operation was (24.7±22.9)days(range:2 to 113 days). The tumor diameter in the robotic group was larger than that in the laparoscopic group((3.5±0.9)cm vs. (2.9±0.7)cm,t=-2.825,P=0.006). The incidences of postoperative biochemical fistula and grade B pancreatic fistula were 20.0%,22.9% and 36.0%,51.4%,respectively(χ²=2.289,P=0.318). There were no grade C pancreatic fistula,lymphatic fistula,biliary fistula,delayed gastric emptying,secondary operation and perioperative death in both groups. Multivariate logistic regression analysis was performed on the occurrence of clinically related pancreatic fistula(above grade B). The results showed that the increase of body mass index(OR=1.285,95%CI:1.053 to 1.569,P=0.014),the larger diameter of the tumor(OR=3.703,95%CI:1.465 to 9.360,P=0.006) and intraoperative pancreatic duct repair(OR=7.889,95%CI:1.471 to 42.296,P=0.016) were independent risk factors,whereas robotic surgery(OR=0.168,95%CI:0.036 to 0.796,P=0.025) was a protective factor. No case of pancreatin dependent dyspepsia and new onset diabetes mellitus was observed. Conclusions: Minimally invasive tumor enucleation is feasible in the treatment of benign and low-grade pancreatic tumors. The incidence of pancreatic fistula is high in the short term after operation,but serious complications are rare. The robot assisted system can reduce the risk of postoperative pancreatic fistula and has more advantages in dealing with larger diameter tumors because of clearer surgical vision and more accurate operation.

[Effect of laparoscopic surgery for pancreatic cancer after neoadjuvant chemotherapy].

Objective: To evaluate the safety and feasibility of laparoscopic surgery after neoadjuvant chemotherapy for pancreatic cancer. Methods: Clinical data of 8 patients underwent laparoscopic surgery after neoadjuvant chemotherapy for pancreatic cancer at Fudan University Shanghai Cancer Center from September 2019 to June 2020 were reviewed retrospectively. There were 5 males and 3 females,aged from 47 to 72 years old. All patients underwent abdominal enhanced CT and PET-CT before operation to accurately evaluate the tumor stage and exclude distant metastasis. Results: Neoadjuvant chemotherapy with AG regimen(gemcitabine 1 000 mg/m2 and albumin bound paclitaxel 125 mg/m2) was received for 2 to 6 cycles before surgery. All 8 patients successfully completed the operation,including 5 cases of pancreaticoduodenectomy,2 cases of radical antegrade modular pancreatosplenectomy(RAMPS),and 1 case of total pancreatectomy. No conversion to laparotomy or laparoscopic assisted surgery. The operation time was 240 to 450 minutes,the blood loss was 100 to 500 ml,the postoperative length of stay was 10 to 16 days. During the follow-up period up to December 31, 2020, there was 1 case suffered grade B pancreatic leakage and abdominal infection. The numbers of resected lymph nodes were 9 to 31. All patients received R0 resection. The follow-up times were 4.5 to 9.5 months. One patient underwent RAMPS was diagnosed as liver metastasis after 2 months of the operation,and the other 7 patients still survived without tumor recurrence. Conclusion: Minimally invasive surgery of pancreatic cancer after neoadjuvant chemotherapy is safe and feasible in experienced pancreatic minimally invasive centers.

[Advances in basic and translational research in neuroendocrine neoplasms].

With the development of diagnostic techniques and the improvement of people's living standards, the detection rate of neuroendocrine tumor has been increasing and people are paying more and more attention to it. With multiple treatment modalities, the clinical research progress of neuroendocrine tumor is remarkable. However, due to the tumor heterogeneity, metastasis and recurrence of neuroendocrine tumor remains a difficult problem for clinicians. The efficacy of neuroendocrine tumor still needs to be improved. Therefore, the biological behavior of neuroendocrine tumor needs to be further studied. In recent years, with the development of molecular biology, the basic and transformation research of neuroendocrine tumor has made some progress. In this paper, we focus on the hot topics of neuroendocrine tumor, such as multiomics (copy number variation, genomics, transcriptomics), tumor microenvironment (immune microenvironment, tumor microvasculature, tumor-associated fibroblasts, etc.), preclinical research model construction (cell lines, organoids, patient derived xenograft models, genetically engineered mice), etc. Specifically, the related clinical transformation significance will be elaborated.

The relief effect of botulinum toxin-A for spastic iliopsoas of cerebral palsy on children.

OBJECTIVE: This work intended to observe the effect of injecting botolinum toxin type A (BTX-A) for relieving spastic iliopsoas of cerebral palsy on children, and to investigate the improvement of this method for the motor function in these children. PATIENTS AND METHODS: From July 2006 to August 2012, 37 children with spastic iliopsoas cerebral palsy were received rehabilitation therapy. The age ranged from 3 to 15 years. The control group were treated by conventional physical therapy (PY). The experimental group were treated not only by the conventional physical therapy, but also BTX-A injection. The dose of BTX-A injection was according to the weight of the child and the Modified Ashworth Scale (MAS). The dose of the injection ranged from 15 IU to 45 IU with the average dose 31.2±13.9 IU. RESULTS: There was no significant difference between two the groups on ages, weight and MAS, GMFM (Gross Motor Function Measure) and extension angle of hip joints before treatment. In both groups, the Modified Ashworth Scale decreased, GMFM and extension angle of hip joints increased after eight weeks. In the control group, the GMFM improved significantly. In the experimental group, MAS, GMFM and extension angle of hip joints changed significantly after therapy. There was significant difference between two groups in MAS, GMFM and extension angle of hip joints after two months. CONCLUSIONS: The BTX-A injection can relieve iliopsoas spasticity of cerebral palsy on children efficiently. This therapy can help children to correct abnormal gait and to improve their motor function.

Sampling survey on intellectual disability in 0 approximately 6-year-old children in China.

OBJECTIVES: To understand the current status of intellectually disabled children and the prevalence of intellectual disability (ID) in children aged 0 approximately 6 years and its risk factors, and to provide scientific evidence to formulate relevant policies for helping intellectually disabled children. METHODS: Multiphase, stratified, unequal proportional and cluster sampling was adopted to investigate 60 124 children aged 0 approximately 6 years. All the children investigated were screened for ID using the Denver Developmental Screening Test, and those with positive screening test would be further diagnosed by varied specialists using the Gesell Developmental Inventory. RESULTS: In total, 560 of 60 124 children were diagnosed as intellectually disabled with an overall prevalence of 0.93%. Prevalence of ID was highest in children living in medium-developed areas with a prevalence of 1.20%, higher than in those living in developed areas (0.75%) and in underdeveloped areas (0.84%). It was higher in rural areas (1.03%) than in urban areas (0.83%), and higher in boys (1.01%) than in girls (0.84%). Prevalence of ID increased with the age of children and decreased with the educational level of their parents. CONCLUSIONS: The study suggested that ID is still prevalent in the children of China, and rehabilitation for them is lagging behind current needs. Early prevention of ID in children and pre-school education for them should be strengthened.

Observation of locomotor functional recovery in adult complete spinal rats with BWSTT using semiquantitative and qualitative methods.

STUDY DESIGN: Experimental rat model of spinal cord transection . SETTING: China rehabilitation research center. OBJECTIVE: To investigate locomotor functional recovery in spinal rats with BWSTT using semiquantitative and qualitative methods. METHODS: Five-day postoperative (dpo), adult female complete spinal rats (at T(8) level) received 40 days of body weight-supported treadmill training (BWSTT). Signs of functional recovery were examined with average combined scores (ACOS) and Basso Beattie and Bresnahan (BBB) scales at different time points. RESULTS: At 1-dpo, none of the spinal rats exhibited hindlimb movements. The spinal rats displayed functional progress with time, but the rare could recover to full weight-bearing hindlimb at 45-dpo. BBB and ACOS scores in the BWSTT group obtained better scores than those in the spinal cord injury (SCI) group at 30- and 45-dpo. Furthermore, all BBB and ACOS scores of spinal rats reached statistical significance between 7- and 30-dpo, and between 15- and 30-dpo. However, only ACOS but not BBB scores in the SCI and BWSTT groups showed statistics differences between 15- and 45-dpo, and between 30- and 45-dpo. The Spearman correlation coefficients of BBB and ACOS scores were 0.913 and 0.972 for the SCI and BWSTT groups, respectively. CONCLUSIONS: The results confirmed the existence of partial spontaneous hindlimb functional recovery in adult chronically spinal cord-transected rats, and that BWSTT can improve motor performance. In addition, our study suggests that qualitative and semiquantiative methods are strongly correlated with locomotor recovery in spinal rats, and the latter may be more sensitive in reflecting minor variance at different time points.

Study of beta-amyloid peptide (Abeta40) insertion into phospholipid membranes using monolayer technique.

beta-Amyloid peptide (Abeta), a normal constituent of neuronal and non-neuronal cells, has been proved to be the major component of extracellular plaque of Alzheimer's disease (AD). The interaction of Abeta with lipid membranes may be essential for its neurotoxicity. Our previous study revealed that membrane insertion may provide a possible pathway by which Abeta prevents itself from aggregation and fibril formation. In the present work we studied the membrane insertion of Abeta and the factors that affect its insertion ability using a monolayer approach. The results show that Abeta is surface active and can insert into lipid monolayers. When a high level of cholesterol is present, Abeta40 can insert into the phospholipid mixtures simulating physiological membrane composition. Acidic pH enhances Abeta insertion, while the effect of ionic strength is rather complex. Abeta insertion ability may be ultimately relative to cholesterol-rich domains in the monolayers, which indicates strong interaction between Abeta and cholesterol.

Study of the spontaneous dissociation of rabbit C-reactive protein.

C-Reactive protein (CRP) is composed of five identical noncovalently linked monomers and characterized as an important acute-phase protein. The CRP subunit obtained by denaturing treatments, which is termed modified CRP, has also been widely studied. In the current work, we found that there exists some degree of natural dissociation of CRP in stock solution. This dissociation is critically dependent on the absence of Ca2+. Low pH could enhance the dissociation of CRP, while ionic strength has little effect. Anilinonaphthalenesulfonate (ANS) fluorescence detections indicate that the exposure of hydrophobic surface increases during the dissociation. Acidic pH conditions also induce an increase in ANS fluorescence. This suggests that hydrophobic interactions between CRP subunits may contribute to the study of its pentameric structure. Surface plasmon resonance experiments indicate that monomeric CRP does not specifically bind to phosphatidylcholine-containing membrane as native CRP does. Electron microscopy shows that monomeric CRP binds to negatively charged lipid through electrostatic forces, and such lipid may induce the dissociation of CRP due to the acidic pH in the diffuse double layer near the membrane.

Study of the correlation of secondary structure of beta-amyloid peptide (Abeta40) with the hydrophobic exposure under different conditions.

Abeta is the core protein of extracellular plaque of Alzheimer's disease, and its neurotoxicity is relative to its conformation. In the current work, the effects of various factors, such as pH, ionic strength and lipid membranes, on the secondary structure of Abeta were studied by circular dichroism. In addition, we detected the exposure of hydrophobic sites of Abeta under different conditions using ANS fluorescence. The results showed that the hydrophobic exposure of the protein was correlated with the content of 3betasheet conformation in the phospholipid-containing environment. The beta-sheet content and hydrophobic exposure of Abeta both increased when reacted with pure PC vesicles, while no beta-sheet content and very low hydrophobic exposure were detected after reaction with 30% cholesterol containing PC vesicles. Since beta-sheet conformation is considered as the toxic conformation of Afbeta such correlation may be important for the pathology of AD.

Intramedullary pressure in the proximal femur before and after treatment of congenital dislocation of the hip in children.

Intramedullary pressure in the proximal femur was measured before and after treatment of congenital dislocation of the hip. The intramedullary pressure before treatment was higher than that of the control group, and after treatment it was lower as a whole; in the close reduction group the pressure decreased as compared with the operation group. In 8 hips, stress test yielded negative results. These findings suggested the characteristics of arterial blockage may be that the potential cause of avascular necrosis of the femoral head after treatment of congenital dislocation of the hip.