A retrospective study from a single center of 252 patients who underwent elective pancreaticoduodenectomy to compare perioperative hemodynamic optimization therapy and usual protocols in terms of perioperative cardiac function.

Perioperative hemodynamic optimization therapy is used to improve cardiac function to meet the increased demand during the perioperative period and to reduce hypervolemia or hypovolemia, tissue hypoperfusion and other postoperative complications. The present single center retrospective study aimed to compare perioperative hemodynamic optimization therapy and usual protocols in terms of perioperative cardiac function in 252 patients who underwent elective pancreaticoduodenectomy. Patients underwent elective pancreaticoduodenectomy under usual protocols of enhanced recovery after surgery procedures without intraoperative fluid optimization (UC; n=142) or with intraoperative fluid optimization (FO; n=110). For intraoperative fluid and vasoactive medication optimization, the patients of the UG cohort underwent usual cardiovascular monitoring and in the FO cohort, fluid interventions were given if stroke volume variations were >20% during and at the end of surgeries. The length of the hospital stay (discharge from operation theater to discharge from the ward) of the FO cohort was shorter than that of the UC cohort (11.02±2.07 days vs. 14.95±3.97 days; P<0.0001). The fluid balance (total input fluid-total output fluid) was higher in the UC cohort than that in the FO cohort (6,101±695 ml vs. 4,623±358 ml; P<0.0001). The number of patients that required intraoperatively metaraminol was greater in the UC cohort than in the FO cohort (P<0.0001). The number of patients that required intraoperatively noradrenaline (P<0.0001) and dopamine/dobutamine (P<0.0001) administration was greater in the FO cohort than those in the UC cohort. A greater number of patients in the UC cohort suffered from pancreatic fistula, arrhythmia, postoperative delirium, electrolyte disturbances, hyponatremia, refractory analgesia and required intraoperative blood products (P<0.05 vs. FO cohort). Pancreaticoduodenectomy under usual protocol with intraoperative fluid optimization may have perioperative and postoperative benefits (level of evidence, 3; technical efficacy stage, 1).

CD43 is an adverse prognostic factor in newly diagnosed multiple myeloma.

Currently, the expression pattern and prognostic value of CD43 expression in multiple myeloma (MM) remain unknown. 109 newly diagnosed MM patients were recruited and CD43 expression was determined by multiparameter flow cytometry, of which 77 (70.6%) were CD43 positive. Patients with positive CD43 expression were more likely to present with, hemoglobin < 85 g/L (p = 0.008), International Staging System (ISS) stage III (p = 0.044), 13q14 deletion (p = 0.034) and more monoclonal plasma cells (p = 0.003). Patients with CD43 positive had significantly poor treatment response (p = 0.021), progression-free survival (PFS) (p = 0.012), and overall survival (OS) (p = 0.023) than those without CD43. The poorer prognosis of CD43-positive patients was retained in multivariate analysis (p = 0.005 for PFS; p = 0.013 for OS). Our study indicated that CD43 was an independent adverse prognostic factor in multiple myeloma.