Laparoscopic spleen-preserving total pancreatectomy for the treatment of low-grade malignant pancreatic tumors: Two case reports and review of literature.

BACKGROUND: Function-preserving pancreatectomy can improve the long-term quality of life of patients with benign or low-grade malignant tumors, such as intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms. However, there is limited literature on laparoscopic spleen-preserving total pancreatectomy (L-SpTP) due to technical difficulties. CASE SUMMARY: Patient 1 was a 51-year-old male diagnosed with IPMN based on preoperative imaging, showing solid nodules in the pancreatic head and diffuse dilation of the main pancreatic duct with atrophy of the distal pancreas. We performed L-SpTP with preservation of the splenic vessels, and the postoperative pathology report revealed IPMN with invasive carcinoma. Patient 2 was a 60-year-old male with multiple cystic lesions in the pancreatic head and body. L-SpTP was performed, and intraoperatively, the splenic vein was injured and required ligation. Postoperative pathology revealed a mucinous cystic tumor of the pancreas with low-grade dysplasia. Both patients were discharged on postoperative day 7, and there were no major complications during the perioperative period. CONCLUSION: We believe that L-SpTP is a safe and feasible treatment for low-grade malignant pancreatic tumors, but more case studies are needed to evaluate its safety, efficacy, and long-term outcomes.

Staple line lockstitch reinforcement decreases clinically relevant pancreatic fistula following distal pancreatectomy: Results of a propensity score matched retrospective analysis.

Background: Postoperative pancreatic fistula (POPF) remains the primary complication of distal pancreatectomies. We aimed to review whether staple line reinforcement with continuous lockstitches would lead to decreased grade B and C pancreatic fistula in patients undergoing distal pancreatectomy. Methods: This retrospective study enrolled consecutive patients scheduled to undergo distal pancreatectomy at a large tertiary hospital. A comparison was conducted between lockstitch reinforcement and non-reinforcement for remnant closure during distal pancreatectomies from August 2016 to February 2021. Propensity score matching was applied to balance the two groups with covariates including abdominal and back pain, diabetes mellitus, and estimated blood loss. The primary outcome was POPF rate. Results: A total of 153 patients were enrolled in the study (89 lockstitch reinforcements, 64 non-reinforcements), of whom 128 patients (64 per group) were analyzed after propensity score matching (1:1). The total POPF rate was 21.9%. POPF was identified in 12.5% (8/64) of the patients who underwent resection with lockstitch reinforcement and 31.2% (20/64) of the patients without reinforcement (odds ratio 0.314, 95% confidence interval 0.130-0.760, P=0.010). No deaths occurred in either group. Neither the major complication rate nor the length of hospital stay after surgery differed between the groups. Conclusions: Compared with the use of stapler alone, staple line lockstitch reinforcement for remnant closure during distal pancreatectomy could reduce the POPF rate. Further multicenter randomized clinical trials are required to confirm these results.

Synthesis, Antibacterial and Anthelmintic Activity of Novel 3-(3-Pyridyl)-oxazolidinone-5-methyl Ester Derivatives.

In this study, a series of 3-(3-pyridyl)-oxazolidone-5-methyl ester derivatives was synthesized and characterized by 1H NMR, 13C NMR, and LC-MS. The conducted screening antibacterial studies of the new 3-(3-pyridyl)-oxazolidone-5-methyl ester derivatives established that the methyl sulfonic acid esters have broad activity spectrum towards Staphylococcus aureus, Streptococcus pneumoniae, Bacillus subtilis and Staphylococcus epidermidis. Among them, compound 12e has the most potent activity, with an MIC of 16 µg/mL against B.subtilis, and could reduce the instantaneous growth rate of bacteria. Furthermore, molecular docking studies were also simulated for compound 12e to predict the specific binding mode of this compound. In addition, anthelmintic activity of these compounds was also evaluated against adult Indian earthworms (Pheretima posthuman). The results showed that compound 11b had the best effect. These results above can provide experimental reference for the development of novel antibacterial and anthelmintic drugs.

Retrograde artery first approach for "shoulder" pancreatic cancers in minimally invasive distal pancreatectomy.

BACKGROUND: "Shoulder" pancreatic cancer, defined as tumor located at the confluence where the splenic vein meets the portal vein, has specific adjacent anatomies. It's difficult to resect this type of tumor with adequate regional lymphadenectomy. METHODS: We described a new concept of "shoulder" pancreatic cancer, and retrospectively analyzed eleven consecutive cases from September 2019 to April 2020, to assess the safety and efficacy of the retrograde artery first approach in minimally invasive distal pancreatectomy. The primary outcome was set as radical (R0) resection rate. RESULTS: All of the 11 cases achieved R0 resection, with a median of 8 (range 5-32) lymph nodes harvested, given the ratio of embraced splenic vein in 72.7% of the cases, splenic artery embracement in 45.5%, and SMV-PV wall invasion in 27.3%. The maximum tumor size on pathology was 35 (range 20-65) mm. The median operative time was 260 (range 155-470) min, and the median estimated blood loss was 200 (range 50-1000) ml. One case needed intraoperative transfusion. One grade B postoperative pancreatic fistula occurred accompanied with abdominal infection, while the rest of cases recovered uneventful. The median postoperative length of stay was 9 (range 6-20) days. CONCLUSIONS: "Shoulder" pancreatic cancers are clinically significant. Retrograde artery first approach is a potentially safe and effective alternative to achieve a radical resection margin for shoulder pancreatic cancers in minimally invasive era. More evidences are needed in the future.

Transcriptomic analysis reveals flavonoid biosynthesis of Syringa oblata Lindl. in response to different light intensity.

BACKGROUND: Hazy weather significantly increase air pollution and affect light intensity which may also affect medicinal plants growth. Syringa oblata Lindl. (S. oblata), an effective anti-biofilm medicinal plants, is also vulnerable to changes in plant photoperiods and other abiotic stress responses. Rutin, one of the flavonoids, is the main bioactive ingredient in S. oblata that inhibits Streptococcus suis biofilm formation. Thus, the present study aims to explore the biosynthesis and molecular basis of flavonoids in S. oblata in response to different light intensity. RESULTS: In this study, it was shown that compared with natural (Z0) and 25% ~ 35% (Z2) light intensities, the rutin content of S. oblata under 50% ~ 60% (Z1) light intensity increased significantly. In addition, an integrated analysis of metabolome and transcriptome was performed using light intensity stress conditions from two kinds of light intensities which S. oblata was subjected to: Z0 and Z1. The results revealed that differential metabolites and genes were mainly related to the flavonoid biosynthetic pathway. We found out that 13 putative structural genes and a transcription factor bHLH were significantly up-regulated in Z1. Among them, integration analysis showed that 3 putative structural genes including 4CL1, CYP73A and CYP75B1 significantly up-regulated the rutin biosynthesis, suggesting that these putative genes may be involved in regulating the flavonoid biosynthetic pathway, thereby making them key target genes in the whole metabolic process. CONCLUSIONS: The present study provided helpful information to search for the novel putative genes that are potential targets for S. oblata in response to light intensity.

A rare intrahepatic subcapsular hematoma (ISH) after laparoscopic cholecystectomy: a case report and literature review.

BACKGROUND: Intrahepatic subcapsular hematoma (ISH) is an extremely rare, life-threatening complication after laparoscopic cholecystectomy (LC). Only few cases have been reported. Herein, we reported a rare giant ISH after LC and summarized all of the reported cases. CASE PRESENTATION: A 32-year old woman with recurrent acute cholecystitis for one year, underwent elective LC without intra-operative complications and was discharged 2 days after operation. On the next day after discharge, she developed severe right upper abdominal pain and was sent to our emergency department. The computed tomography scan showed a 10.9 × 12.5 × 6.6 cm ISH in the right liver without free fluid and the hemoglobin dropped to 86 g/l from 127 g/l. Postoperative hemorrhagic shock and a giant ISH after LC were diagnosed. After fluid resuscitation, the hemodynamic was still unstable and the hemoglobin kept dropping. An emergency laparoscopic exploration was performed and the ISH was confirmed, however no active bleeding point was found. A drainage tube was placed under liver for early warning of rupture. Patient was discharged home 10 days after readmission. CONCLUSIONS: Giant ISH is an extremely rare, life-threatening complication after LC. This case showed that the need to consider this rare complication in patients suffering abdominal pain after LC and timely and correct diagnosis and treatment were crucial to saving the lives of the patients.

Delays in HIV diagnosis and associated factors among patients presenting with advanced disease at a tertiary care hospital in Beijing, China.

Delayed diagnosis of HIV infection is associated with advanced immunosuppression and increased risk of onward transmission. Little data exists regarding factors associated with diagnostic delays among patients presenting with advanced HIV disease in China. Medical records of patients with HIV/AIDS hospitalized at a 2000-bed tertiary hospital in Beijing, China between 1997 and 2012 were retrospectively reviewed. Demographic and clinical data of patients newly diagnosed with HIV at the hospital were abstracted. Patient characteristics, disease parameters, and the time interval between the first medical visit and the visit leading to HIV diagnosis were compared among three periods: 1997-2002, 2003-2008 and 2009-2012. Chi-square, Kruskal-Wallis and logistic regression analyses were used as appropriate. A quarter of patients (72/279) were newly diagnosed with HIV at the hospital, consisting of 11, 29 and 32 patients in 1997-2002, 2003-2008 and 2009-2012 respectively. The median time delay between the first medical visit and the visit leading to HIV diagnosis decreased over time from 91 days among patients diagnosed before 2002, to 75 days between 2003 to 2008, and 39 days after 2009 (p = 0.036). However, the median CD4+T cell count at diagnosis was 26 cells/µL [interquartile range 3-132 cells/µL] in 1997-2002, and remained unchanged across time intervals. Forty-one (57%) patients had AIDS-defining conditions and Pneumocystis jiroveci pneumonia was the most common opportunistic infection (31 cases). These results reveal persistent missed opportunities for timely HIV testing among patients with advanced disease. Strategies for promoting early HIV testing in healthcare settings are needed in China.

Solid pseudopapillary tumor of the pancreas with liver metastasis: Clinical features and management.

OBJECTIVE: To summarize the diagnosis and management of metastatic pancreatic solid pseudopapillary tumors (SPTs). METHODS: We retrospectively analyzed the clinical data of patients with metastatic pancreatic SPTs who were admitted to Peking Union Medical College Hospital from November 2001 to September 2013. RESULTS: A total of 187 patients with pancreatic SPTs were admitted. Four patients had liver metastasis, and all four were female patients aged 20-72 years old. Each patient with metastases underwent surgical resection with good postoperative recovery. The mean follow-up period was 30 months (range, 1-64 months). None of the patients had obvious recurrence or distant metastasis. CONCLUSIONS: Pancreatic SPT with liver metastasis is very rare, and surgical resection is an effective treatment option. The principle of surgical treatment is to resect the primary and metastatic lesions as completely as possible. The affected patients require long-term postoperative follow-up.

Comparison of psychological influence on breast cancer patients between breast-conserving surgery and modified radical mastectomy.

OBJECTIVE: To compare the influence of breast-conserving surgery (BCS) and modified radical mastectomy (MRM) on the psychological state of breast cancer patients. METHODS: Patients receiving MRM or BCS, and fulfilling the study criteria, were recruited. Patients were required to complete a self-reporting inventory (SCL- 90) on admission and 6 months after surgery and a self-rating depression scale (SDS) when discharged from hospital and 6 months after surgery. RESULTS: A total of 70 patients received MRM and 50 BCS. Compared with the national standard, patients suffered to some extent psychological problems on admission, at discharge from hospital and at 6 months after surgery. Patients received BCS had a higher score of SDS compared with those with MRM when discharged from hospital. However, 6 months after surgery, SDS score increased in MRM and decreased in the BCS group, so the difference was significant. CONCLUSION: The short-term psychological state of patients receiving BCS is worse than that with MRM but superior to MRM 6 months postoperatively. BCS imposed less influence on long term psychological state of breast cancer patients compared with MRM.