Usage of a simplified blumgart pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy: a single center experience.

BACKGROUND: Blumgart pancreaticojejunostomy (PJ) was shown to be an effective method for pancreaticojejunostomy in open pancreaticoduodenectomy. But the original Blumgart method is involved in complicated and interrupted sutures, which may not be suitable for the laparoscopic approach. In this study, we introduced a simplified Blumgart method for laparoscopic pancreaticojejunostomy. METHODS: We retrospectively reviewed 90 cases of pancreaticoduodenectomy in our institute from 2019 to 2022. Among them, 32 patients received LPD with simplified Blumgart PJ, while 29 received LPD with traditional duct-to-mucosal anastomosis (the Cattel-Warren technique) and 29 received OPD with traditional duct-to-mucosal anastomosis. And the time length for PJ and the surgical outcome were compared in these three groups. RESULTS: The simplified Blumgart pancreaticojejunostomy was accomplished in all 32 cases with no conversion to open surgery due to improper sutures. And the time length for laparoscopic simplified Blumgart pancreaticojejunostomy was 26 ± 8.4 min, which was shorter than laparoscopic traditional ductal to mucosa pancreaticojejunostomy (39 ± 13.7 min). Importantly, the overall incidence for POPF and grade B&C POPF rate in the laparoscopic simplified Blumgart method group were 25% and 9.38% respectively, which were lower than the other two groups. Moreover, we performed univariate analysis and multivariate analysis and found soft pancreas, pancreatic ductal diameter < = 3 mm and intraoperative blood loss were independent risk factors for POPF after PD. CONCLUSION: Our data suggest that the simplified Blumgart method is a feasible and reliable method for laparoscopic PJ which deserves further validation.

A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging.

BACKGROUND: Periampullary diverticulum (PAD) may make the performance of endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis more difficult and may increase complication rates. The present study evaluated the effects of PAD on first-time ERCP in patients with choledocholithiasis. METHODS: Outcomes were compared in patients with and without PAD and in those with four types of PAD: papilla located completely inside the diverticulum (type I), papilla located in the inner (type II a) and outer (type II b) margins of the diverticulum; and papilla located outside the diverticulum (type III). Parameters compared included cannulation time and rates of difficult cannulation, post-ERCP pancreatitis (PEP) and perforation. RESULTS: The median cannulation times in patients with types I, II a, II b, III PAD and in those without PAD were 2.0 min, 5.0 min, 0.67 min, 3.5 min, and 3.5 min, respectively, with difficult cannulation rates in these groups of 7.4%, 31.4%, 8.3%, 18.9%, and 23.2%, respectively. The rates of PEP in patients with and without PAD were 5.3% and 5.1%, respectively. Four patients with and one without PAD experienced perforation. CONCLUSIONS: The division of PAD into four types may be more appropriate than the traditional division into three types. Cannulation of type I and II b PAD was easier than cannulation of patients without PAD, whereas cannulation of type II a PAD was more challenging. PAD may not increase the rates of PEP.

Theoretical investigation of the low lying electronic states of MgGa.

In this work, we investigate the low-lying electronic states correlated to the first and the second dissociation channels of MgGa molecule, neglecting and including the spin-orbit coupling effect. High-level ab initio calculations have been performed by using the icMRCI + Q method. Potential energy curves, spectroscopic constants, electron configurations and dipole moments are derived and discussed. Molecular structures of several magnesium-group 13 diatomics have been probed and analyzed. Information associated with transition dipole moments, Franck-Condon factors, vibrational branching ratios and radiative lifetimes between the Ω states are also well characterized. It is anticipated this work will provide some inspiration for further studies on MgGa.

Pancreatic neuroendocrine tumors: A review of serum biomarkers, staging, and management.

Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of tumors with complicated treatment options that depend on pathological grading, clinical staging, and presence of symptoms related to hormonal secretion. With regard to diagnosis, remarkable advances have been made: Chromogranin A is recommended as a general marker for pNETs. But other new biomarker modalities, like circulating tumor cells, multiple transcript analysis, microRNA profile, and cytokines, should be clarified in future investigations before clinical application. Therefore, the currently available serum biomarkers are insufficient for diagnosis, but reasonably acceptable in evaluating the prognosis of and response to treatments during follow-up of pNETs. Surgical resection is still the only curative therapeutic option for localized pNETs. However, a debulking operation has also been proven to be effective for controlling the disease. As for drug therapy, steroids and somatostatin analogues are the first-line therapy for those with positive expression of somatostatin receptor, while everolimus and sunitinib represent important progress for the treatment of patients with advanced pNETs. Great progress has been achieved in the combination of systematic therapy with local control treatments. The optimal timing of local control intervention, planning of sequential therapies, and implementation of multidisciplinary care remain pending.

Theoretical study of the low-lying electronic states, including the spin-orbit interactions, of the sulfur monochloride cation.

High-level ab initio computations have been performed on the experimentally unknown species SCl+. The low-lying Λ-S electronic states correlated to the first and the second dissociation channels as well as their corresponding Ω states have been investigated by the icMRCI+Q methodology employing basis sets up to quintuple-ζ quality. Information about potential energy curves, electron configurations, spectroscopic constants, dipole moments and transition properties are derived and discussed. The results for SCl+ represent an improvement over our previous theoretical descriptions for the ground state. In addition, several low-lying excited states that have not been accessed experimentally and theoretically are also been well characterized in this work. The accuracy of our predictions for SCl+ are verified by comparisons of spectroscopic constants and vibrational levels between our accompany SCl computations and those reported in literatures for the neutral species. The feasibility of performing laser cooling of SCl+ has also been discussed and the photoelectron spectrum of SCl+(X3Σ-) + e â† SCl(X2Π) is simulated.

Ab initio investigation on the low-lying electronic states of magnesium antimonide.

The twelve Λ-S electronic states of the first four dissociation limits of the MgSb molecule have been examined at the icMRCI+Q level employing basis sets of quintuple-ζ quality. The potential energy curves, vibrational levels and spectroscopic constants of the species have been investigated. The permanent dipole moments of the interested states are derived, and the transition dipole moments, Einstein emission coefficients, radiation lifetimes and Franck-Condon factors between selected states are also determined. Four Λ-S states of the first two dissociation limits split into seven Ω states under the effect of spin-orbit coupling. Characterizations of the MgSb low-lying Ω states are performed for the first time. In addition, the results and relevant data provided in this work on MgSb are compared with the antimony-IIA group and magnesium-VA group diatomic species. It is anticipated that this work will shed some light on further investigations of MgSb and other antimony-IIA group systems.

Characterization of the low-lying electronic states of tin monohydride cation including the spin-orbit coupling effect: A theoretical perspective.

High-level ab initio computations have been performed on SnH+. The potential energy curves and spectroscopic constants of the low-lying Λ-S electronic states, as well as their associated Ω states, are derived at the icMRCI + Q level employing basis sets of quintuple-ζ quality. The transition dipole moments, Einstein coefficients, radiative lifetimes and Franck-Condon factors of three spin-forbidden transition bands ( [Formula: see text] , [Formula: see text] and [Formula: see text] ) are determined. Comparisons between our predictions and available experimental results indicate reasonable agreement. The spin-orbit coupling effect has been proved to affect these low-lying electronic states significantly.

Theoretical investigation on the low-lying electronic states of beryllium antimonide.

The Λ-S electronic states with respect to the lowest four dissociation limits of BeSb are investigated theoretically on the icMRCI + Q level employing basis set of quintuple-ζ quality. The geometrical parameters, potential energy curves, vibrational energy levels, spectroscopic constants for the twelve Λ - S states are obtained, analyzed and compared with those of the Beryllium-VA group diatomic family species where data are available. The permanent dipole moments, transition dipole moments, Einstein emission coefficients, radiative lifetimes and Franck-Condon factors for interested Λ - S states are also derived. Further assessments of the spin-orbit coupling effect are performed for states associated with the first two dissociation asymptotes of BeSb. Four Λ - S states split into seven Ω states, and some of the PECs are distorted significantly through the spin-orbit coupling effect, which is similar to its isovalent diatomics BeAs. In consideration of potential risks of manipulating beryllium-containing species directly, the information associated with molecular structures, spectroscopic parameters as well as transition properties that provide in this paper is anticipated to serve as guidelines for further researches of BeSb.

An ab initio investigation on the low-lying electronic states of NaMg.

Theoretical investigations for NaMg have been performed on the icMRCI + Q level employing basis set of quintuple-ζ quality with corrections of core-valence correlation and scalar relativistic effect. The geometrical parameters, potential energy curves, vibrational energy levels, spectroscopic constants for the eight Λ-S states, with respect to the lowest four dissociation limits, are investigated. Through the spin-orbit coupling effect, these states split into fourteen Ω states. The permanent dipole moments, transition dipole moments, Einstein emission coefficients, radiative lifetimes and Franck-Condon factors for all Ω states are studied. The feasibility of performing laser cooling of NaMg has also been discussed. Our predictive results are anticipated to serve as guidelines for further researches on NaMg.

Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs.

Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

Apatinib (YN968D1) reverses multidrug resistance by inhibiting the efflux function of multiple ATP-binding cassette transporters.

Apatinib, a small-molecule multitargeted tyrosine kinase inhibitor, is in phase III clinical trial for the treatment of patients with non-small-cell lung cancer and gastric cancer in China. In this study, we determined the effect of apatinib on the interaction of specific antineoplastic compounds with P-glycoprotein (ABCB1), multidrug resistance protein 1 (MRP1, ABCC1), and breast cancer resistance protein (BCRP, ABCG2). Our results showed that apatinib significantly enhanced the cytotoxicity of ABCB1 or ABCG2 substrate drugs in KBv200, MCF-7/adr, and HEK293/ABCB1 cells overexpressing ABCB1 and in S1-M1-80, MCF-7/FLV1000, and HEK293/ABCG2-R2 cells overexpressing ABCG2 (wild-type). In contrast, apatinib did not alter the cytotoxicity of specific substrates in the parental cells and cells overexpressing ABCC1. Apatinib significantly increased the intracellular accumulation of rhodamine 123 and doxorubicin in the multidrug resistance (MDR) cells. Furthermore, apatinib significantly inhibited the photoaffinity labeling of both ABCB1 and ABCG2 with [(125)I]iodoarylazidoprazosin in a concentration-dependent manner. The ATPase activity of both ABCB1 and ABCG2 was significantly increased by apatinib. However, apatinib, at a concentration that produced a reversal of MDR, did not significantly alter the ABCB1 or ABCG2 protein or mRNA expression levels or the phosphorylation of AKT and extracellular signal-regulated kinase 1/2 (ERK1/2). Importantly, apatinib significantly enhanced the effect of paclitaxel against the ABCB1-resistant KBv200 cancer cell xenografts in nude mice. In conclusion, apatinib reverses ABCB1- and ABCG2-mediated MDR by inhibiting their transport function, but not by blocking the AKT or ERK1/2 pathway or downregulating ABCB1 or ABCG2 expression. Apatinib may be useful in circumventing MDR to other conventional antineoplastic drugs.

[Progress of individualized chemotherapy guided by chemosensitivity test].

In spite of receiving chemotherapy, the response of patients with cancer can be extremely variable. Chemosensitivity testing is being applied in institutes and some hospitals to improve the effects of chemotherapy. It would be useful for choosing the most effective drug and strategy for individual chemotherapy and to exclude the resistance of the tumor cells. In this way, the individualized chemotherapy can be established. Up to today, there are more than 10 approaches established for chemosensitivity testing assays, such as single cell culture assay (including MTT, MTS, ATP), nude mouse model sensitivity examination, collagen gel droplet embedded culture drug sensitivity test and histoculture drug response assay etc. This paper reviews some current methods, and their possibility for directing clinical chemotherapy.