The Role of C-reactive Protein and Procalcitonin in Predicting the Occurrence of Pancreatic Fistula in Patients who Underwent Laparoscopic Pancreaticoduodenectomy: a Retrospective Study.

The occurrence of postoperative pancreatic fistula following laparoscopic pancreaticoduodenectomy (LPD) is a significant concern, yet there is currently a lack of consensus on reliable predictive methods for this complication. Therefore, the aim of this study was to assess the clinical significance of C-reactive protein (CRP) and procalcitonin (PCT) values and their reliability in early predicting the development of clinically relevant pancreatic fistula (CRPF) following LPD.A retrospective analysis was conducted using data from 120 patients who had LPD between September 2019 and December 2021. Preoperative assessment data, standard patients' demographic and clinicopathological characteristics, intra- and postoperative evaluation, as well as postoperative laboratory values on postoperative days (PODs) 1, 3, and 7, including white blood cells (WBCs), CRP, and PCT, were prospectively recorded on a dedicated database. Two clinicians separately collected and cross-checked all of the data.Among 120 patients [77 men (64%), 43 women (36%], CRPF occurred in 15 patients (11 grade B and 4 grade C fistulas). The incidence rate of CRPF was 12.3%. A comparison of the median values of WBCs, PCT, and CRP across the two groups revealed that the CRPF group had higher values on most PODs than the non-CRPF group. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) and cutoff values. It was discovered that POD 3 has the most accurate and significant values for WBCs, CRP, and PCT. According to the ROC plots, the AUC for WBCs was 0.842, whereas the AUC for PCT was 0.909. As for CRP, the AUC was 0.941 (95% CI 0.899-0.983, p < 0.01) with a cutoff value of 203.45, indicating a sensitivity of 93.3% and specificity of 91.4%.Both CRP and PCT can be used to predict the early onset of CRPF following LPD, with CRP being slightly superior on POD 3.

Novel Nomogram Based on Inflammatory Markers for the Preoperative Prediction of Microvascular Invasion in Solitary Primary Hepatocellular Carcinoma.

Purpose: We aimed to develop and to validate a novel nomogram based on inflammatory markers to preoperatively predict microvascular invasion (MVI) in patients with solitary primary hepatocellular carcinoma (HCC). Patients and Methods: Data from 658 patients with solitary primary HCC who underwent hepatectomy at the First Affiliated Hospital of Zhengzhou University from June 2018 to October 2021 were retrospectively analyzed. Patients were divided into training (n=441) and validation (n=217) cohorts according to surgical data. Independent risk factors for MVI were identified via univariate and multivariate logistic regression analyses in the training cohort. A novel nomogram was developed based on the independent risk factors identified. Its accuracy was evaluated using a calibration curve and concordance index (C-index). The predictive value was evaluated using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results: Preoperative alpha-fetoprotein >969 µg/L (P<0.001), tumor size (P=0.002), neutrophil >1.8×109/L (P=0.002), gamma-glutamyl transpeptidase-to-platelet ratio (GPR) >0.32 (P=0.001), aspartate aminotransferase-to-platelet ratio (APR) >0.18 (P<0.001), gamma-glutamyl transpeptidase-to-albumin ratio (GAR) >2.30 (P=0.001), and gamma-glutamyl transpeptidase-to-lymphocyte ratio >29.58 (P<0.001) were identified as preoperative independent risk factors for MVI and were used to establish the nomogram. The C-index of the training and validation cohorts were 0.788 (95% confidence interval [CI]: 0.744-0.831) and 0.735 (95% CI: 0.668-0.802), respectively. The calibration curve analysis revealed that the standard curve fit well with the predicted curve. ROC curve analysis demonstrated high efficiency of the nomogram. DCA verified that the nomogram had notable clinical value. Conclusion: Preoperative GPR >0.32, APR >0.18, and GAR >2.30 were independent risk factors for MVI in patients with solitary primary HCC, suggesting their utility as preoperative predictors of MVI. The novel nomogram developed and validated in this study may aid in determining optimal therapeutic approaches for patients with solitary HCC at risk for MVI.

1H, 13C, 15N backbone and side-chain resonance assignments of the pathogenic G131V mutant of human prion protein (91-231).

Human prion disease, also known as transmissible spongiform encephalopathy (TSEs), is caused by the conformational conversion of the normal cellular prion protein (PrPC) into the scrapie form (PrPSc). Pathogenic point mutations of prion proteins typically facilitate conformational conversion and lead to inherited prion diseases. A previous study has demonstrated that the pathogenic G131V mutation of human prion protein (HuPrP) brings in Gerstmann-Sträussler-Scheinker syndrome. However, the three-dimensional structure and dynamic features of the HuPrP(G131V) mutant remain unclear. It is expected that the determination of these structural bases will be beneficial to the pathogenic mechanistic understanding of G131V-related prion diseases. Here, we performed 1H, 15N, 13C backbone and side-chain resonance assignments of the G131V mutant of HuPrP(91-231) by using heteronuclear multi-dimensional NMR spectroscopy, and predicted the secondary structural elements and order parameters of the protein based on the assigned backbone chemical shifts. Our work lays the necessary foundation for further structural determination, dynamics characterization, and intermolecular interaction assay for the G131V mutant.

A Common Polymorphism in SCN2A Predicts General Cognitive Ability through Effects on PFC Physiology.

Here we provide novel convergent evidence across three independent cohorts of healthy adults (n = 531), demonstrating that a common polymorphism in the gene encoding the α2 subunit of neuronal voltage-gated type II sodium channels (SCN2A) predicts human general cognitive ability or "g." Using meta-analysis, we demonstrate that the minor T allele of a common polymorphism (rs10174400) in SCN2A is associated with significantly higher "g" independent of gender and age. We further demonstrate using resting-state fMRI data from our discovery cohort (n = 236) that this genetic advantage may be mediated by increased capacity for information processing between the dorsolateral PFC and dorsal ACC, which support higher cognitive functions. Collectively, these findings fill a gap in our understanding of the genetics of general cognitive ability and highlight a specific neural mechanism through which a common polymorphism shapes interindividual variation in "g."

A novel method for the quantitative evaluation of lumbar spinal stenosis.

STUDY DESIGN: A retrospective study of computed tomography (CT) myelographic images in patients with degenerative lumbar spinal stenosis (LSS). OBJECTIVES: To introduce a new technique for the quantitative evaluation of LSS. BACKGROUND: Advances in hardware and software technology now permit inexpensive digitalization of radiological images, and enable methodologies for quantifying space available for neural elements in spinal canal. However, a valid method with quantitative evaluation of spinal stenosis in living patients has not been developed yet. METHODS AND MATERIALS: Preoperative CT myelographic scans of 50 patients with degenerative LSS were collected for retrospective investigation. The patients subsequently underwent lumbar decompressive surgery. They included scans from thoracic vertebra 12 (T12) to sacrum (S1), in which each segment was scanned through both the vertebral body and disk. All CT scan films were digitized using a high-resolution digital camera. ImageTool software was used to measure three parameters: cross-sectional area of dural sac at disk level (A), cross-sectional area of spinal canal at midpedicular level (B), and cross-sectional area of vertebral body (C). The dural sac canal ratio (DSCR) was calculated as A/B x 100%. Low DSCR implied severe dural sac compression with a high degree of stenosis. The spinal canal vertebral ratio (CVR) was also calculated as B/C x 100%. Low CVR implied a low baseline of canal capacity for neural elements. They were calculated from T12 to S1. RESULTS: The study consisted of 26 male and 24 female patients, with an average age of 68.4 (35-97) years. A total of 295 segments were evaluated, of which 118 (40%) were surgically decompressed. There were wide ranges of canal cross-sectional areas (140-475 mm(2)) and dural sac cross-sectional area (54-435 mm(2)). Male patients had a slightly larger canal cross-sectional area than female patients at each level. The mean CVR was found decreased from T12 (26.1%) to L4 (18.3%). This was higher in female than in male patients, especially from T12 to L2 (P < 0.01). There were significant correlations between spinal canal and dural sac cross-sectional area (r = 0.55, P < 0.001), and also between CVR and DSCR (r = 0.31, P < 0.001). Of the levels decompressed, 82% was performed from the level L2 to L5, in which there was no significant difference in canal cross-sectional area and CVR between decompression and nondecompression (P > 0.05). There was a good correspondence between decreasing mean DSCR and increasing percentile of levels decompressed. CONCLUSION: DSCR represents a useful method for the quantitative diagnosis of lumbar spinal canal stenosis. ImageTool software is a useful tool in measuring spinal morphometry.

Alendronate inhibits spine fusion in a rat model.

STUDY DESIGN: A posterolateral lumbar fusion model in rats. OBJECTIVE: To study the effects of alendronate on posterolateral lumbar fusion in rats. SUMMARY OF BACKGROUND DATA: To our knowledge, there are no studies that show a significant inhibition of manual palpation-assessed spine fusion by alendronate. METHODS: A total of 75 Sprague-Dawley rats underwent intertransverse fusion with 7-tailbone autograft at L4-L5. Animals received saline (control), alendronate equivalent to human dose (dose1, 5 microg/kg/day), or 10 times the human dose (dose10, 50 microg/kg/day) via subcutaneous osmotic pumps starting the day of surgery. Eight weeks after surgery, animals were euthanized, and fusion was assessed by manual palpation. Radiographic area and optical density of fusion masses were calculated. Histomorphometry was used to assess the percentage area of fusion masses occupied by bone or marrow tissues. RESULTS: Manual palpation fusion rates were lower in alendronate groups (50% and 40%, respectively) than in the control group (95%, P = 0.002). Interobserver and intraobserver kappa values were high (0.97-1.00). There were dose-dependent and statistically significant (P < 0.001) increases in fusion mass area and optical density with increasing alendronate dose. Fusion masses in dose10 animals had significantly higher percent area of bone tissue (P = 0.01) and lower percent area of marrow elements (P < 0.001) when compared to control animals. CONCLUSIONS: Alendronate inhibits spine fusion in rats. Fusion masses in alendronate-treated animals appeared radiographically larger and denser than those in control animals despite lower fusion rates. Quantitative histomorphometry confirmed that alendronate inhibited bone graft resorption and incorporation. We recommend that patients undergoing spine arthrodesis should not take alendronate until fusion is achieved.

Resorbable posterolateral graft containment in a rabbit spinal fusion model.

OBJECT: The authors studied the effect of a resorbable graft containment device in a rabbit posterolateral lumbar spinal fusion model. METHODS: Twenty rabbits were divided into four groups: autologous bone graft (ABG), ABG with the MacroPore containment device (ABG + MP), demineralized bone matrix (DBM), and DBM with the containment device (DBM + MP). Fusion mass was assessed at 6 weeks with high-resolution radiography and volumetric computerized tomography. The graft containment device was associated with alteration of the fusion mass structure and significant enhancement of fusion mass volume (ABG versus ABG + MP, p = 0.027; DBM versus DBM + MP, p = 0.043). CONCLUSIONS: A bioabsorbable protective graft containment device successfully enhanced posterolateral spinal fusion mass volume.

Resorbable posterolateral graft containment in a rabbit spinal fusion model.

The effect of a resorbable graft containment device was evaluated in a rabbit posterolateral lumbar spinal fusion model. Twenty rabbits were divided into four groups: autogenous bone graft (ABG), ABG with the MacroPore containment device (MacroPore Biosurgery Inc, San Diego, Calif) (ABG+MP), demineralized bone matrix (DBM), and DBM with the containment device (DBM+MP). Fusion mass was assessed at 6 weeks with high resolution radiographs and volumetric computed tomography (CT). The graft containment device was associated with alteration of the fusion mass structure and significant enhancement of fusion mass volume (ABG versus ABG+MP, P=.027; DBM versus DBM+MP, P=.043). A bioabsorbable, protective graft containment device successfully enhanced posterolateral spinal fusion mass volume.

Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation.

STUDY DESIGN: A retrospective chart review was conducted for 112 patients who underwent revision posterior lumbar spine decompression, fusion, and segmental instrumentation. OBJECTIVE: To ascertain factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. SUMMARY OF BACKGROUND DATA: Posterior lumbar spine decompression and fusion with segmental instrumentation is a common procedure in the treatment of degenerative lumbar spine disorders. Many patients undergoing this procedure have had previous lumbar spine surgery, yet little is known about the factors predicting hospital stay, operative time, blood loss, and transfusion. METHODS: The charts of 112 patients (53 men and 59 women) with degenerative lumbar spinal stenosis who underwent revision surgery from March 1992 to June 1999 were reviewed. Their average age was 54 years (range, 27-84 years). All the surgeries included decompression and fusion with segmental instrumentation. The patients' demographics, comorbid conditions, factors related to previous lumbar spine surgery, diagnosis, number of levels fused, and preoperative hemoglobin and hematocrit were collected and used as the independent variables. Multiple regression analysis was used to ascertain factors predicting length of hospital stay, operative time, intraoperative blood loss, and transfusion. RESULTS: The mean length of hospital stay was 6 +/- 2.4 days, the operative time 280 +/- 62 minutes, the estimated intraoperative blood loss 1073 +/- 716 mL, and the total volume of blood transfused 1.04 +/- 1.17 U. For 63% of the patients, a blood transfusion was needed. Increasing age was the significant predictor for hospital stay (P < 0.001). The factors predicting operative time were number of levels fused (P < 0.001), diagnosis of degenerative scoliosis (P < 0.05), and excessive body weight (P < 0.01). The factors predicting intraoperative blood loss were number of levels fused (P < 0.01), body weight (P < 0.001), and high preoperative hemoglobin (P < 0.001). Both logistic and linear regression analysis showed that the factors predicting blood transfusion were number of levels fused (P < 0.01), age (P < 0.05), and low preoperative hemoglobin (P < 0.001). Other factors associated with hospital stay and blood transfusion were unemployment associated with three or more comorbid conditions and complications. The women had less intraoperative blood loss (P < 0.01), but received more transfused blood than the men (P < 0.01). CONCLUSIONS: Number of levels fused and age seem to be the most significant factors predicting hospital stay, operative time, intraoperative blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation.