[Effectiveness of minimally invasive surgery in the treatment of pancreatic acinar cell carcinoma].

Objective: To explore the effectiveness of minimally invasive surgical treatment for pancreatic acinar cell carcinoma (PACC). Methods: Six patients with PACC diagnosed in Peking University Third Hospital from January 2010 to September 2022 were retrospectively selected. Preoperative evaluation was performed on whether the lesions were eligible for surgery, including whether radical resection of liver metastases could be performed. Laparoscopic or Da Vinci robot-assisted resection was performed on six patients, and spleen retention was determined according to the original lesions and the relationship with peripheral blood vessels and tissues, while simultaneous resection was performed on cases of peripheral organ tissue invasion. The patients' basic information, preoperative general conditions, preoperative diagnosis and tumor stage, minimally invasive surgery methods, postoperative complications, pathological results, tumor stage and follow-up data were collected and analyzed to explore the effectiveness of minimally invasive surgery. Results: Among the six patients, four were males and two were females, with the age of 25-69 years. Five patients had abdominal pain and distension before surgery, five patients had tumors located at the tail of the pancreatic body, and one patient had tumors located at the head of the pancreas. Preoperative imaging (enhanced CT and MRI) was performed to measure the tumor diameter (2.8-10.0 cm). Tumor markers were elevated in two patients before surgery, and six patients underwent surgery through laparoscopy or robotic platform. No complications such as postoperative pancreatic fistula and bleeding were clinically relevant during and after surgery. There were two cases with concurrent or heterochronous liver metastasis, two cases with lymph node metastasis and nodular metastasis, four cases with tumor invasion of surrounding organs (stomach, spleen or duodenum), and three cases with vascular cancer thrombi. The follow-up time of the six patients was 12 to 165 months, and one patient underwent three operations due to postoperative liver metastasis and residual pancreatic recurrence, and the results were satisfactory. All the six patients survived at the last follow-up. Conclusions: PACC is prone to invade the surrounding organs, and has a large tumor diameter. Radical surgery for PACC can be completed through minimally invasive surgery, and satisfactory oncology prognosis can be obtained. In addition, some PACC patients with recurrence and metastasis can still be treated by surgery.

[Controversies and prospects for surgical treatment of pancreatic neuroendocrine neoplasms with liver metastases].

The incidence of pancreatic neuroendocrine neoplasm(pNEN) increased over the past two decades. Liver metastasis, the most common type of distal metastasis, is also one of the most important prognostic factors. Although several medical treatments, including biotherapy, chemotherapy, targeted therapy, peptide receptor radionuclide therapy and locoregional therapy, are available for pNEN with liver metastases, surgery is still the only possible treatment for cure. Currently, there are several controversies as regards surgical treatment for pNEN with liver metastases. These controversies include, but are not limited to, whether surgical resection is appropriate for pancreatic neuroendocrine tumor G3 with liver metastases, how to classify primary lesion and hepatic metastases comprehensively and accurately, what is the optimal surgical strategy for type Ⅱ liver metastases, who can benefit greatly from cytoreduction, and how to refine the Milan criteria for liver transplantation. This article aims to discuss those main controversies and provide prospects for future clinical trials.

The natural course of otitis media with effusion in infants who failed universal newborn hearing screening: a retrospective cohort study.

OBJECTIVES: To analyse the natural course of infants with otitis media with effusion who failed universal newborn hearing screening and to explore the appropriate observation period. METHODS: This retrospective cohort analysis included infants with otitis media with effusion who failed universal newborn hearing screening every 3 months for 12 months. RESULTS: The average recovery time of the 155 infants was 7.08 ± 0.32 months after diagnosis. Multivariate Cox regression analysis confirmed that frequent reflux, maxillofacial deformities and initial hearing status were independent factors affecting recovery. Moreover, the cumulative recovery of most infants with mild hearing loss and infants with moderate hearing loss accompanied by frequent reflux was significantly higher at six months after diagnosis than at three months. CONCLUSION: For most infants with mild hearing loss, as well as those with moderate hearing loss accompanied by frequent reflux, the observation period can be extended to six months after diagnosis.

[Molecular targeted therapy strategy and clinical research progress in pancreatic ductal adenocarcinoma].

The incidence of pancreatic ductal adenocarcinoma(PDAC) is increasing year by year among digestive system tumors.It has a high degree of malignancy and a poor prognosis.Its five-year survival rate is less than 8%.Traditional radiotherapy and chemotherapy are not sensitive to pancreatic cancer,so finding a new drug is the future hope for pancreatic cancer.In recent years,molecular targeted therapy has made obvious progress in diseases such as hematological malignancies,non-small cell lung cancer and melanoma,and a large number of targets have been tried in pancreatic cancer, for example, gene mutation targets, important signaling pathway targets, receptor targets, etc. The use of these targeted drugs alone or in combination has shown good results in preclinical models and some clinical trials, and some treatment have been standardized for patients with pancreatic cancer, while other options that have not yet been tested in large-scale clinical trials also offer a variety of potential possibilities for future targeted treatments for pancreatic cancer.

[Advances in indocyanine green fluorescence imaging during hepatectomy].

While surgical operation is the preferred treatment for liver malignancies,the postoperative recurrence rate remains high. In the early 21st century,Japanese scientists first reported the use of indocyanine green(ICG) in liver resection. Follow-up studies also found its potential applications such as identifying tumors,determining surgical margins,delineating segmental boundaries,and preventing bile leakage. At present,ICG fluorescence imaging is applied to some types of hepatectomy with excellent effect and is expected to assist in generating surgical strategies for liver malignancies. However,its safety and efficacy still need further studies to evaluate.

[The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)].

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

[Characteristics of pancreatic ductal adenocarcinoma immune microenvironment and related immunotherapy strategies].

Pancreatic ductal adenocarcinoma is one of the common malignant tumors of the digestive tract. It has the characteristics of strong occlusion, aggressiveness, easy metastasis, and resistance to radiotherapy and chemotherapy. Therefore, its five-year survival rate is extremely low, with a rate of less than 8%. Looking for a new treatment is an urgent need to improve the prognosis of pancreatic ductal adenocarcinoma. In recent years, a large number of clinical trials have been carried out, such as immune checkpoint inhibitors, monoclonal antibodies to important antigens, and immune cell therapy. However, it is disappointing that no satisfactory clinical benefits have been achieved. The special microenvironment of pancreatic cancer nests makes immunotherapy not as effective as other malignant tumors. This article introduces the characteristics of the suppressive immune microenvironment of pancreatic cancer and the latest clinical studies of different types of immunotherapy at home and abroad, and analyzes the mechanisms and potentials of combined treatment based on the characteristics of the immune microenvironment.

[Problems and strategies in clinical application of associating liver partition and portal vein ligation for staged hepatectomy].

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.

[The value of Gd-EOB-DTPA-enhanced MRI in patients with major resection of liver cancer].

Objective: To investigate the value of Gd-EOB-DTPA-enhanced MRI in evaluating liver function and predicting the risk of post-hepatoectomy liver failure in patients with major resection of liver cancer. Methods: A total number of 212 patients were included from June 2016 to June 2019 at Department of General Surgery, Peking University Third Hospital with a retrospectively collected data.All patients underwent Gd-EOB-DTPA-enhanced MRI for diagnosis and preoperative evaluation of liver function.There were 135 males and 77 females, with age of (63.1±10.3) years old (range: 18 to 86 years old) . Relative enhancement ratio (RER) of the region of interest on Gd-EOB-DTPA-enhanced MRI was acquired by two independent researcher and then conducted the comparison of RER among the patients with or without post-hepatoectomy liver failure (PHLF) .Preoperative evaluation demonstrated that 141 cases infected by hepatitis virus, 128 cases with hepatitis B alone and 11 cases with hepatitis C alone, 2 cases had both of hepatitis B and C, and all patients were grade A judged by Child-Pugh score. The relationship between RER and PHLF was evaluated by Pearson correlation analysis and the diagnostic value of RER in predicting PHLF was test by receiver operating characteristic curve. Results: PHLF occurred in 42 patients according to ISGLS standard. Among them, 31 cases had level A liver failure, 9 cases had level B liver failure and 2 had level C failure. There was a significant correlation between RER and overall level of PHLF and RER was also significantly associated with severe B to C level of PHLF (P<0.05) .The further receiver operating characteristics curve analysis showed that the diagnostic accuracy of RER on overall PHLF was 0.818 (sensitivity 72.9%, specificity 83.3%, cut-off value 73.5%, 95%CI: 0.75 to 0.887) and on severe PHLF was 0.924 (sensitivity 97.0%, specificity 90.9%, cut-off value: 61.5%, 95%CI: 0.79 to 0.90) . Conclusion: For patients who planned to undergo major resection of liver cancer, preoperative Gd-EOB-DTPA-enhanced MRI can help with the assessment of liver function and predicting the risk for post-hepatectomy liver failure.

[Treatment strategies of pancreatic neuroendocrine neoplasms with liver metastases].

Liver metastases is the most common distant metastases of pancreatic neuroendocrine neoplasms, and it is also one of the main factors affecting the prognosis of patients. With the development of treatment technology and the rise of a multidisciplinary treatment model, the treatment plan for patients with liver metastases has gradually evolved into a comprehensive treatment plan including surgery, intervention, medicine, and radiation therapy. Radical surgery is still the only treatment currently available to cure patients with pancreatic neuroendocrine tumors and liver metastases. Very few selected patients can also benefit from liver transplantation. For most patients who are unable to undergo surgery can choose intervention, medicine and radiation therapy which can improve the patient's prognosis to a certain extent. Targeted therapy and immunotherapy have good development prospects, and further research is still needed. With multidisciplinary treatment, individualized treatment can help patients obtain the best treatment results.

Curcumin exerts protective effect on PC12 cells against lidocaine-induced cytotoxicity by suppressing the formation of NLRP3 inflammasome.

OBJECTIVE: To explore the protective effect of curcumin on lidocaine-insulted PC12 cells. MATERIALS AND METHODS: We first treated PC12 cells with different doses of lidocaine, and then treated the cells with curcumin or Nod-like receptor pyrin domain3 (NLRP3) inhibitor (MCC950). Subsequently, the cell viability, apoptosis, reactive oxygen species (ROS) production and NLRP3 inflammasome were detected by cell counting kit-8 (CCK8), Annexin V/PI staining, FCM and Western blot analysis, respectively, and the level of IL-1ß in PC12 cells was determined by an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: Lidocaine inhibited the viability of PC12 cells, and it induced cell apoptosis, promoted ROS release and activated NLRP3 inflammasome in PC12 cells, but its effects were reversed by the treatment of curcumin. Moreover, NLRP3 over-expression also induced cytotoxicity in PC12 cells, which was also rescued by the treatment of curcumin. CONCLUSIONS: Our study indicates that curcumin exerts protective effect against lidocaine-induced cytotoxicity on PC12 cells by suppressing the activity of NLRP3 inflammasome, which provides new ideas on screening natural product for neurological damage therapy.

[Gastroenteropancreatic neuroendocrine tumor microenvironment and related therapy].

Neuroendocrine tumor(NET) is a kind of highly heterogeneous and ubiquitous tumor, frequently localized in the gastrointestinal tract and pancreas. Surgery combined with regional ablation, endocrine therapy,chemotherapy and targeted therapy presents a favorable prognosis when treated with G1 or G2 gastroenteropancreatic neuroendocrine tumor(GEP-NET). However, there are only limited therapeutic strategies for metastatic unresectable tumors and poorly differentiated NEC,which are closely related to the special tumor microenvironment of neuroendocrine tumors.Targeting tumor microenvironment therapy is an important method in current systematic therapy, but till now the knowledge of neuroendocrine tumor microenvironment and its related treatment are limited. This article will specifically introduce the characteristics of tumor microenvironment in GEP-NET from the following aspects: the formation of enrichment vascular supply in TME,the role of tumor stroma,immune cells and cancer associacted fibroblast, and immune checkpoint and future trend of immunotherapy.

[Pancreatic ductal adenocarcinoma immune microenvironment and immunotherapy prospects].

The tumor components of pancreatic ductal adenocarcinoma (PDAC) are composed of immune microenvironment of extracellular matrix, fibroblasts, endothelial cells and immune cells together with a minority of malignant cells. The failure of the therapeutic measures, such as chemotherapy, targeted therapy and immunotherapy, has been linked to the specific immune microenvironment of pancreatic cancer. By analyzing the components of immune microenvironment of pancreatic cancer, the mechanism of various components in pancreatic cancer such as highly immunosuppressive, hypoxic and connective tissue hyperplasia can be clarified. New efforts in single-cell profiling will enable a better understanding of the composition of the microenvironment in primary and metastatic PDAC, as well as an understanding of how the microenvironment may respond to novel therapeutic approaches.

[Laparoscopic treatment for pancreatic pseudocysts].

Pancreatic pseudocyst is the most common pancreatic cystic disease in clinical practice.In the surgical treatment of pancreatic pseudocysts, most surgeons preferred laparoscopic surgery in recent years.The options and the timing of laparoscopic surgery for pancreatic pseudocysts in different situations are explored in the paper.Pancreatic pseudocysts during the observation period, the imaging examination to detect whether the cyst has disappeared or increased, such as cysts found to be enlarged or still can not dissipate after 6 months, the largest diameter greater than 6 cm, and clinical symptoms, surgical drainage should be considered treatment.Surgery based on the location of the cyst and surgical experience of surgical options.Pancreatic cyst often choose laparoscopic cyst-gastric anastomosis, far from the stomach cyst should choose laparoscopic cyst-jejunal anastomosis.Laparoscopic surgery for the treatment of pancreatic pseudocyst has a unique advantage, short operation time, less bleeding, less trauma, less postoperative complications, rapid recovery, is a safe and effective treatment options.

Does the addition of hyperbaric oxygen therapy to conventional treatment modalities influence the outcome of soldiers with idiopathic sudden sensorineural hearing loss?

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a 30-decibel (dB) loss in hearing over three contiguous frequencies within 3 days. The cause remains unknown, and there is currently no consensus in the literature as to how it is best treated. Conventional treatment in our unit comprises steroids, pentoxyphiline and dextran, with the potential addition of hyperbaric oxygen therapy (HBOT). METHODS: A prospective randomised trial was performed on all soldiers diagnosed with ISSNHL in our institution from 1 January 2007 to 31 December 2016. Participants were randomly allocated to one of two groups. Group A was treated with conventional treatment plus HBOT. Group B was treated with conventional treatment only. Data collection included age, gender, clinical symptoms, pure-tone audiometry results and treatment outcome. RESULTS: 60 participants were enrolled (53 male, 7 female) with ages ranging from 18 to 65 years (mean age of 30.3). No significant differences were observed in the baseline characteristics between the two groups, including gender, age, site, associated symptoms, duration of symptoms and severity of hearing loss. Hearing recovery using Siegel's criteria on days 8 and 13 showed no significant differences between treatment groups. However, the hearing recovery on day 180 was significantly better in those who received the conventional treatment plus HBOT (P<0.05). Additionally, no significant side effects were observed in either group. CONCLUSIONS: HBOT plus existing conventional treatment was associated with a better outcome than conventional treatment alone. We would recommend the addition of HBOT is recommended as a first-line treatment modality for all soldiers presenting with ISSNHL.

Spontaneous retropharyngeal emphysema: A case report.

Retropharyngeal emphysema is usually secondary to trauma, iatrogenic injury, and obstructive respiratory diseases. Without prompt and adequate treatment, severe complication such as airway compromise may occur. Spontaneous retropharyngeal emphysema, defined by the presence of free air in the retropharyngeal space without any precipitating cause, is a rare clinical condition in pediatric otolaryngology. The predominant symptoms are sore throat, odynophagia, dysphagia, and neck pain. Here, we report a case of spontaneous retropharyngeal emphysema.

[The treatment options of pancreatic neuroendocrine neoplasm with liver metastasis].

Liver metastasis is the one of the main prognostic factors of pancreatic neuroendocrine neoplasm (PNEN). With the development of multidisciplinary collaboration among surgical oncology, medical oncology, and intervention treatment, the treatment of PNEN with liver metastasis gradually tends to become diversification. Surgery is still the only way for curing the patients with pancreatic neuroendocrine tumor with liver metastasis when the histological types are G1 and G2. Medical oncology and intervention treatment could be selected for those having PNEN with diffuse liver metastasis or those cannot tolerate surgery. Liver transplantation only suits for a small number of selected patients. The present article explored the relationship between histological classifications and the treatment options of PNEN with liver metastasis, and discussed the specific treatments from perspectives of surgical treatment, medical treatment and intervention treatment.

Correlation between expression of LRP16, Ki67 and EGFR and breast cancer clinical pathologic factors and prognosis.

OBJECTIVE: To investigate the expression of leukemia-related protein 16 (LRP16), proliferating cell nuclear antigen K-67 (Ki67) and epidermal growth factor receptor-1 (EGFR-1) in breast cancer tissue and to explore the correlation between the expression of those proteins and breast cancer clinical pathologic factors and prognosis. PATIENTS AND METHODS: The expressions of LRP16, Ki67 and EGFR in breast cancer tissues of 86 cases were detected by the immunohistochemical method and the correlations between the expression of LRP16, Ki67 and EGFR and clinical pathologic factors and prognosis were investigated. RESULTS: Positive expression rates of LRP16, Ki67 and EGFR in breast cancer tissue were 52.3%, 70.9% and 16.3%, respectively. There was no statistical difference in the expression of RP16, Ki67 and EGFR between different age groups (p>0.05). The expression of LRP16 was correlated with clinical stage, histological grade, tumor size and lymphatic metastasis (p<0.05); the expression of Ki67 was correlated with clinical stage, histological grade, tumor size and lymphatic metastasis (p<0.05); the expression of EGFR was correlated with histological grade (p<0.05). Comparison of postoperative local recurrence and metastasis time between LRP 16 positive group and negative group showed statistically significant difference (p<0.05); comparison of postoperative local recurrence and metastasis time between Ki67 positive group and negative group also showed statistically significant difference (p<0.05); comparison of postoperative local recurrence and metastasis time between EGFR positive group and negative group showed no statistically significant difference (p<0.05). CONCLUSIONS: Detection of expression levels of LPR16, Ki67 and EGFR in breast cancer tissue improves the understanding of biological behaviors of breast cancer, which in turn provide clinical guidance in diagnosis, treatment and prognosis assessment.