[Risk factors for delayed gastric emptying after laparoscopic pancreaticoduodenectomy: a single-center experience of 1 000 cases].

Objective: To explore the causes and summarize the treatment experience for clinically relevant delayed gastric emptying(DGE) after laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 1 000 patients who underwent LPD in the Department of Liver Transplantation and Hepatobiliary Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University between March 2017 and September 2022 was retrospectively collected. There were 640 males and 360 females,with an age of (60.1±11.4)years(range: 13 to 93 years),and 590 patients were older than 60 years. Depending on the severity of DGE,patients were divided into a clinically relevant DGE group and a 0/A grade DGE group. The comparison between the two groups was performed by the χ2 test,Fisher's exact probability method,t test or the rank sum test,and the effects of various treatment strategies for clinically relevant DGE were evaluated. Results: LPD was conducted successfully in all 1 000 patients,with a surgical time of (344.8±103.6)minutes(range:160 to 450 minutes) and intraoperative blood loss (M(IQR)) of 100 (150) ml(range:50 to 1 000 ml). A total of 74 patients(7.4%) developed clinically relevant DGE. Compared to those in the 0/A grade DGE group,patients in the clinically relevant DGE group had a higher preoperative body mass index of ((24.9±3.5)kg/m2 vs. (23.9±3.3)kg/m2,t=-2.419,P=0.016),more postoperative bile leakage(51.4%(38/74) vs. 10.8%(100/926)),pancreatic fistula(59.5%(44/74) vs. 22.9%(212/926)),abdominal infection(74.3%(55/74) vs.14.6%(135/926)),and abdominal bleeding(43.2%(32/74) vs. 11.3%(105/926))(all P<0.05). Among these patients,10 cases(13.5%) received enteral nutrition treatment,22 cases(29.7%) received parenteral nutrition treatment,and 42 cases(56.8%) received a combination of enteral and parenteral nutrition treatment. The time for patients to return to a normal diet was 21(14)days (range: 8 to 85 days). Compared to those who received only enteral(23.5(27.0)days) or parenteral nutrition treatment(15.5(11.0)days),patients who received a combination of enteral and parenteral nutrition treatment(25.5(31.0)days) had a longer time to return to a normal diet (Z=20.019,P<0.01). Among the 60 patients who developed secondary DGE,48 cases(80.0%) received ultrasound-guided puncture and drainage treatment,while 12 cases(20.0%) only received anti-infection treatment. The patients in the non-puncture drainage group had a longer time to return to a normal diet than those in the puncture drainage group (26.5(12.5)days vs. 20.0(11.0)days, Z=-2.369,P=0.018). Conclusions: Patients with clinically relevant DGE after LPD had a higher proportion of postoperative complications such as pancreatic fistula,biliary fistula and abdominal infection. A combination of enteral and parenteral nutrition treatment is needed for patients with a long-term course of DGE."Smooth" drainage and ani-infectious therapy could contribute to the recovery of DGE.

[Advances in internal fixation for the treatment of extra-articular distal tibial fracture].

Extra-articular distal tibial fractures as a result of high-energy damage are often comminuted or displaced, frequently accompanied by severe soft tissue injuries.Poor blood supply and various complications make the treatment more difficult,affecting life quality of the patients.The main goals of the treatment are to abtain a healed,well-aligned fracture,functional range of motion of the ankle joint and minimizing complications.It is generally recommended that surgical treatment be performed in the proper context of local conditions to facilitate early functional exercise.Plate fixation and intramedullary nail fixation are the common options for closed fractures.This article focuses on the two treatment methods and some important auxiliary technologies in both domestic and foreign, hoping to provide some references for clinical treatment.

Immunogenicity of the envelope GP3 protein of porcine reproductive and respiratory syndrome virus displayed on baculovirus.

Porcine reproductive and respiratory syndrome virus (PRRSV) has been recognized as one of the most important pathogens of pigs throughout the world. The minor envelope protein GP3 of PRRSV plays an important role in clearing of the virus infection and protecting the animals. In this study, a recombinant baculovirus (BacSC-GP3) expressing His6-tagged GP3 with the transmembrane (TM) and cytoplasmic (CT) domains of envelope protein gp64 was constructed and its immunogenicity was evaluated in mouse and piglet models. The His6-tagged GP3 was successfully displayed on the surface of virions as well as virus-infected Sf-9 cells. The animals immunized with BacSC-GP3 gave a slightly higher (piglets) up to a markedly higher (mice) humoral and lymphocyte proliferation responses than those that received a commercial killed vaccine. This is the first study on the immunogenicity of recombinant GP3-baculovirus, which indicates that the latter can represent an alternative strategy for developing a more effective PRRSV vaccine.

Interferon as a mediator of human lymphocyte suppression.

Evidence is presented that interferon (IF) is a major mediator of the human concanavalin A (Con A) suppressor cell. The suppressive effects of Con A-activated lymphocytes on the mitogen responses of normal responder cells were largely abrogated by addition of anti-human leukocyte IF serum. Similar suppressor activity was generated by coculture of peripheral blood leukocytes (PBL) with a melanoma cell line (MeWo) and a HeLa cell line persistently infected with measles virus that induced the production of IF by lymphocytes. A human mammary carcinoma line (MCF-7) and two bladder carcinoma lines (T24 and TCCSUP) failed to induce IF or suppression. Addition of anti-human leukocyte IF serum to suppressor cells and supernates from tumor cell-lymphocyte cocultures largely abolished suppression and neutralized the antiviral activity of such supernates. Exposure of PBL from purified protein derivative (PPD)-positive donors to PPD caused the production of suppressor activity and IF. PBL from PPD-negative donors failed to produce significant amounts of IF or to suppress on exposure to PPD. Supernates from PBL treated with virus (Newcastle disease virus [NDV]) contained IF and suppressed the mitogen responses of responder PBL. Both the suppressive and the antiviral activities of this material were eliminated after treatment with anti-IF serum. To ascertain whether antiviral and suppressive activities were mediated by the same types of IF, supernates from PBL cultured with Con A, PPD, NDV, and tumor cells were treated with anti-IF serum or acid pH. In all cases antiviral activity was neutralized in parallel with abrogation of suppressor activity. These results provide strong evidence for the role of IF as a mediator of human suppressor cell activity.

Rat carnitine palmitoyltransferase Ibeta mRNA splicing isoforms.

Carnitine palmitoyltransferase I (CPT-I) catalyzes the rate-determining step in mitochondrial fatty acid beta-oxidation. The enzyme has two cognate structural genes (alpha and beta) that are differentially expressed in tissues. We show multiple mature mRNAs in rat heart derived from alternative splicing of CPT-Ibeta transcripts. Two novel messages are deleted for regions of the previously described mRNA that encode membrane-spanning and regulatory domains, suggesting that the cognate isozymes will exhibit unique kinetic characteristics.

Giant lymph-node hyperplasia, plasma-cell type, of the mediastinum, with peripheral neuropathy.

A case of mediastinal giant lymph-node hyperplasia, plasma-cell type, is described. The patient had progressive peripheral neuropathy for which no apparent cause was found. Giant lymph-node hyperplasia with associated peripheral neuropathy has not been reported previously.

Breast carcinoma-associated antigen. An immunocytochemical study.

An antiserum raised against a high molecular weight fraction of a medullary carcinoma of the breast was used to study breast carcinomas by means of an indirect unlabeled antibody peroxidase-antiperoxidase (PAP) technic. Strong cytoplasmic staining was demonstrated in all of 30 breast cancers tested and in one of three intraductal papillomas. Weak cytoplasmic staining was detected in four of nine fibroadenomas, two malignant melanomas, and one of six carcinomas of the colon. No cytoplasmic staining was seen in 24 other specimens of breast tissue, including 12 specimens from patients who had fibrocystic disease and five fibroadenomas, or in 17 extramammary malignant tumors. The antiserum appears to identify a breast carcinopma-associated antigen.

Analysis of the thromboxane/prostacyclin balance in human urine by gas chromatography/selected ion monitoring: abnormalities in diabetics.

We microanalyzed 2,3-dinor-6-keto-prostaglandin F1 alpha (2,3-dinor-6-keto-PGF1 alpha 1) and 11-dehydrothromboxane B2 (11-dehydro-TXB2, 2) in human urine. Samples containing a [2H4]-analogue as an internal standard were extracted by chromatography using Sep Pak tC18 and silica gel. The compounds were then analysed by means of the lactone ring opening reaction and dimethylisopropylsilylation. The conversion of 1 to 1-methyl ester (ME)-propylamide (PA)-9, 12, 15-dimethylisopropylsilyl (DMIPS) ether derivative and of 2 to 1-ME-6-methoxime (MO)-9, 12, 15-tris-DMIPS ether derivative was followed by gas chromatography/selected ion monitoring (GC/SIM). Interfering substances from the urine matrix were eliminated during GC/SIM analysis using a DB-5 column. We were able to detect 1 (222-1031 pg/mg creatinine) and 2 (18-155 pg/mg creatinine) in human urine. Furthermore, the thromboxane/prostacyclin (IX/PGI) ratio in the urine of diabetics was higher than that of healthy volunteers. This method can be used to determine the TX/PGI balance in human urine.

Atypical stromal smooth muscle hyperplasia of prostate.

A prostatic lesion was resected but recurred six years later with the same atypical smooth muscle hyperplasia in the stroma and without glandular atypia. Ultrastructural study confirms the smooth muscle origin and its atypicality. Review of previous reports of leiomyosarcoma of the prostate show that the minimum criteria for malignancy are gross evidence of capsular invasion and one to two mitotic figures per ten high-power field. Cellular pleomorphism and cellularity by themselves are insufficient to diagnose sarcoma.

Inhibition of beta-amyloid cytotoxicity by midkine.

Midkine (MK) is a neurotrophic and angiogenic growth factor whose expression occurs mainly in fetus. It was reported that MK was present in senile plaques of Alzheimer's disease (AD). To investigate the role of MK during amyloid plaques formation in AD, we examined the in vitro effect of MK on Abeta aggregation and Abeta-induced cytotoxicity. We found that incubation of MK with Abeta resulted in the formation of MK/Abeta complexes. The C-terminus of MK (60-121) played a similar role as the full length MK in complex formation. This interaction of MK and Abeta demonstrated significant inhibition on Abeta self-aggregation. MK also inhibited the cytotoxicity of Abeta on PC12h cells. These findings suggest that MK protects the cells from Abeta-induced cytotoxicity through its complex formation with Abeta. MK is probably expressed to prevent cell death in AD.

Desmoid tumor of the sternum presenting as an anterior mediastinal mass.

A 20-year-old man with a large, asymptomatic mediastinal mass was found to have desmoid-type fibromatosis (DF) by needle biopsy. The tumor arose from the internal periosteum of the sternum and mimicked an anterior mediastinal mass. A wide resection of the sternum, including portions of the clavicles and costal cartilages, and reconstruction with a Gore-Tex soft tissue patch were performed. Although extremely rare, desmoid tumor of the sternum should be considered in the differential diagnosis of anterior mediastinal tumors.

Abdominal visceral peliosis associated with bacillary angiomatosis. Ultrastructural evidence of endothelial destruction by bacilli.

Peliosis involving solid internal organs is a rare entity, and it has been reported in association with chronic debilitating diseases. Bacillary angiomatosis (BA), on the other hand, is a recently identified lesion found virtually only in individuals infected by the human immunodeficiency virus. We describe herein two cases of visceral BA and peliosis in human immunodeficiency virus-infected patients. Based on light and electron microscopic findings, we conclude that (1) BA bacilli present in the hepatic sinusoidal endothelial cells, in a suitable host milieu, may be the causative agents of peliosis hepatis; (2) BA bacilli can be found both intracellularly and extracellularly; and (3) peliosis is also identified in association with BA in abdominal lymph nodes.

Poisoning with N-3-pyridylmethyl-N'-p-nitrophenylurea (Vacor). Immunoperoxidase demonstration of beta-cell destruction.

A 49-year-old woman ate N-3-pyridylmethyl-N'-p'nitrophenylurea (PNU; Vacor) and was admitted to the hospital 12 hours later with a blood glucose level of 940 mg/dl and an anion-gap metabolic acidosis. Her diabetes was successfully treated, but she contained to manifest severe orthostatic hypotension. A painless ileus developed, followed by cecal perforation and death. Immunoperoxidase staining of paraffin-embedded pancreatic tissue obtained during postmortem examination clearly demonstrated the pancreatic beta-cell destruction. Results of this same staining technique also suggested that fewer alpha cells were present.

A preliminary report on transplantation of microskin autografts overlaid with sheet allograft in the treatment of large burns.

The technique of transplantation of autologous microskin grafts (MG) with overlays of split-thickness skin allografts was used in the treatment of nine extensively burned patients. Preparation of MG includes: 1) mincing small pieces of split-thickness skin autografts into skin particles (SPs); 2) dispersing the SPs evenly on a piece of silk cloth; 3) transferring SPs to the dermal surface of an allograft sheet (20/1000 in.); 4) transplanting the allograft with SPs to the excised wound. The mean burn area (total/3 degrees, mean +/- SEM) of this group was 74.9 +/- 16.6/62.1 +/- 18.1% TBSA (range 40 to 94/28 to 90%). The mean age was 27 years (range 19 to 38). Early staged excisions followed immediately by MG applications were performed on 35 large body sites, including extremities, chests plus abdomens and backs. The mean area excised and grafted with MG was 41.7 +/- 11.0% TBSA (range 26 to 62%). The average time for complete healing was about six to seven weeks postgrafting. Eight patients survived; one died of overwhelming pulmonary infection 22 days postburn. Advantages of this technique are: 1) the great potential of MG to provide a large expansion ratio of 8:1 to 15:1, average greater than 10:1 in this series; 2) good maintenance of the healed graft to withstand trauma except in areas of repeated flexion; 3) ease of preparation and application with less cost compared to cultured epidermal sheet grafts; 4) prevention of infection in extremely large burns by providing continuous epidermal coverage following sheet allograft application.

Observations on stability and contraction of composite skin grafts: xenodermis or allodermis with an isograft overlay.

Composite skin grafts of xenodermis or allodermis with a thin split-thickness isograft overlay were evaluated for stability and contraction. Male inbred Lewis rats were used as recipients, with Buffalo rats serving as allogeneic dermis donors. Cryopreserved human skin was used for xenodermis grafts. The two components of the composite graft, the xenodermis or allodermis and the isograft overlay, were grafted in one operation to a surgically created wound. Wounds were observed for 1 year. The composite skin grafts took fairly well, although spotty loss of the overlaid isograft was noted. The xenodermis and allodermis remained grossly intact even at 1 year after grafting. However, composite skin grafts in this animal model contracted more than did sheet isografts alone.

Comparison of scar contracture with the use of microskin and Chinese-type intermingled skin grafts on rats.

Wounds that were measured precisely 4 x 5 cm in size were created over the dorsal surfaces of rats. The defects were grafted with the use of either the microskin or Chinese technique of intermingled auto/allograft with an expansion ratio of 10:1. The size of the grafted wound of each rat was recorded on the fifth graft day after grafting and then weekly for 11 weeks. The extent of scar contracture on each rat was calculated weekly as a percentage of the original size. The results showed that the scar contracture associated with the Chinese type of intermingled auto/allograft transplantation was less than that associated with the microskin technique. The healing process in both forms of grafting was uneventful.

Keratosis punctata of the palmar creases.

We report on a 31-year-old man with keratosis punctata (punctate hyperkeratosis) of the palmar creases. We examined a lesion ultrastructurally and were unable with routine electron microscopic techniques to note any significant abnormalities.

[Effect of alpha 1-adrenoceptor subtypes on beta-adrenoceptor mediated positive inotropic response in rat left atria].

The distribution of the alpha 1-adrenoceptor (alpha 1-AR) subtypes and the effects of activation of alpha 1-AR subtypes on the beta-adrenoceptor (beta-AR) mediated positive inotropic response were investigated. The radioligand binding assays indicated that the Bmax and Kd values were 11.7 +/- 18 fmol/mg.protein and 86.0 +/- 9.6 pmol/L respectively. Pretreatment of the preparations with 20 mumol/L chloroethylclonidine (CEC) which inactivated alpha 1B subtype, decreased the Bmax to 45.7 +/- 5.2 fmol/mg.protein (P < 0.01). The inhibition curves of 5-methyl-urapidil were best fitted to two site model and indicated that alpha 1A subtype took 28.5% of total 125IBE specific binding sites. In the functional experiments, norepinephrine (NE) induced a positive inotropic response in a concentration dependent manner by activation of both beta- and alpha 1-AR. The concentration-response curves (CRC) for NE were shifted rightward after the pretreatment of the preparations with 20 mumol/L CEC, but leftward in the presence of 1 nmol/L WB4101. In the presence of 10 mumol/L phentolamine which inactivated both alpha 1-AR subtypes, the CRC for NE were shifted leftward. When alpha 1-AR was activated by phenylephrine the CRC for isoproterenol (selective beta-AR agonist) were shifted rightward. The results suggested that the alpha 1B subtype enhanced while the alpha 1A subtype inhibited the beta-AR mediated positive inotropic response. When both alpha 1A and alpha 1B subtypes were activated simultaneously the alpha 1A subtype showed a dominate role.