The Effect of Perioperative Dexamethasone on Postoperative Complications After Pancreaticoduodenectomy: A Multicenter Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of perioperative dexamethasone on postoperative complications after pancreaticoduodenectomy. BACKGROUND: The glucocorticoid dexamethasone has been shown to improve postoperative outcomes in surgical patients, but its effects on postoperative complications after pancreaticoduodenectomy are unclear. METHODS: This multicenter, double-blind, randomized controlled trial was conducted in four Chinese high-volume pancreatic centers. Adults undergoing elective pancreaticoduodenectomy were randomized to receive either 0.2 mg/kg dexamethasone or a saline placebo as an intravenous bolus within 5 minutes after anesthesia induction. The primary outcome was the Comprehensive Complication Index (CCI) score within 30 days after the operation, analyzed using the modified intention-to-treat principle. RESULTS: Among 428 patients for eligibility, 300 participants were randomized and 265 were included in the modified intention-to-treat analyses. One hundred thirty-four patients received dexamethasone and 131 patients received a placebo. The mean (SD) CCI score was 14.0 (17.5) in the dexamethasone group and 17.9 (20.3) in the placebo group (mean difference: -3.8; 95% CI: -8.4 to 0.7; P = 0.100). The incidence of major complications (Clavien-Dindo grade ≥III; 12.7% vs 16.0%, risk ratio: 0.79; 95% CI: 0.44 to 1.43; P = 0.439) and postoperative pancreatic fistula (25.4% vs 31.3%, risk ratio: 0.81; 95% CI: 0.55 to 1.19; P = 0.286) were not significantly different between the two groups. In the stratum of participants with a main pancreatic duct ≤3 mm (n = 202), the CCI score was significantly lower in the dexamethasone group (mean difference: -6.4; 95% CI: -11.2 to -1.6; P = 0.009). CONCLUSIONS: Perioperative dexamethasone did not significantly reduce postoperative complications within 30 days after pancreaticoduodenectomy.

Strain-Induced Photocatalytic H2 Production over BiVO4 in Pure Water without Any Cocatalyst.

In this study, BiVO4 nanosheets (BiVO4-NS) were prepared by a facile hydrothermal method. It is found that sonication-induced strain can effectively promote the H2 production over BiVO4-NS in the presence of pure water without any cocatalysts. With the assistance of the sonication, the H2 production over BiVO4-NS is 1.344 mmol·g-1 after 3 h simulated sunlight irradiation, which is 24.8 times higher than that of BiVO4-NS without sonication (0.054 mmol·g-1). In addition, the products of water oxidation are determined to be hydroxyl radicals and hydrogen peroxide. Moreover, BiVO4-NS also shows obviously enhanced photoactivity than that of the commercially available BiVO4 nanoparticles (BiVO4-C). The improved photoactivity of BiVO4-NS is attributed to the effective charge separation and low charge transfer resistance. The underlying mechanism of sonication-promoted water splitting is investigated by a variety of controlled experiments. The results show that ultrasonic waves can produce obvious strain inside the sample, which results in lattice distortion of BiVO4. Therefore, the conduction band of BiVO4 is obviously negative shifted, which is beneficial for H2 production. In addition, the strain in BiVO4 also produces local polarization of the sample, which effectively promotes the charge transfer and separation process. It is hoped that our study could provide a new strategy for achieving efficient photocatalytic water splitting.