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.

Urinary orosomucoid and retinol binding protein levels as early diagnostic markers for diabetic kidney Disease.

BACKGROUND: Diabetic kidney disease (DKD) is the most common microvascular complication of diabetes, which has been a major cause of end-stage renal failure. Diagnosing diabetic kidney disease is important to prevent long-term kidney damage and determine the prognosis of patients with diabetes. In this study, we investigated the clinical significance of combined detection of urine orosomucoid and retinol-binding protein for early diagnosis of diabetic kidney disease. METHODS: We recruited 72 newly diagnosed patients with type 2 diabetes and 34 healthy persons from August 2016 to July 2018 at the First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital). Using the Mogensen grading criteria, participants were classified as having diabetes or diabetic kidney disease, and healthy persons constituted the control group. Urine orosomucoid and retinol-binding protein levels were measured and correlated with other variables. RESULTS: With the aggravation of renal damage, the level of urinary mucoid protein gradually increased. Urinary retinol-binding protein and microalbumin levels were significantly higher in the diabetes group than in control and nephropathy groups. Orosomucoid and retinol-binding protein might be independent risk factors for diabetes and diabetic kidney disease. Urinary orosomucoid significantly correlated with retinol-binding protein and microalbumin levels in the diabetic kidney disease group. CONCLUSION: Elevated urine orosomucoid and retinol-binding protein levels can be detected in the early stages of type 2 diabetic kidney disease. Both of these markers are important for diabetic kidney disease detection and early treatment.

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.

Hierarchically porous nanosheets-constructed 3D carbon network for ultrahigh-capacity supercapacitor and battery anode.

An advanced hierarchically porous nanosheets-constructed three-dimensional (3D) carbon material (HPNSC) is prepared by using low-cost agricultural waste-nelumbium seed-pods as the precursor, and potassium hydroxide (KOH) as the activator. The as-prepared HPNSC material has a hierarchically porous nanosheets-constructed structure with 3D carbon nanosheet network morphology, which can enable fast and efficient transfer of Li+/Na+/H+ during charge-discharge process. The assembled HPNSC//HPNSC symmetric supercapacitors exhibit an improved energy density of 41.3 W h kg-1 with a power density of 180 W kg-1 in 1 mol l-1 Na2SO4 electrolyte. The energy density can still be maintained at 16.3 W h kg-1 even if the power density is increased to 9000 W kg-1. When acting as the reversible electrode for lithium ion batteries, this HPNSC material can achieve a high specific capacity of 1246 mA h g-1 at 0.1 A g-1. Moreover, sodium ion battery with HPNSC electrode exhibits excellent cycling performance of 161.8 mA h g-1 maintained even after being cycled 3350 times. The electrochemical performances clearly indicate that the HPNSC developed in this work is a very promising energy storage electrode material, and can further provide new insights for designing and developing highly porous materials for energy storage in other fields.

[The diagnosis and therapy of pancreatic cystic tumors].

OBJECTIVE: To discuss the surgical option and the treatment of complications of pancreatic cystic tumors. METHODS: From January 1997 to December 2009, 32 patients with pancreatic cystic tumors in our center were reviewed retrospectively. There were 6 male and 26 female, aging from 24 to 76 years. Of the 32 patients, 16 patients had serous cystadenoma, 9 patients had mucinous cystadenoma; 1 patients had mucinous cystadenocarcinoma; 4 patients had intraductal papillary mucinous neoplasms and 3 patients had pancreatic solid pseudopapillary neoplasms. Tumor located in pancreatic head in 12 patients and in pancreatic body and tail in 20 patients. RESULTS: All patients received surgical treatment and there was no perioperative death. Pancreato-duodenectomy was performed in 10 patients, duodenum-preserving pancreatic head resection in 1 patient, distal pancreactomy in 13 patients, including laparoscopic distal pancreactomy in 2 patients, pancreatic tumor resection in 3 patients, middle segmental resection in 4 patients; 1 patients with mucinous cystadenocarcinoma received palliative surgery. Complication included gastroparesis in 3 patients and pancreatic fistula in 5 patients, and all recovered by conservative treatment. These 29 patients were followed up 4 - 120 months, 3 patients died from tumor metastasis or other disease within 4 to 34 months after surgery. Others were alive and there was no tumor recurrence or metastasis. CONCLUSIONS: CT scan should be the first choice of non-invasive examination for cystic pancreatic diagnosis. Positive and timely operation should be performed in the patient with cystic pancreatic tumor, and it acts as a cancer preventive treatment. The selection of surgical approach should be individualized, the principal of damage control surgery should be followed. Complications such as gastroparesis and pancreatic fistula should be paid more attention.

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.

[Effects of early goal-directed fluid therapy on intra-abdominal hypertension and multiple organ dysfunction in patients with severe acute pancreatitis.].

OBJECTIVE: To observe the effects of early goal-directed fluid therapy with hydroxyethyl starch 130/0.4 on intra-abdominal hypertension (IAH), multiple organ dysfunction and fluid balance in severe acute pancreatitis (SAP) patients. METHODS: According to the criteria of selection and exclusion, 120 SAP patients within 72 hours after the symptom occurred from 4 study sites were recruited. They were given standard medication according to "the guideline of diagnosis and treatment of SAP in China" in SICU or PICU. The patients were randomly divided into two groups with crystalloid (control group) and colloid plus crystalloid resuscitation (research group). The objective of fluid therapy was to keep steady hemodynamics for 8 days. IAP was measured three times daily by means of urinary bladder transduction. Function of liver, renal and lung were detected daily. APACHE II score and fluid balance were calculated daily. RESULTS: Total 120 cases were recruited into research group (n = 59) and control group (n = 61). The demography and baseline data were comparable. IAP was lower in research group than that in control group at day 4 and day 5 (P < 0.05). There was no significant difference in APACHE II scores between two groups pre- and after admission. The decline of daily IAP to baseline (DeltaIAP) in research group was significantly higher than in research group from day 2 to day 8(P < 0.05), whilst the decline of daily APACHE II score to baseline (DeltaAPACHE II score) in research group were significantly higher from day 4 to day 8 (P < 0.05). Negative fluid balance emerged much earlier in the research group (P = 0.036). Percentage of patients with negative fluid balance within 8 days was significantly higher in research group than that in control group (94.9% vs. 62.3%). The amount of positive fluid balance was significantly lower in research group (P = 0.039). IAP correlated significantly with APACHE II score (r(2) = 0.322, P = 0.000). PaO2/FiO2 was significantly higer in research group at day 4 and day 8. CONCLUSIONS: It is very important to pay close attention to IAP in early fluid therapy of SAP patients. Early goal-directed fluid therapy with HES130/0.4 shortens the duration of positive fluid balance, decreases the amount of positive fluid balance, reduces APACHE II score, relieves IAH, and improves PaO2/FiO2.

Self-Supporting, Flexible, Additive-Free, and Scalable Hard Carbon Paper Self-Interwoven by 1D Microbelts: Superb Room/Low-Temperature Sodium Storage and Working Mechanism.

Hard carbon is regarded as a promising anode material for sodium-ion batteries (SIBs). However, it usually suffers from the issues of low initial Coulombic efficiency (ICE) and poor rate performance, severely hindering its practical application. Herein, a flexible, self-supporting, and scalable hard carbon paper (HCP) derived from scalable and renewable tissue is rationally designed and prepared as practical additive-free anode for room/low-temperature SIBs with high ICE. In ether electrolyte, such HCP achieves an ICE of up to 91.2% with superior high-rate capability, ultralong cycle life (e.g., 93% capacity retention over 1000 cycles at 200 mA g-1 ) and outstanding low-temperature performance. Working mechanism analyses reveal that the plateau region is the rate-determining step for HCP with a lower electrochemical reaction kinetics, which can be significantly improved in ether electrolyte.

Highly Improved Cycling Stability of Anion De-/Intercalation in the Graphite Cathode for Dual-Ion Batteries.

Conventional ion batteries utilizing metallic ions as the single charge carriers are limited by the insufficient abundance of metal resources. Although supercapacitors apply both cations and anions to store energy through absorption and/or Faradic reactions occurring at the interfaces of the electrode/electrolyte, the inherent low energy density hinders its application. The graphite-cathode-based dual-ion battery possesses a higher energy density due to its high working potential of nearly 5 V. However, such a battery configuration suffers from severe electrolyte decomposition and exfoliation of the graphite cathode, rendering an inferior cycle life. Herein, a new surface-modification strategy is developed to protect the graphite cathode from the anion salvation effect and the deposition derived from electrolyte decomposition by generating an artificial solid electrolyte interphase (SEI). Such SEI-modified graphite exhibits superior cycling stability with 96% capacity retention after 500 cycles under 200 mA g-1 at the upper cutoff voltage of 5.0 V, which is much improved compared with the pristine graphite electrode. Through several ex situ studies, it is revealed that the artificial SEI greatly stabilizes the interfaces of the electrode/electrolyte after reconstruction and gradual establishment of the optimal anion-transport path. The findings shed light on a new avenue toward promoting the performance of the dual-ion battery (DIB) and hence to make it practical finally.

An FeP@C nanoarray vertically grown on graphene nanosheets: an ultrastable Li-ion battery anode with pseudocapacitance-boosted electrochemical kinetics.

In order to develop promising anode materials for lithium-ion batteries (LIBs), a unique nanocomposite abbreviated as G⊥FP@C-NA, in which a carbon-coated FeP nanorod array (FP@C-NA) is vertically grown on a conductive reduced graphene oxide (G) network, has been successfully prepared via a scalable strategy. Benefiting from the distinctive structure, G⊥FP@C-NA exhibits much improved conductivity, structural stability and pseudocapacitance-boosted ultrafast electrochemical kinetics for Li storage. As a result, the G⊥FP@C-NA delivers a high Li-storage capacity (1106 mA h g-1 at 50 mA g-1), outstanding rate capability (565 mA h g-1 at 5000 mA g-1) and long-term cycling stability (1009 mA h g-1 at 500 mA g-1 after 500 cycles and 310 mA h g-1 at 2000 mA g-1 after 2000 cycles) when used as an anode material for LIBs. As expected, this kind of nanoarray structure is attractive and can also be extended to other electrode materials for various energy storage systems.

Dendrite-free deposition on lithium anode toward long-life and high-stable Li//graphite dual-ion battery.

Metallic lithium protection plays a crucial role on improving the electrochemical properties of Li-anode-based batteries. Herein, for an advanced Li//graphite dual-ion battery, constructing a robust and conductive film of carbon nanofibers on a Li anode effectively achieves dendrite-free Li growth and hence significantly enhances the long-life cyclic stability.

Hierarchical GeP5/Carbon Nanocomposite with Dual-Carbon Conductive Network as Promising Anode Material for Sodium-Ion Batteries.

Due to the Earth's scarcity of lithium, replacing lithium with earth-abundant and low-cost sodium for sodium-ion batteries (SIBs) has recently become a promising substitute for lithium-ion batteries. However, the shortage of appropriate anode materials limits the development of SIBs. Here, a dual-carbon conductive network enhanced GeP5 (GeP5/acetylene black/partially reduced graphene oxide sheets (GeP5/AB/p-rGO)) composite is successfully prepared by a facile ball milling method. The dual-carbon network not only provides more transport pathways for electrons but also relaxes the huge volume change of the electrode material during the charge/discharge process. Compared with only AB- or GO-modified GeP5 (GeP5/AB or GeP5/GO) composite, the GeP5/AB/p-rGO composite shows a superior sodium storage performance with an excellent rate and cycle performance. It delivers a high reversible capacity of 597.5 and 175 mAh/g at the current density of 0.1 and 5.0 A/g, respectively. Furthermore, at the current density of 0.5 A/g, the GeP5/AB/p-rGO composite shows the reversible capacity of 400 mAh/g after 50 cycles with a little capacity attenuation. All above results prove that the GeP5/AB/p-rGO composite has a good prospect of application as an anode material for SIBs.

A Scalable Strategy To Develop Advanced Anode for Sodium-Ion Batteries: Commercial Fe3O4-Derived Fe3O4@FeS with Superior Full-Cell Performance.

A novel core-shell Fe3O4@FeS composed of Fe3O4 core and FeS shell with the morphology of regular octahedra has been prepared via a facile and scalable strategy via employing commercial Fe3O4 as the precursor. When used as anode material for sodium-ion batteries (SIBs), the prepared Fe3O4@FeS combines the merits of FeS and Fe3O4 with high Na-storage capacity and superior cycling stability, respectively. The optimized Fe3O4@FeS electrode shows ultralong cycle life and outstanding rate capability. For instance, it remains a capacity retention of 90.8% with a reversible capacity of 169 mAh g-1 after 750 cycles at 0.2 A g-1 and 151 mAh g-1 at a high current density of 2 A g-1, which is about 7.5 times in comparison to the Na-storage capacity of commercial Fe3O4. More importantly, the prepared Fe3O4@FeS also exhibits excellent full-cell performance. The assembled Fe3O4@FeS//Na3V2(PO4)2O2F sodium-ion full battery gives a reversible capacity of 157 mAh g-1 after 50 cycles at 0.5 A g-1 with a capacity retention of 92.3% and the Coulombic efficiency of around 100%, demonstrating its applicability for sodium-ion full batteries as a promising anode. Furthermore, it is also disclosed that such superior electrochemical properties can be attributed to the pseudocapacitive behavior of FeS shell as demonstrated by the kinetics studies as well as the core-shell structure. In view of the large-scale availability of commercial precursor and ease of preparation, this study provide a scalable strategy to develop advanced anode materials for SIBs.

Pseudocapacitance-boosted ultrafast Na storage in a pie-like FeS@C nanohybrid as an advanced anode material for sodium-ion full batteries.

In order to develop promising anode materials for sodium-ion batteries (SIBs), a novel pie-like FeS@C (P-FeS@C) nanohybrid, in which all ultrasmall FeS nanocrystals (NCs) are completely embedded into the carbon network and sealed by a protective carbon shell, has been prepared. The unique pie-like structure can effectively speed up the kinetics of electrode reactions, while the carbon shell stabilizes the FeS NCs inside. Studies show that the electrochemical reaction processes of P-FeS@C electrodes are dominated by the pseudocapacitive behavior, leading to an ultrafast Na+-insertion/extraction reaction. Hence, the prepared P-FeS@C nanohybrid exhibits superior Na-storage properties especially high rate capability in half cells. For example, it can deliver reversible capacities of 555.1 mA h g-1 at 0.2 A g-1 over 150 cycles and about 60.4 mA h g-1 at 80 A g-1 (an ultrahigh current density even higher than that of the capacitor test). Furthermore, an advanced P-FeS@C//Na3V2(PO4)2O2F full cell has been assembled out, which delivers a stable specific capacity of 441.2 mA h g-1 after 80 cycles at 0.5 A g-1 with a capacity retention of 91.8%.

Association and Intragenic Single-Nucleotide Polymorphism Interactions of the XRCC1 Polymorphisms for Pancreatic Cancer Susceptibility.

OBJECTIVES: X-ray repair cross-complementing group 1 (XRCC1) gene is an important candidate gene for influencing human cancer risks. This study examined the main and interactive effect of 9 single-nucleotide polymorphisms (SNPs) (Arg194Trp, Arg280His, Arg399Gln, c.1254C>T, c.1517G>C, c.1471G>A, C310T, 539del542, and T1915C) of XRCC1 in contribution to pancreatic cancer (PC). METHODS: A total of 298 PC patients and 298 healthy controls were enrolled. Selected SNPs in XRCC1 were genotyped. The generalized multifactor dimensionality reduction method investigated gene-gene interactions. RESULTS: Single-locus analyses showed that, in the codominant model, the GO genotype of 539del542 might have a higher risk for PC (odds ratio [OR], 1.47; 95% confidence interval [95% CI], 1.05-2.08). For T1915C polymorphism, the TC and CC genotypes both had a higher risk for PC (OR, 1.76; 95% CI, 1.25-2.48; OR, 1.83; 95% CI, 1.05-3.19, respectively); and a similar result was observed in the dominant model (OR, 1.77; 95% CI, 1.28-2.46). A tendency of association between Arg280His and PC was also detected in the dominant model (OR, 0.70; 95% CI, 0.48-1.00). Furthermore, the generalized multifactor dimensionality reduction method showed that the 4-locus model was significant, involving Arg280His, 539del542, T1915C, and c.1517G>C (P < 0.05). CONCLUSIONS: Thus, XRCC1 polymorphisms may contribute to the risk of PC independently or in an interactive manner.

miR-216a may inhibit pancreatic tumor growth by targeting JAK2.

This study was aimed to investigate miR-216a expression in pancreatic cancer and determine its effects on proliferation. miR-216a was found downregulated in pancreatic cancer tissues as compared to benign pancreatic lesions. JAK2 was identified as a miR-216a gene target. Further, in vivo treatment of PANC-1 tumors with miR-216a reduced JAK2 protein levels in the tumor and reduced tumor volume. In conclusion, miR-216a may function as a tumor suppressor regulating pancreatic cancer cells by targeting the JAK/STAT pathway. Further studies with a larger number of patient samples are necessary to fully explore the diagnostic and therapeutic potential of miR-216a for pancreatic cancer.

[Value of perioperative adjuvant therapy in liver transplantation for advanced hepatocellular carcinoma].

OBJECTIVE: To evaluate the clinical value of perioperative adjuvant chemotherapy in prevention of tumor recurrence and improvement of patient survival after liver transplantation for advanced hepatocellular carcinoma (HCC). METHODS: Twenty patients with advanced HCC (pTNM stages III and IV a) receiving liver transplantation with preoperative transcatheter arterial chemoembolization (TACE) and postoperative adjuvant chemotherapy (ADM+5-Fu+CDDP) were retrospectively reviewed in comparison with 16 patients receiving liver transplantation only for tumor recurrence, cumulative and tumor-free survivals. The feasibility and side-effects of the treatments were also studied. RESULTS: The recurrence rate was lower in the perioperative treatment group than in non-treatment group (12/20, 60.0% vs 11/16, 87.5%, P<0.05). The 1- and 2-year overall survival rates were 70.8% and 47.1% for the chemotherapy group and 43.8% and 20.5% for the non-chemotherapy group respectively, showing significant differences between them (P<0.05). The 1- and 2-year tumor-free survival rates were 60.6%, 40.5% and 33.6%, 15.6% in the two groups, respectively, with also significant differences (P<0.05). CONCLUSIONS: Perioperative adjuvant treatment may significantly decrease the likeliness of tumor recurrence and prolong the survival of patients with advanced HCC after liver transplantation. Chemotherapy with ADM+5-Fu+CDDP can be effective and safe with only mild side-effects.

[Effects of the HLA antibodies on allograft acute rejection after cadaveric liver transplantation].

OBJECTIVE: To evaluate the effect of perioperative HLA antibody changes on acute allograft rejection in cadaveric liver transplantation. METHODS: Totally 134 patients received modified piggyback liver transplantation and enzyme-linked immunosorbent assay was performed for HLA antibody detection before and the 1, 7, 14 and 30 days after operation. B ultrasound-guided liver biopsy was employed for diagnosis of acute allograft rejection, and the perioperative changes of HLA antibodies were evaluated for their effect on allograft acute rejection. RESULTS: Of the 44 recipients with preoperative positivity for HLA antibodies, acute rejection occurred in 56.8% of the patients, as compared with 25.9% in those negative for HLA antibody (P=0.001). The patients who became positive for HLA antibody postoperatively had a rate of acute rejection of 60%, which was significantly higher than that in those persistently negative for HLA antibody (18.6%, P=0.003). CONCLUSION: HLA antibody positivity before transplantation may contribute to acute rejection episode in liver transplantation, and persistent posttransplant HLA antibody positivity is closely associated with the occurrence of acute rejection.