Ligamentum teres hepatis wrapping of the gastroduodenal artery stump for protection in total laparoscopic pancreaticoduodenectomy: a single-center experience.

OBJECTIVE: Hemorrhage from the stump of the gastroduodenal artery (GDA) is a significant postoperative risk with pancreaticoduodenectomy (PD). Studies have shown that wrapping the GDA stump using the omentum or the falciform ligament can help prevent bleeding. We aimed to determine whether wrapping the GDA stump with the ligamentum teres hepatis (LTH) would reduce postoperative PD hemorrhage. METHODS: We retrospectively reviewed data for 148 patients who underwent laparoscopic pancreatoduodenectomy (LPD) at our hospital from November 2015 to September 2021. We compared perioperative data from 63 LPD patients without wrapping of the GDA (unwrapped group) and 85 whose GDA stumps were wrapped (wrapped group). RESULTS: There were no significant differences in the groups' baseline characteristics. The postoperative GDA stump bleeding incidence was significantly lower in the wrapped group than that in the unwrapped group (7.9% vs. 0, respectively). There was also no significant difference in the incidence of other complications (intra-abdominal infection, postoperative pancreatic fistula (POPF), biliary fistula, and gastrointestinal bleeding). CONCLUSION: Using the LTH to wrap the GDA stump during LPD can reduce bleeding from the GDA stump but not the incidence of other complications.

Therapeutic effect of fenofibrate for non-alcoholic steatohepatitis in mouse models is dependent on regime design.

Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver diseases. In most cases, NAFLD progresses from benign steatosis to steatohepatitis (NASH), and then to cirrhosis. No treatment is currently approved for NAFLD/NASH in the clinic. Fenofibrate (FENO) has been clinically used to treat dyslipidemia for more than a half century, but its effects on NASH are not established. FENO's half-life is quite different between rodent and human. The aim of this study was to investigate the potential of pharmacokinetic-based FENO regime for NASH treatment and the underlying mechanisms. Methods: Two typical mouse NASH models, methionine-choline deficient (MCD) diet-fed mice and choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD)-fed mice, were used. MCD model was designed as therapeutic evaluation in experiment 1 and CDAHFD model was designed as preventive in experiment 2. Three doses of FENO (5, 25, 125 mg/kg), two times a day (BID), were administered to the above models. Serum markers of liver injury, cholestasis, and the histology of liver tissues were investigated. Normal mice were used as a model in experiment 3 for toxicity evaluation, Quantitative-PCR and Western Blot assays were used to investigate the inflammatory responses, bile acid synthesis as well as lipid catabolism. Results: Mice on the MCD and CDAHFD diets developed steatohepatitis as expected. Treatment with FENO (25 mg/kg·BID) significantly decreased hepatic steatosis, inflammation and fibrosis in both therapeutic and preventive models. In the MCD model, the therapeutic action of FENO (25 mg/kg·BID) and 125 mg/kg·BID on histopathology and the expression of inflammatory cytokines were comparable. In reducing macrophage infiltration and bile acid load, FENO (25 mg/kg·BID) was superior to 125 mg/kg·BID. In all the aspects mentioned above, FENO (25 mg/kg·BID) was the best among the 3 doses in the CDAHFD model. In a third experiment, the effects of FENO (25 mg/kg·BID) and 125 mg/kg·BID on lipid catabolism were comparable, but 125 mg/kg·BID increased the expression of inflammatory factors and bile acid load. In both models, FENO (5 mg/kg·BID) showed little effect in hepatic steatosis and inflammation, neither the adverse effects. FENO (125 mg/kg·BID) aggravated liver inflammation, increased bile acid synthesis, and promoted the potential of liver proliferation. In toxicity risk assay, FENO (25 mg/kg·BID) treatment showed low potential to trigger bile acid synthesis, inflammation and hepatocyte proliferation. Conclusion: A new regime, FENO (25 mg/kg·BID) is potentially a therapeutic strategy for the NASH treatment. Translational medicine is warranted to prove its effectiveness in the clinic.

The clinical characteristics of pancreatic colloid carcinoma and the development and validation of its cancer-specific survival prediction nomogram.

Background: Pancreatic colloid carcinoma (CC) is a subtype of pancreatic ductal adenocarcinoma (DAC) with low incidence but high malignancy. Unfortunately, there is no consensus regarding the clinical features and prognostic factors associated with CC, and the prognosis is unpredictable. We aimed to assess the clinicopathological characteristics of this rare disease and develop a nomogram for predicting cancer-specific survival (CSS) in CC. Methods: We gathered comprehensive clinicopathological data from the Surveillance, Epidemiology, and End Results (SEER) database on 17,617 patients with DAC and 561 individuals with CC. Kaplan-Meier was used to plot each survival curve. Subsequently, we split the 561 patients with CC in a 7:3 split ratio between an internal training cohort (n=393) and an external validation cohort (n=168). The independent prognostic factors for CC patients in the training cohort were discovered using univariate and multivariate Cox regression analyses, and a nomogram was created. We assessed the nomogram's performance by using the concordance index (C-index), the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results: The median for follow-up of CC patients was 15 months (range: 1-163 months), and the 1-, 3-, and 5-year CSS were 58.4%, 30.2% and 22.6%. For CC patients in the training cohort, age [hazard ratio (HR) =1.29; 95% confidence interval (CI): 1.00-1.65], sex (HR =0.64; 95% CI: 0.51-0.81), T3 stage (HR =2.21; 95% CI: 1.26-3.88), T4 stage (HR =2.76; 95% CI: 1.47-5.18), N1 stage (HR =1.29; 95% CI: 1.02-1.63), M1 stage (HR =1.60; 95% CI: 1.17-2.18), surgery (HR =0.30; 95% CI: 0.22-0.42), and radiotherapy (HR =0.76; 95% CI: 0.58-1.01) were the main predictors of the nomogram. The C-indexes of the training cohort and the validation cohort were 0.734 and 0.732, respectively. The 1-, 3-, and 5-year AUC values of the nomogram were predicted to be 0.827, 0.816, and 0.831 in the training cohort, 0.801, 0.841, and 0.835 in the validation cohort, respectively. Conclusions: Based on several clinical features, we established the first predictive model of CC. This nomogram could be used to guide treatment decisions in patients with CC.

Therapeutic response analysis for patients with adenosquamous carcinoma of the gallbladder: data analysis based on the Surveillance, Epidemiology, and End Results (SEER) database.

Background: Adenosquamous carcinoma of the gallbladder (GBASC) is a rare histological variant without defined appropriate clinical measures. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, data on a cohort of patients with GBASC were collected from 21 cancer registries between 1975 and 2018. We used Kaplan-Meier analysis to evaluate the effectiveness of different treatment regimens on patients with GBASC. Then we used Cox proportional hazards regression method to determine the prognostic factors for cancer-specific survival (CSS) of GBASC patients. Results: A total of 388 patients with GBASC were identified: 80 patients diagnosed as early stage and 308 patients diagnosed as advanced stage. For early-stage GBASC, radical lymph node dissection improved the CSS significantly; for advanced-stage GBASC, radical surgery, nonradical surgery, lymph node dissection, chemotherapy, and radiotherapy improved the CSS significantly. Surgery, lymph node dissection, radiation, chemotherapy, age, race, and the American Joint Committee on Cancer (AJCC) stage were the independent risk factors for the CSS of GBASC patients. Conclusions: Radical intraoperative lymph node dissection provided a survival benefit for patients with early-stage GBASC, whereas chemotherapy and radiotherapy provided no significant benefit; surgical treatment, more complete lymph node dissection, radiotherapy, and chemotherapy provided survival benefits for patients with advanced GBASC. The prognosis for GBASC patients is affected by the factors of surgery, lymph node dissection, radiation, chemotherapy, age, race, and the AJCC stage.

Bioinformatics algorithm for lung adenocarcinoma based on macropinocytosis-related long noncoding RNAs as a reliable indicator for predicting survival outcomes and selecting suitable anti-tumor drugs.

As a highly conserved endocytic mechanism during evolution, macropinocytosis is enhanced in several malignant tumors, which promotes tumor growth by ingesting extracellular nutrients. Recent research has emphasized the crucial role of macropinocytosis in tumor immunity. In the present study, we established a new macropinocytosis-related algorithm comprising molecular subtypes and a prognostic signature, in which patients with lung adenocarcinoma (LUAD) were classified into different clusters and risk groups based on the expression of 16 macropinocytosis-related long noncoding RNAs. According to the molecular subtypes, we discovered that patients with LUAD in cluster1 had a higher content of stromal cells and immune cells, stronger intensity of immune activities, higher expression of PD1, PDL1, and HAVCR2, and a higher tumor mutational burden, while patients in cluster2 exhibited better survival advantages. Furthermore, the constructed prognostic signature revealed that low-risk patients showed better survival outcomes, earlier tumor stage, higher abundance of stromal cells and immune cells, higher immune activities, higher expression of PD1, PDL1, CTLA4, and HAVCR2, and more sensitivity to Paclitaxel and Erlotinib. By contrast, patients with high scores were more suitable for Gefitinib treatment. In conclusion, the novel algorithm that divided patients with LUAD into different groups according to their clusters and risk groups, which could provide theoretical support for predicting their survival outcomes and selecting drugs for chemotherapy, targeted therapy, and immunotherapy.

Arylsulfatase I is a prognostic biomarker for head and neck squamous cell carcinoma and Pan-cancer.

BACKGROUND: Sulfatase gene family members mediate various biological functions in tumor stroma and tumor cell environments. However, the expressions and prognostic value of Arylsulfatase I (ARSI), a sulfatase gene family member, in head and neck squamous cell carcinoma (HNSC) have not been fully established. METHODS: Arylsulfatase I expressions in pan-cancer were profiled using publicly available databases. Then, univariate Cox regression, Kaplan-Meier, and the Pearson's correlation analyses were performed to determine correlations between ARSI expressions and cancer prognosis, immune cell status, and drug sensitivity. Gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA) were used to assess the potential mechanisms underlying ARSI functions in HNSC. RESULTS: Arylsulfatase I was highly expressed in 15 cancer types, with significant expressions in HNSC. Elevated ARSI levels were associated with worse prognostic outcomes in HNSC patients. In addition, GSVA and GSEA showed that ARSI was highly involved in tumor cell escape and inflammatory responses. Expressions of ARSI negatively correlated with tumor mutation burden or microsatellite instability and positively correlated with immune-related genes. Elevated ARSI expressions conferred poor tolerance to daporinad and sinularin, but increased cell sensitivity to dasatinib and XAV939. CONCLUSION: Arylsulfatase I is a promising prognostic and therapeutic target for HNSC.