Development and validation of a gene signature for pancreatic cancer: based on inflammatory response-related genes.

Pancreatic cancer (PC) is one of the most common malignant tumors in the world with a poor prognosis. There were limited studies investigating the genetic signatures associated with inflammatory responses, tumor microenvironment (TME), and tumor drug sensitivity prediction. In the Cancer Genome Atlas (TCGA) dataset, we constructed an inflammatory response-related genes prognostic signature for PC, and predictive ability of the model was assessed via the International Cancer Genome Consortium (ICGC) database. Then, we explored the differences of TME, immune checkpoint genes and drug resistance genes, and the cancer cell sensitivity to chemotherapy drugs between different risk score group. Based on the TCGA and ICGC databases, we constructed and validated a prognostic model, which consisted of 5 genes (including AHR, F3, GNA15, IL18, and INHBA). Moreover, the prognostic model was independent prognostic factors affecting overall survival (OS). The low-risk score group had better OS, and lower stromal score, compared with patients in the high-risk score group. The difference of antigen-presenting cells, T cell regulation, and drug resistance genes between different risk score groups was found. In addition, the immune checkpoint genes were positively correlation to risk score. The expression levels of AHR, GNA15, IL18, and INHBA were related to the sensitivity of anti-tumor chemotherapy drugs. Gene set enrichment analysis (GSEA) showed significant pathway such as calcium signaling pathway and p53 signaling pathway. We successfully constructed a 5-inflammatory response-related gene signature to predict survival, TME, and cancer cell sensitivity to chemotherapy drugs in PC patients. Furthermore, substantiation was warranted to verify the role of these genes in tumorigenesis.

Successful rescue of renal transplantation with cardiac arrest after electrical storm: A case report.

RATIONALE: Most patients with end-stage chronic kidney disease are associated with complications such as renal hypertension, renal anemia, hyperkalemia, water-sodium retention, and disorders of acid-base balance after long-term renal replacement therapy, which can lead to increased cardiac burden, some degree of myocardial damage, and finally progress to arrhythmia and heart failure. These are the main reasons why patients with chronic kidney disease are prone to cardiovascular events after renal transplantation. PATIENT CONCERNS: We report a case of sudden onset of ventricular fibrillation on the postoperative second day, with repeated electrical storm accompanied by cardiac arrest during resuscitation, a very long cardiopulmonary resuscitation (CPR) process of 5 hours and 14 minutes, and >20 cycles of cardiac defibrillation. DIAGNOSES: According to the patient history and resuscitation process, a diagnosis of ES with cardiac arrest after renal transplantation was formulated. INTERVENTION: According to the American Heart Association guidelines for CPR and cardiovascular emergencies, resuscitation measures such as CPR, tracheal intubation, electric defibrillation, symptomatic medication, etc. were performed on the patient. OUTCOMES: Finally, the patient was successfully resuscitated, after which the patient had stable respiratory circulation and no neurological complications. To our knowledge, this is the only reported case in which a patient survived with good neurologic outcomes after a resuscitation that lasted as long as 5 hours and 14 minutes. LESSONS: This case of adequate resuscitation can provide experience and a basis for CPR of patients with in-hospital complications of cardiovascular events for a long time.

Different subpopulations of regulatory T cells in human autoimmune disease, transplantation, and tumor immunity.

CD4+CD25+ regulatory T cells (Tregs), a subpopulation of naturally CD4+ T cells that characteristically express transcription factor Forkhead box P3 (FOXP3), play a pivotal role in the maintenance of immune homeostasis and the prevention of autoimmunity. With the development of biological technology, the understanding of plasticity and stability of Tregs has been further developed. Recent studies have suggested that human Tregs are functionally and phenotypically diverse. The functions and mechanisms of different phenotypes of Tregs in different disease settings, such as tumor microenvironment, autoimmune diseases, and transplantation, have gradually become hot spots of immunology research that arouse extensive attention. Among the complex functions, CD4+CD25+FOXP3+ Tregs possess a potent immunosuppressive capacity and can produce various cytokines, such as IL-2, IL-10, and TGF-ß, to regulate immune homeostasis. They can alleviate the progression of diseases by resisting inflammatory immune responses, whereas promoting the poor prognosis of diseases by helping cells evade immune surveillance or suppressing effector T cells activity. Therefore, methods for targeting Tregs to regulate their functions in the immune microenvironment, such as depleting them to strengthen tumor immunity or expanding them to treat immunological diseases, need to be developed. Here, we discuss that different subpopulations of Tregs are essential for the development of immunotherapeutic strategies involving Tregs in human diseases.

Pancreaticoduodenectomy With Arterial Approach of Total Mesenteric Resection of the Pancreas for Pancreatic Head Cancer.

BACKGROUND: This study aims to observe and analyze the clinical efficacy of the pancreaticoduodenectomy (PD) with total mesopancreas excision (TMpE) via the artery approach for carcinoma of head of the pancreas. METHODS: From October 2015 to October 2016, 60 patients with pancreatic head cancer were enrolled in this study. Twenty-eight patients were treated with PD with TMpE via the artery approach (group A), while 32 patients were treated with PD alone (group B) in our hospital. The clinical data of the patients were retrospectively collected, including intra-operative evaluation index, R0 resection rate of postoperative pathological specimens, postoperative complications, and the tumor recurrence time was observed after operation (at third, sixth, and 12th months). Clinical efficacy of PD with TMpE via the artery approach was evaluated between the two groups. RESULTS: There was no significant difference in the operation time or perioperative death between the two groups (P > 0.05). Postoperative specimen pathology showed that there was a statistically significant difference in the R0 resection rate between the two groups (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Tumor recurrence rate at month 3 post operation was 0 (0/28) in group A and 3.13% (1/32) in group B. There was no significant difference in the 6-month recurrence rate (P > 0.05). Postoperative recurrence rate in group A was significantly lower than that in group B at month 12 (P < 0.05). CONCLUSIONS: The PD with TMpE via the artery approach treatment of pancreatic head cancer can reduce the amount of intra-operative bleeding and save the operation time without increasing postoperative complications. It provides effective technical support for combined vascular anastomosis in the treatment of pancreatic head cancer with venous system invasion, and ensures the safety of operation. Moreover, this procedure can improve the R0 resection rate and reduce the recurrence rate in the near future. As a safe, effective and feasible surgical method for the treatment of pancreatic head cancer, it can be widely used in clinical practice.

Retroperitoneal abscess and acute acalculous cholecystitis after iatrogenic colon injury: report of a case.

Acute acalculous cholecystitis has a high mortality rate due to the difficulties in early diagnosis and high rate of complications like empyema, gangrene and perforation. We report a case of 20-year-old male with acute severe pancreatitis, acute renal failure and acute peripancreatic fluid collection who was transferred to our department after blood filtration treatment in ICU. After percutaneous catheter drainage for 20 hours, the patient got a high fever. Computed tomography revealed retroperitoneal colon injury. In this case, percutaneous catheter drainage was performed again and the pus cavity was flushed regularly, after which the patient's state gradually improved. Unpredictably, septic shock appeared on the 51(st) day. Repeated computed tomography revealed acute acalculous cholecystitis and abscess formation. After percutaneous transhepatic gallbladder catheterization and drainage, the patient got better gradually. Three months later the retroperitoneal catheter was removed. Four months later, ultrasound examination showed normal gallbladder and the catheter was removed.

Multiple tumor marker protein chip detection system in diagnosis of pancreatic cancer.

BACKGROUND: The clinical stage of the disease at diagnosis often determines the prognosis and survival rate of a patient with pancreatic cancer. Early symptoms of pancreatic cancer are often not obvious on imaging (ultrasound, computed tomography (CT), and so on), and when patients present with weight loss, jaundice and abdominal pain and other symptoms, they are usually already in the advanced stages of pancreatic cancer. However, the examination of combined tumor markers might improve their sensitivity or specificity in aiding diagnosis. METHODS: Twelve tumor markers including AFP, CEA, NSE, CA125, CA15-3, CA242, CA19-9, PSA, f-PSA, FER, ß-HCG and HGH were measured by the protein biochip detection in serum in 235 pancreatic cancer patients, 230 benign pancreatic disease patients and 240 healthy people. RESULTS: Positive detection rates of tumor markers were: CA19-9 (49.3%), CA125 (45.1%), FER (44.2%), CA242 (42.5%), CEA (38.6%), CA15-3 (36.7%), ß-HCG (29.6%), AFP (24.5%), NSE (18.2%), PSA (19.5%), f-PSA (9.4%) and HGH (8.7%) respectively. There was significant difference in CA19-9, NSE, CEA, CA242 and CA125 by multi-tumor marker protein biochip detection among patients with cancer, benign disease and healthy people (P<0.05). The positive rate of 5 tumor markers was 94.9%, and this was much higher than that of any single marker. CONCLUSION: The detection of CA19-9, NSE, CEA, CA242 and CA125 in the multi-tumor marker protein biochip system is helpful in the diagnosis of pancreatic cancer.

Extended local resection for treatment of periampullary carcinoma of vater.

BACKGROUND: The trauma caused by pancreatoduodenectomy for periampullary carcinoma of vater is often severe and extensive. The purpose of this study was to evaluate the effect of extended local resection in the treatment of periampullary carcinoma of vater. METHODS: The extra-hepaticobiliary tract, the confluence of the pancreatic and biliary duct, vater ampulla and duodenal papilla were resected en bloc in 8 patients with periampullary carcinoma from 1995 to 1998. RESULTS: One patient died perioperatively. Duodenal obstruction developed postoperatively in one of 7 survived patients and was relieved after reoperation. All the 7 patients were followed up for more than 6 months without recurrence. CONCLUSION: Extended local resection fulfils the task of radical treatment of periampullary malignancy.

Surgical treatment for uncinate process carcinoma of the pancreas.

OBJECTIVES: To analyze the clinical features of uncinate process carcinoma of the pancreas and to improve the resection rate. METHODS: From January 1990 to June 1999, 10 patients with pancreas uncinate process carcinoma received Whipple's operation. Portal vein (PV) resection and reanastomosis were performed in 5 patients, and the resected length varied from 2.0 to 4.2 cm. Two patients underwent PV lateral wall partial resection. RESULTS: Among the 7 patients undergoing PV resection, 1 died of hepatic failure 3 days after operation. One patient suffered from postoperative chylous ascites. These 6 patients survived 13 to 29 months postoperatively. Among the 3 patients without PV resection, 2 survived 13 months and 14 months respectively. One patient was alive by the end of follow-up for 11.5 months postoperatively. CONCLUSION: Although uncinate process carcinoma of the pancreas has a tendency to invade the adjacent PV and superior mesentery vein, it should not be simply regarded as a contraindication of radical resection.