Establishment and validation of a nomogram based on coagulation parameters to predict the prognosis of pancreatic cancer.

BACKGROUND: In recent years, multiple coagulation and fibrinolysis (CF) indexes have been reported to be significantly related to the progression and prognosis of some cancers. OBJECTIVE: The purpose of this study was to comprehensively analyze the value of CF parameters in prognosis prediction of pancreatic cancer (PC). METHODS: The preoperative coagulation related data, clinicopathological information, and survival data of patients with pancreatic tumor were collected retrospectively. Mann Whitney U test, Kaplan-Meier analysis, and Cox proportional hazards regression model were applied to analyze the differences of coagulation indexes between benign and malignant tumors, as well as the roles of these indexes in PC prognosis prediction. RESULTS: Compared with benign tumors, the preoperative levels of some traditional coagulation and fibrinolysis (TCF) indexes (such as TT, Fibrinogen, APTT, and D-dimer) were abnormally increased or decreased in patients with pancreatic cancer, as well as Thromboelastography (TEG) parameters (such as R, K, α Angle, MA, and CI). Kaplan Meier survival analysis based on resectable PC patients showed that the overall survival (OS) of patients with elevated α angle, MA, CI, PT, D-dimer, or decreased PDW was markedly shorter than other patients; moreover, patients with lower CI or PT have longer disease-free survival. Further univariate and multivariate analysis revealed that PT, D-dimer, PDW, vascular invasion (VI), and tumor size (TS) were independent risk factors for poor prognosis of PC. According to the results of modeling group and validation group, the nomogram model based on independent risk factors could effectively predict the postoperative survival of PC patients. CONCLUSION: Many abnormal CF parameters were remarkably correlated with PC prognosis, including α Angle, MA, CI, PT, D-dimer, and PDW. Furthermore, only PT, D-dimer, and PDW were independent prognostic indicators for poor prognosis of PC, and the prognosis prediction model based on these indicators was an effective tool to predict the postoperative survival of PC.

Severe hemorrhagic complications in acute necrotizing pancreatitis: a retrospective single-center study / 中华肝胆外科杂志

Objective:To study the clinical features in patients with acute necrotizing pancreatitis (ANP) complicated by hemorrhage, and to analyze the treatments and their outcomes.Methods:The clinical data of 44 ANP patients with hemorrhage managed at the Department of Pancreas Center, the First Affiliated Hospital of Nanjing Medical University from September 2015 to December 2020 were retrospectively analyzed. There were 34 males and 10 females, aged (48.9±12.2) years old. Clinical data were collected on the bleeding sites, bleeding interventions, and treatment outcomes. Follow-up visits were made by outpatients visits or telephone.Results:Of the 44 patients with bleeding, 8 had gastrointestinal bleeding, 31 had intra-abdominal bleeding, and the remaining 5 had mixed bleeding sites. The median interval from onset of ANP to development of hemorrhage was 30.5(20.8, 40.3) d. For the 13 patients with gastrointestinal bleeding and mixed sites of bleeding: 4 patients were successfully treated by endoscopically for upper gastrointestinal ulcers, 5 patients were successfully treated by endovascular embolization using digital subtraction angiography (DSA) to detect the sites of bleeding, and 4 patients were successfully treated by surgery. For the 31 patients with intra-abdominal hemorrhage: 24 underwent DSA. For the 7 patients who did not undergo DSA, 3 who were hemodynamically stable were treated conservatively, 2 underwent immediate open surgery to stop bleeding within 24 h after surgical debridement of infected pancreatic necrosis, 1 did not undergo DSA because the family members decided to abandon further treatment, and 1 died while preparing for DSA. For the 29 patients who underwent DSA, vascular abnormalities were found in 69.0%(20/29), with splenic artery hemorrhage being the most common. In the 44 patients with bleeding: 29.5%(13/44) were examined by endoscopy, and 4 were successfully stopped by endoscopic treatment; 65.9%(29/44) patients were examined by DSA, and 15 patients were successfully treated by intravascular embolization; 14 patients (31.9%) were treated by open surgery and 11 patients were successfully stopped. The mortality rate was 47.7%(21/44), of which 5 patients died from hemorrhagic shock complicated by multiple organ dysfunction syndrome (MODS) and 16 patients died from sepsis complicated by MODS. The mortality rate of 55.6%(20/36) in patients with intra-abdominal and mixed sites of bleeding was significantly higher than that of the 12.5%(1/8) in patients with gastrointestinal bleeding ( P=0.048). None of the 23 surviving patients developed recurrence of intra-abdominal and/or gastrointestinal bleeding on follow-up. Conclusion:Major bleeding commonly occurred about 1 month after ANP and it was associated with a higher in-hospital mortality rate. DSA, endoscopy, and open surgery were effective means to achieve hemostasis.

RNA sequence analysis reveals pathways and candidate genes associated with pancreatic acinar cells injury in a mouse pancreatitis model.

Compared with acute pancreatitis caused by other reasons, hyperlipidemia pancreatitis has a higher severity, complication and organ failure rate. Our previous studies have found that hyperglycemia may promote the occurrence and development of hyperlipidemia pancreatitis, but the mechanism is still unclear. Pancreatic acinar cell injury is the initial link of acute pancreatitis and plays a vital role in the course of the disease. The aim of the present study was to analyze the differentially expressed genes (DEGs) between hyperlipidemia acute pancreatitis (HLAP) mouse and hyperglycemia and hyperlipidemia acute pancreatitis (HLGAP) mouse by RNA-sequence. The GO and KEGG analysis of these DEGs did not indicate a direct pathway related to acinar cell injury. However, in further targeted analysis, we found that there are different genes related to cell injury between the HLAP and HLGAP groups, such as necroptosis, autophagy, mitophagy and ferroptosis. In the later immunofluorescence experiments, it was also confirmed that the genes related to cell injury were significantly differentially expressed between the two groups. In conclusion, there are multiple cell injury modes in the course of hyperglycemia and hyperlipidemia pancreatitis. More importantly, the correlation and transition between multiple cell injury modes may be the key mechanism for the occurrence and development of pancreatitis.

From “archaeological style-like debridement” to “grave digging”: a historical inspiration and practical thinking of surgical treatment for severe acute pancreatitis / 中华消化外科杂志

Severe acute pancreatitis (SAP) is an ancient and fatal disease,the understanding of this disease has experienced tortuous and long-time process.Throughout the history,surgical intervention plays a dominant role in treatment of SAP.Instead of traditional “archaeological style-like” extensive resection,the strategy of minimally invasive debridement and drainage that was called “grave digging” is preferred currently.In the past two decades,with in-depth cognition about this disease,a series of interventional,minimally invasive & endoscopic techniques derived from computer-assisted imaging techniques,surgical strategy represented by “ step-up” minimally invasive methods have been developed,which has changed traditional treatment model,brought satisfied therapeutic effect,and been widely accepted.Authors reviewed the process of surgical treatment in SAP for seeking deep understanding,gaining experiences,expanding our horizons,to guide clinical practices and avoid insufficient or excessive intervention,aiming to reduce mortality & morbidity and bring the maximal benefits for patients.

Adjustment of positive end-expiratory pressure during presence of tonic diaphragm electrical activity in rabbits with acute respiratory distress syndrome / 中华急诊医学杂志

Objective To study the positive end-expiratory pressure (PEEP) adjustment after recruitment maneuver during acute respiratory distress syndrome (ARDS) especially in the presence of tonic diaphragm electrical activity (Tonic EAdi) in order to obtain optimum PEEP and in turn to get successful oxygenation.Methods Rabbit model of ARDS was nade by intratracheal instillation of hydrochloric acid.After sufficient recruitment maneuvers,the rabbits were randomly (random number) divided into two groups,namely Tonic EAdi group ( n =5 ) and maximum oxygenation group ( n =5 ).In Tonic EAdi group,the regulation of PEEP was guided by Tonic EAdi.In maximum oxygenation group,PEEP was adjusted as per maximum oxygenation.The differences in magnitude of PEEP,pulmonary mechanics,gas exchange and hemodynamics were compared between two groups.The t-test was used to compare continuous variables between the two independent samples,and the difference was statistically significant when P ＜ 0.05.Results (1) PEEP:The PEEP was (10.7 + 1.4) cmH2O (1 cm H2O=0.098 kPa) in Tonic EAdi group and (10.0 ± 2.8) cm H2O in maximum oxygenation group (P ＞ 0.05). (2) Pulmonary mechanics:After PEEP adjustment,there was no significant difference in tidal volume ( Vr),peak pressure (Ppeak) and mean pressure (Pmean) between the two groups (P ＞ 0.05 ).(3) Gas exchange:After PEEP adjustment,there was no significant difference in oxygenation index (PaO2/FiO2) and partial pressure of arterial carbon dioxide ( PaCO2 ) between the two groups (P ＞ 0.05).Conclusions Tonic EAdi could be a good indicator for regulating PEEP in ARDS.

A pilot study of diaphragmatic function evaluated as predictors of weaning in chronic obstructive pulmonary disease patients / 中华内科杂志

Objective To evaluate the predictive performance of neuro-mechanical coupling (NMC) and neuro-ventilatory coupling (NVC) in the weaning outcome in patients with chronic obstructive pulmonary disease (COPD). Methods Sixteen patients were enrolled when the criteria for their first spontaneous breathing trial (SBT) was met. A 30-minute SBT was attempted, with the measurement of electrical activity of the diaphragm (Edi) , NMC, NVC, NVC ×NMC, index of rapid shallow breathing (f/Vt) , airway occlusion pressure (P0.1) and f/Vt ×P0.1 at 0, 5 and 30 min. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. Results Successful weaning(S group) was observed in 6 patients while weaning failure(F group) in 10 patients. (1)The predictive capacity of Edi: at 30 min of SBT, Edi showed higher values in the F group (P ＜ 0. 05), the area under the ROC curves(AUC) was 0. 817(P ＜0. 05). (2) The predictive capacity of NVC and NMC:at 5, 30 min of SBT, NVC and NMC showed higher values in the S group (P ＜0. 05); at 30 min of SBT NVC presented the largest AUC than any other time of SBT (0. 822, P ＜ 0. 05), while the AUC of NMC was 0. 800 (P ＞ 0. 05). (3) The predictive capacity of NVC × NMC: at 30 min of SBT, the AUC of NVC × NMC was larger than NVC (0. 864, P ＜ 0. 05) , showing greater sensitivity (100. 0%) and specificity (83. 3%) .(4) The predictive capacity of f/Vt and P0.1: f/Vt and f/Vt × P0.1 presented poor predictive performance in the failed patients. Conclusions Edi, NVC and NVC × NMC were good predictor for the weaning outcome in patients with COPD.

Protective effects of pulmonary stretch reflex on the lung injury in rabbits with acute respiratory distress syndrome / 中华急诊医学杂志

Objective To evaluate the effect of the pulmonary stretch reflex on the lung injury in acute respiratory distress syndrome (ARDS). Method ARDS models of rabbits were induced by intratracheal infusion hydrochloric acid and ventilated with neurally adjusted ventilatory assist (NAVA) with a tidal volume ( VT) of 6 mL/kg and the electrical activity of diaphragm ( Eadi)-determined PEEP level. The rabbits were randomly ( random number) divided into two groups: ( 1 ) sham operation (Sham) group ( n = 5 ),(2) bilateral vagotom (VAG) group( n = 5 ). Gas exchange and pulmonary mechanics were determined at baseline, after lung injury and ventilation 1, 2, 3 h respectively. Indices about pulmonary permeability,pathological changes and inflammatory response were also measured. Results Compared with Sham group,the PaO2/FiO2in VAG group decreased significantly at ventilation 2 h, 3 h (P ＜0.05). There was no significant difference on PaCO2 between Sham and VAG group (P ＞ 0.05 ), and VAG group had the higher VT,peak pressure ( Ppeak), mean pressure (Pm) compared with Sham group at the time point of ventilation 1 h, 2 h, 3 h (P＜0.05). Compared with Sham group, the dead space fraction (VD/VT) and the respiratory system elastance (Ers) in VAG group increased (P ＜ 0.05 ) and the static pulmonary compliance (Cst)decreased markedly (P ＜ 0.05 ) after 3 h ventilation. The wet/dry weight (W/D), lung injury score, tumor necrosis factor-α ( TNF-α), interleukin-8 ( IL-8 ), myeloperoxidase ( M PO ) and malondialdehyde ( M DA )in VAG group elevated significantly when compared with Sham group ( P ＜ 0.05 ). Conclusions The lung injury in ARDS was aggravated after bilateral vagotomy, which demonstrated that the pulmonary stretch reflex may have the lung protective effect.

Pneumonia in acute stroke patients / 中国实用内科杂志

Objective To study the risk factors of pneumonia in the acute stroke patients,and provide support for nursing. Methods 391 acute stroke patients were analysed to investigat the rate of pneumonia and its relation with age,the type and the severity of stroke, the basic disease and the prognosis. Results It was showed that the rate increased in the patients of old age, with severe stroke, and having some basic diseases such as diabetes, heart disease, tumor, immunity disease,old stroke. The mortality in the acute stroke patients with pneumonia was higher than the control. Conclusion Controlling the rate of pneumonia can help us to succeed in treating acute stroke patients.

Difference of the tremor of Parkinson's disease in early stage and physiological tremor by tremor analysis / 临床神经病学杂志

Objective To explore the difference of the tremor of Parkinson's disease(PD) in early stage and physiological tremor by tremor analysis.Methods 14 patients with PD(group PD) and 9 cases of physiological tremor(group physiological tremor) were studied.The surface electrode of the accelerometry(Acc) was pasted at the end of certer-metacarpal of back of hand.At the same time,surface electrodes of electromyography(EMG) were pasted on the forearm flexors and extensors.The tremor graphices and myoelectric activities were recorded in 30 s with and without 1000 g bearing respectively.Tremor frequency and related myoelectric activities were analysed.Results Acc record: The main manifestations were static tremor and tremor frequency was no significant difference when with and without loading in group PD.In group physiological tremor,the main manifestations were posture or active tremor.With loading,the tremor frequency was significant reduced(P