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Objective To analyze the expression and role of the disulfidptosis-related gene PDZ and LIM domain protein 1(PDLIM1)in various tumors.Methods The expression of PDLIM1 mRNA was analyzed by Xiantao website.The diagnostic and prognostic capabilities of PDLIM1 in 33 types of tumors were explored using the Xiantao website and Sangerbox 3.0 data analysis platform.The correlation between PDLIM1 and clinical classification and its staging was analyzed by the TISIDB database.The correlation between PDLIM1 and tumor immunity was analyzed by Sangerbox 3.0 data analysis platform and Kaplan-Meier Plotter database.Protein-protein interaction networks(PPI)were constructed by STRING database and Cytoscape,and were enriched by Sangerbox 3.0 data analysis platform.Finally,the GSCA website was applied to acquire the expression of PDLIM1 mRNA and its sensitivity to drugs.Results There was heterogeneity in the expression of PDLIM1 mRNA among 33 tumors.PDLIM1 had good diagnostic ability in cholangiocarcinoma(CHOL),glioblastoma multiforme(GBM),kidney renal clear cell carcinoma(KIRC),lung adenocarcinoma(LUAD),ovarian cancer(OV),pancreatic cancer(PAAD),skin cutaneous melanoma(SKCM)and testicular germ cell tumor(TGCT).High expression of PDLIM1 mRNA in glioma,low-grade glioma(LGG),KIPAN,GBM,uveal melanoma(UVM),and adrenocortical carcinoma(ACC)suggested poor prognosis,while low expression in sarcoma suggested poor prognosis.PALIM1 mRNA expression was correlated with the classification of head and neck squamous cell carcinoma(HNSC),kidney renal papillary cell carcinoma(KIRP),uterine corpus endometrial carcinoma(UCEC),uterine carcinosarcomas(UCS),and UVM as well as the staging of cervical squamous cell carcinoma and endocervical adenocarcinoma(CESC),HNSC,UCEC,and LGG.PDLIM1 was significantly associated with immune infiltration of 36 tumors led by prostateadenocarcinoma(PRAD),and was found to have a relatively good prognosis after immunotherapy in patients with high PDLIM1 mRNA expression.PDLIM1 exerted effects on organisms mainly through its involvement in the regulation of actin cytoskeleton,cell adhesion,and cancer-related pathways,and was sensitive to various drugs led by Isoliquiritigenin.Conclusion PDLIM1 was closely related to the clinical prognosis and immune infiltration of a variety of tumors,and it is expected to be a cancer diagnostic and prognostic biomarker or therapeutic target.
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Objective:To explore the clinical efficacy of radical surgery after successful conversion therapy for liver cancer.Methods:We retrospectively analyzed the clinical data of 10 patients with liver cancer who underwent successful conversion therapy and subsequent radical surgery in Peking University People's Hospital from Nov 2019 to Dec 2021.Results:The median age of the 10 patients was 64 (51.25,68.50) years. The median number of conversion therapy cycles was 11 (4.75,25.00). No serious adverse reactions were found in the patients during conversion therapy. After conversion therapy, 8 patients underwent partial hepatectomy, and 2 patients underwent radiofrequency ablation. Postoperative complications occurred in 4 patients. All complications were classified as Clavien-Dindo grade Ⅰ or Ⅱ. The median follow-up time was 13 (9.75,49.75) weeks. Three patients had tumor recurrence after surgery. Among the patients with tumor recurrence, 1 patient died of liver failure.Conclusions:Conversion therapy is an effective treatment for patients with clinically unresectable liver cancer. The incidence of serious adverse reactions in conversion therapy for liver cancer is low. The radical surgery can be safely performed in patients with good general condition and liver function. Radical surgery after conversion therapy can prolong the survival time of patients for unresectable liver cancer.
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Objective:To propose an automatic planning approach for Eclipse15.6 planning system based on Eclipse scripting application programming interface (ESAPI) and evaluate its clinical application.Methods:20 patients with nasopharyngeal carcinoma and 20 cases of rectal cancer were selected in the clinical planning. The developed automatic planning script SmartPlan and RapidPlan were used for automatic planning and dosimetric parameters were compared with manual planning. The differences were compared between two groups by using Wilcoxon signed rank test. Results:The dosimetric results of automatic and manual plans could meet clinical requirements. There was no significant difference in target coverage in nasopharyngeal carcinoma planning between two groups ( P>0.05), and automatic plans were superior to manual plans in organs at risk sparing ( P<0.05). Except for the homogeneity index of PTV and the maximum dose of bowel in rectal cancer plans, the other dosimetric parameters of the automatic plans were better than those of the manual plans (all P<0.05). Conclusions:Compared with the manual plans, the automatic plans have the same or similar target coverage, similar or better protection of organs at risk, and more convenient implementation. The developed SmartPlan based on ESAPI has clinical feasibility and effectiveness.
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Objective:To evaluate the immunogenicity of recombinant factor H binding protein(fHBP) by detecting serum antibody titer and serum bactericidal antibody test (SBA).Methods:fHBP sequence was selected and synthesized, connected to plasmid pET43.1a, transformed to Escherichia coli BL21(DE3), and expressed two recombinant fHBP proteins, included two subfamilies, fHBPA and fHBPB. After purification, the recombinant fHBP proteins were immunized to rabbits and mice. The immune antiserum titer and the bactericidal titer to epidemic strains of meningococcal bacteria group B were measured by ELISA and SBA respectively. Results:The antiserum titer of fHBP immunized rabbits was greater than 2.0×10 6, and that of immunized mice was not less than 1.0×10 6. fHBP immunized rabbit serum had bactericidal titer more than 1∶128 to 41 strains A subfamily and 20 strains B subfamily in the SBA against 69 endemic strains, and there was no cross-protection between the subfamily bacteria. The bactericidal titers of mouse serum immunized fHBPA to strains A subfamily such as Nm210902 Nm211009、Nm450522 were 1∶1 024, 1∶608、1∶861, to Nm510703、Nm311304、Nm431002 were 1∶234、1∶861、1∶430 respectively, and mouse serum immunized fHBP B to strains B subfamily Nm311302、Nm311304、Nm431002 were 1∶876、1∶274、1∶1858, all of three strains were positive in bactericidal titers. Conclusions:the titer of fHBP antiserum was higher than 1.0×10 6, the bactericidal titer was no less than 1∶128 to 61 epidemic strains, and it has a 94.2% protective effect on 69 meningococcal epidemic strains group B.
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Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.
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Objective:To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma(SHCC).Methods:Sixty five SHCC patients with intact clinical data, treated in the Center of Hepatobiliary Surgery, Peking University People's Hospital between Feb 2005 and Aug 2012, were enrolled in this study. Among them, 30 patients were treated by MWA, and the other 35 by hepatectomy. Follow-up was conducted from Mar 2013 to Feb 2021. The differences in long-term survival, intraoperative blood loss, operative time, postoperative complications, performance status (PS), and postoperative hospital stay were compared between the two groups.Results:The survival probability at 1, 3, 5 and 10 years was 93.2%, 82.5%, 55.6% and 41.2%, respectively, in the MWA group, and 97.1%, 82.6%, 67.2% and 48.3%, in the resection group ( P=0.347). The MWA group had less perioperative complications, less blood loss, shorter operation time, better PS score and better hospital stay than the surgical resection group (all P<0.001).There was no statistically significant difference in the survival rate between BCLC stage 0~A1 and A2~A4 patients( P=0.773, 0.536). Conclusions:Microwave ablation in the treatment of small hepatocellular carcinoma can achieve similar results as hepatectomy with less traumatic,better postoperative PS score and shorter postoperative hospital stay.
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Objective To investigate the effect of Roux-en-Y hilar-jejunum anastomosis in surgical resection of hilar cholangiocarcinoma.Methods The clinical data of 31 patients with hilar cholangiocarcinoma admitted from Feb 2009 to Feb 2017 who underwent Roux-en-Y hilar-jejunum anastomosis after resection were retrospectively analyzed.Results According to Bismuth-Corlette classification there were 6 cases of Ⅲ a,6 cases of Ⅲ b and 19 cases of type Ⅳ.These patients all successfully underwent Roux-en-Y hilar-jejunum anastomosis,with intraoperative blood loss of 50-4 000 ml [on average of (1 146 ± 1 082) ml].The average operation time was (346 ± 118) min,and the average hilar-jejunum anastomosis time was (35 ± 13) min.The average postoperative hospital stay was (20 ± 11)days.There were 25 cases of R0 resection (80.6%).The postoperative complication rate was 25.8%(8/31).The overall median survival time was 21 months,and the 1-,3-,and 5-year survival rates were 68.8%,14.6% and 3.6%,respectively.During the follow-up period,7 cases of reflux cholangitis,5 cases of biliary anastomotic stenosis,and 1 case of adhesive intestinal obstruction were found.Conclusion The hilar-jejunum anastomosis is simple,safe,widely applicable prcedure,which is easy to perform.
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To explore efficacy of acupoint massage combined with acupoint application on arterial blood gas and postoperative complications for patients undergoing laparoscopic cholecystectomy. Patients undergoing laparoscopic cholecystectomy (LC) in general anesthesia condition were randomly enrolled from local hospital into control group and experimental group. Four acupuncture points were prepared for acupoint massage and acupoint application, including bilateral Hegu acupoint (LI4), Neiguan Point (PC6), Zusanli Point (ST36) and Tanzhong acupoint (CV17). All patients in experimental group were treated with point acupressure treatment combined with acupoint application before LC, while control group directly receive LC surgery. The peak inspiratory pressure (PIP), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2) and pH were examined at multiple time points during LC surgery. Related postoperative complications were documented for further analysis. All data were analyzed to assess efficacy of acupoint massage combined with acupoint application on arterial blood gas. There is no difference in baseline condition between experimental group and control group. Compared with control group, PetCO2 and SpO2 in experimental group were significantly increased while PIP was decreased. PH in experimental group ranged in a more stable domain. Hypercapnia and deep venous thrombosis were mitigated in experimental group compared with control group. Moreover, multiple pneumoperitoneum-related complications were alleviated after combined treatment, including pain and frequency of nausea and vomiting. Acupoint massage combined with acupoint application ameliorated related postoperative complications, and reduced side events of LC surgery via improving carbon dioxide metabolism.
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Acupuncture Therapy/methods , Cholecystectomy, Laparoscopic/adverse effects , Postoperative Complications/prevention & control , Acupuncture Points , Adult , Blood Gas Analysis , Carbon Dioxide/blood , Female , Humans , Male , Massage , Middle Aged , Preoperative Care , Prognosis , Treatment OutcomeABSTRACT
Pregnancy has increased susceptibility to H1N1 influenza virus infection. Maternal influenza infection is associated with increased risk of morbidity and mortality. A case of influenza A (H1N1) during late pregnancy (pregnancy 1, birth 0, pregnancy 30+2 weeks) was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th, 2018. The patient was set on mechanical ventilation with a FiO2 of 1.0, a positive end-expiratory pressure (PEEP) of 15 cmH2O (1 cmH2O = 0.098 kPa), and a tidal volume of 4-6 mL/kg (ideal body weight). However the pulse oxygen saturation (SpO2) could only be maintained at about 0.85. The disease was controlled by the treatments of anti-infection, mechanical ventilation, immune therapy, nutritional support, preventive anticoagulant treatment by heparin sodium, adequate negative fluid balance, and other organ support therapy. This article introduced the treatment process of the patient in detail, and provided experience for clinical treatment.
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Pregnancy has increased susceptibility to H1N1 influenza virus infection. Maternal influenza infection is associated with increased risk of morbidity and mortality. A case of influenza A (H1N1) during late pregnancy (pregnancy 1, birth 0, pregnancy 30+2 weeks) was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th, 2018. The patient was set on mechanical ventilation with a FiO2 of 1.0, a positive end-expiratory pressure (PEEP) of 15 cmH2O (1 cmH2O = 0.098 kPa), and a tidal volume of 4-6 mL/kg (ideal body weight). However the pulse oxygen saturation (SpO2) could only be maintained at about 0.85. The disease was controlled by the treatments of anti-infection, mechanical ventilation, immune therapy, nutritional support, preventive anticoagulant treatment by heparin sodium, adequate negative fluid balance, and other organ support therapy. This article introduced the treatment process of the patient in detail, and provided experience for clinical treatment.
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Objective To investigate the clinical efficacy and prognostic factors for combined caudate lobectomy radical resection plus broad lymph node dissection in patients of hilar cholangiocarcinoma.Methods The clinical data and follow-up results of patients with hilar cholangiocarcinoma surgically treated from Feb 2008 to Feb 2017 were retrospectively analyzed.Result The R0 resection rate[72.2% (13/18) vs 43.9% (18/41)],operation time [(433 ± 136) min vs (302 ± 122) min],intraoperative blood loss [(1 789 ± 1 091) ml vs (776 ± 755) ml] and postoperative complication rate [66.7% (12/18) vs 36.6% (15/41)]were significantly higher in the hepatic lobe combined with caudate lobe resection group than that without caudate lobe resection group (P < 0.05).The median survival time of patients with enlarged lymph node dissection was longer than that of patients with regional lymph node dissection (33 months vs 13 months,P <0.05).Univariate and multivariate analysis showed that the preoperative serum CA199 level > 1 000 U/ml,the degree of microscopic margin and tumor TNM stage were significantly correlated with the prognosis of the patients (P < 0.05).Conclusion Combined with caudate lobe resection can improve R0 resection rate.Targeted lymph node dissection helps prolong survival.The degree of microscopic margin,preoperative CA199 and TNM staging are independent risk factors for the prognosis of patients with hilar cholangiocarcinoma.
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BACKGROUND: The purpose of this study was to introduce the mechanism and clinical application of muscular atrophy that is a hotspot in the 65th Annual Meeting of American College of Sports Medicine and the 9th World Conference on Exercise Is Medicine and the World Conference of Basic Science of Muscle Hypertrophy and Atrophy. OBJECTIVE: To summarize and analyze the frontiers and hotspots of research findings on muscular atrophy, in order to provide new ideas for further research of exercise improving muscle function and the mechanism and application in this field, and provide a reference for the study on sports science, sports medicine, and sports rehabilitation in China. METHODS: Related reports and cutting-edge research findings in 65th Annual Meeting of American College of Sports Medicine were collected. Meanwhile, PubMed database between January 1993 and August 2018 was retrieved. The keywords were "skeletal muscle, muscle atrophy, movement and muscle, resistance movement". Thirty-five articles related to the molecular mechanism and clinical application of muscle atrophy were included for analysis and discussion. RESULTS AND CONCLUSION: The World Congress is a unique opportunity to bring together interdisciplinary investigators for the most comprehensive meeting ever held on this topic. The program will include a keynote lecture, tutorials, and symposia from leading experts. The meeting focused on the intrinsic and extrinsic variables that regulate skeletal muscle hypertrophy and atrophy. How exercise brings about skeletal muscle atrophy and its application in clinical problems such as aging, disease, injury, chronic diseases, and how these changes may relate to chronic disease were discussed as well. The research on muscle hypertrophy is mostly concentrated in the field of competitive sports.
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Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.
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Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.
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Objective To evaluate the therapeutic effect or safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage.Methods The clinical data of 70 patients with a history of esophagogastric variceal hemorrhage from 2009 to 2015 were analyzed.29 cases received spleen preserving paraesophagogastric devascularization and 41 were given portoazygous devascularization plus splenectomy.Results Postoperative portal pressure in spleenpreserving group decreased 14%,that in splenectomy group decreased 23% (t =2.87,P =0.01).The average blood loss in without splenectomy group was (829 ± 720) ml in contrast to (1 400 ± 1 329) ml in splenectomy group (t =2.311,P =0.024).Postoperative WBC and platelet count in without splenectomy group were lower (t =-5.379,t =-4.924,all P <0.01).The postoperative complication rate (24% vs.39%),and portal venous thrombosis (10% vs.31%) were all in favour of splenectomy free group (x2 =0.036,P <0.05).The 1-and 3-year's recurrent bleeding rate were 4% and 8% compared with 4% and 8% (all P > 0.05).Conclusion Paraesophagogastric devascularization without splenectomy has less blood loss during the surgery,lower rate of PVT and comparable effect against post-op recurrent bleeding in contrast to devascularization plus splenectomy.
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Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and < 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P < 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.
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Objective To investigate the significance of tumor markers CEA and CA19-9 in predicting the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.Methods A retrospective analysis of 110 cases with primary duodenal carcinoma treated in our hospital from January 1999 to December 2016 was conducted.ROC analysis,univariate and multivariate analysiswere performed to investigate the relationship between CEA,CA19-9 and the clinicopathologic characteristics of primary duodenal carcinoma.Kaplain-Meier method was used to analyze the relationship between CEA and CA19-9 and the prognosis of primary duodenal carcinoma.Results CEA level was of value for predicting the depth of infiltration,lymphatic involvement,metastasis and TNM stage.The receiver operating characteristic was 0.629,0.672,0.749,0.692 respectively.Univariate analysis showed serum CA19-9 lever was related to the depth of infiltration and serum CEA lever were related to tumor differentiation,lymphatic invasion,metastasis and TNM stage.Logistic analysis showed that CEA value was only associated with metastasis (OR:9.853,P < 0.01).Patients with elevated serum CEA level had a significant worse prognosis than patients with normal serum CEA level (P < 0.05).Conclusion Serum CEA level was closely associated with the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.
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Objective: To analyze the clinical value of modified endoscopic nipple resection in duodenal papillary adenoma resection Methods: 40 patients with duodenal papillary adenoma were randomly divided into observation group (20 cases) and control group (20 cases)according to the random number table. The patients of control group were treated by conventional resection of papillary adenoma, while the patients of observation group were treated by modified endoscopic nipple resection. The resection rate and the implantation of stent between the two groups were compared. Besides, the occurrence rate of complication and postoperative follow-up between the two groups also were compared. Results: The complete resection rate of observation group (95.00%) was not significant difference with that of control group (90.00%), while en bloc resection rate of observation group (85.00%) significant higher than that of control group (55.00%) (x2=4.28, P0.05). In postoperative three months, the difference of recently complication between the two groups was significant (x2=6.14, P0.05) in more than postoperative three months. After the follow-up of one year, the recurrence rate of observation group (10.34%) was no significant with that of control group (14.29%)(x2=0.17, P>0.05). Conclusion: The modified endoscopic nipple resection can enhance the en bloc resection rate, and reduce the incidence of complications and the recurrence rate. Besides, it has many dominances including higher feasibility in clinical practices. Therefore, its promotion is worthy.
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Objective To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.Methods Clinical data of 351 patients who underwent pancreaticoduodenectomy in our hospital from Jan 2001 to Dec 2015 were retrospectively analyzed.Results The overall incidence of pancreatic fistula was 20.2% (71/351),with grade A in 34 (9.7%) patients,grade B in 25 (7.1%),and grade C in 12 (3.4%).Postoperative hospital stay was significantly prolonged in patients with grade B and C pancreatic fistula.Multivariate analysis using Logistic regression identified three variables as independent factors associated with pancreatic fistula,namely,BMI (OR =2.281),preoperative total bilirubin level (OR =2.180) and soft pancreatic texture (OR =3.653).Preoperative total bilirubin level (OR =2.684),soft pancreatic texture (OR =5.128) and postoperative hemorrhage (OR =9.030) were independent risk factors of grade B and C pancreatic fistula after pancreaticoduodenectomy.Conclusions The incidence of pancreatic fistula after pancreaticoduodenectomy is still high.Pancreatic fistula prolongs the postoperative hospital stay significantly.The incidence of grade B and C pancreatic fistula could be reduced by avoiding postoperative hemorrhage.
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Objective To investigate the accuracy and feasibility of brachial artery peak velocity variation (ΔVpeakbrach) and inferior vena cava variability (VIVC) as indicators of fluid responsiveness in critically ill patients. Methods A single-center prospective observation was conducted. The patients on mechanical ventilation with spontaneously breathing admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from June 2013 to August 2015 were enrolled. The patients were diagnosed as severe sepsis or sepsis shock. The peak velocity in brachial artery and diameter of the inferior vena cava at the end of inspiration and expiration was measured by bedside portable ultrasonic machine, and then ΔVpeakbrach and VIVC were calculated. The hemodynamic parameters were collected at baseline and after volume expansion (VE). The stroke volume (SV) was measured by pulse-indicated continuous cardiac output (PiCCO). Patients were classified as responders or non-responders according to the variation of SV (ΔSV) increased ≥ 15% or not after VE. Receiver operating characteristic curve (ROC) was plotted to evaluate the sensitivity and specificity of ΔVpeakbrach and VIVC in predicting volume responsiveness. Results Among 58 patients after VE, 32 patients were defined as responders and the rest 26 were defined as non-responders.There were no differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, dose of vasoactive agent, ventilator parameters and infection site. Compared with baseline hemodynamic parameters, heart rate (HR) was decreased (bpm: 95±18 vs. 103±21), and systolic blood pressure (SBP) was increased [mmHg (1 mmHg = 0.133 kPa): 92±8 vs. 80±7] after VE in responders; central venous pressure (CVP) was increased after VE in non-responders (mmHg: 11±4 vs. 8±3, all P < 0.05). The ΔVpeakbrach [(15.4±4.3)% vs. (11.2±3.5)%] and VIVC [(18.6±4.1)% vs. (14.3±3.6)%] in responders were significantly increased as compared with those of non-responders (both P < 0.05). The area under ROC curve (AUC) of ΔVpeakbrach for predicting volume responsiveness was 0.816. When the cut-off value of ΔVpeakbrach was ≥ 13.3%, the sensitivity was 71.9%, and the specificity was 80.8%. AUC of VIVC for predicting volume responsiveness was 0.733. When the cut-off value of VIVC was ≥ 19.25%, the sensitivity was 53.1%, and the specificity was 88.5%. Conclusion ΔVpeakbrach and VIVC are reliable indicators for predicting volume responsiveness in critical patients.