[A single-center retrospective study of percutaneous drainage clinical characteristics of grade B and C postoperative pancreatic fistula and determination of the optimal intervention time].

Objective: To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow. Methods: Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher's exact test between the two groups. Results: Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21),χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay(M(IQR))(24(20)days vs. 39(53)days,Z=3.023,P=0.003). Conclusions: The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

[Value of serum YKL-40 in the diagnosis of anti-MDA5-positive patients with dermatomyositis complicated with severe pulmonary injury].

OBJECTIVE: To investigate the value of serum and bronchoalveolar lavage fluid (BALF) chitinase-3-like-1 protein (YKL-40) in the diagnosis of anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis (DM) patients complicated with serious pulmonary injury, including rapidly progressive interstitial lung disease (RP-ILD) and pulmonary infection. METHODS: Anti-MDA5 antibodies positive patients with DM who were hospitalized in the Department of Rheumatology of China-Japan Friendship Hospital from 2013 to 2018 were involved in this study. Demographic information, clinical, laboratory and imaging data were retrospectively collected. ELISA was used to detect the serum and BALF levels of YKL-40. The receiver operating characteristic (ROC) curve was drawn, and the area under ROC curve (AUC) was used to evaluate the diagnostic value of serum YKL-40 for pulmonary injury.Interstitial lung disease (ILD) was confirmed by chest high-resolution CT (HRCT). RP-ILD was defined as progressive respiratory symptoms such as dyspnea and hypoxemia within 3 months, and/or deterioration of interstitial changes or appearace of new pulmonary interstitial lesions on chest HRCT. Pulmonary infection was considered as positive pathogens detected in qualified sputum, blood, bronchoalveolar lavage fluid or lung biopsy specimens. RESULTS: A total of 168 anti-MDA5-positive DM patients including 108 females and 60 males were enrolled in the study. Of these patients, 154 had ILD, and 66(39.3%) of them presented RP-ILD. Seventy patients with pulmonary infection were confirmed by etiology. In the patients with RP-ILD, 39 (59.1%) of them were complicated with pulmonary infection. While only 31 cases(30.4%) had pulmonary infection in the non-RP-ILD patients. The incidence of pulmonary infection in the patients with RP-ILD was significantly higher than that of those with non-RP-ILD (P < 0.001). The serum YKL-40 levels in the RP-ILD patients with pulmonary infection were the highest compared with RP-ILD without pulmonary infection, non-RP-ILD with pulmonary infection and non-RP-ILD without pulmonary infection groups among all the patients [83 (42-142) vs. 42 (21-91) vs. 43 (24-79) vs. 38 (22-69), P < 0.01].The sensitivity, specificity and AUC of serum YKL-40 in the diagnosis of RP-ILD complicated with pulmonary infection were 75%, 67%, and 0.72, respectively. The AUC of diagnosed of anti-MDA5 positive DM patients complicated with RP-ILD and pulmonary infection was higher than that of patients complicated with only RP-ILD and only pulmonary infection (0.72 vs. 0.54 and 0.55, Z=2.10 and 2.11, P < 0.05). CONCLUSION: The prognosis of anti-MDA5-positive DM patients with RP-ILD and pulmonary infection were poor. Serum YKL-40 level can be used as a helpful tool for the diagnosis of coexistence of these conditions in the patients.

[Ovarian metastases of pancreatic ductal adenocarcinomas: the clinicopathological characteristics and outcomes of 10 cases].

Objective: To investigate the clinicopathological characteristics and outcomes of a series of ovarian metastases of pancreatic ductal adenocarcinoma. Methods: Data of clinical manifestation, pathological characteristic, treatment and follow-up result from ten patients with ovarian metastases of pancreatic ductal adenocarcinoma confirmed by pathology were retrospectively analyzed. Results: The median age of onset was 46 years (38~79 years). The primary tumors were located in the body and tail of the pancreas in 8 cases. Bilateral ovarian metastasis occurred in 8 patients at the time of diagnosis. The median time from patients with clinical symptom to ovarian metastases was 2.5 months (0~12 months). Peritoneal metastasis was found in all of 10 cases. Nine cases were accompanied by CA125 elevation. The major features of metastatic carcinoma in the ovary were cystic-solid appearance (8 cases) and mucinous adenocarcinoma (6 cases) with no obvious immunohistochemical features in pathological observation. All patients underwent palliative ovariectomy at onset, and one patient underwent primary tumor resection simultaneously. Seven patients received chemotherapy. The median survival time of the 10 patients was 10.3 months. Conclusions: Ovarian metastases of pancreatic ductal adenocarcinoma are easily misdiagnosed. The final diagnosis depends on clinical manifestations, imaging and histopathological observation. Ovariectomy may be associated with better outcome.

Effect of lncRNA MALAT1 expression on survival status of elderly patients with severe pneumonia.

OBJECTIVE: The aim of this study was to explore the relationship between serum MALAT1 level and clinical features of elderly patients with severe pneumonia and its impact on patients' survival. PATIENTS AND METHODS: A total of 150 elderly patients with severe pneumonia were enrolled in this study. According to patients' prognosis, enrolled subjects were divided into two groups, including death group (n=63) and survival group (n=87). The clinical data and indicators of subjects were collected, and χ2 and t-tests were used for statistical analysis. MALAT1 expression in the serum of all subjects was examined through the qPCR assay. Meanwhile, the predictive value of MALAT1 for patient death was assessed by the receiver operating characteristic curve (ROC). RESULTS: PT, APTT, DD, APACHE II scores, and MODS scores in death group were remarkably higher, while HB, HCT, TT, and PaO2/FiO2 were conversely lower than those in survival group (p<0.05). QRT-PCR results revealed significantly increased MALAT1 expression in death group when compared with survival group, especially in those patients with a history of smoking and COPD (p<0.05). In addition, ROC analysis confirmed the predictive value of MALAT1 for the prognosis of elderly patients with severe pneumonia. CONCLUSIONS: MALAT1 is highly expressed in the serum of elderly patients with severe pneumonia. Furthermore, it may serve as a marker for the prediction of survival of these patients.

[Characteristics and outcomes of primary angiosarcoma].

Objective: The study was designed to analyze the clinicopanthologic characteristics, treatments and outcomes of a series of patients with primary angiosarcoma. Methods: The clinical, surgical and pathological data and treatment of 68 patients with pathologically confirmed angiosarcoma admitted to Peking Union Medical College Hospital from January 1990 to June 2017 was retrospectively analyzed. Kaplan-Meier method and Log rank test were used for univariate survival analysis and Cox regression model was used for multivariate survival analysis. Results: A total of 68 patients were enrolled, 38 were male, 30 were female. The median age at diagnosis was 50.5 years. The time from symptom onset to diagnosis was (7.5±7.5) months. The primary sites included face and scalp, breast, chest wall, lung, heart, liver, spleen, extremities, bones and so on. At diagnosis, the mean size of tumors were (7.4±7.3) cm, 28 patients (41.2%) had localized disease (stage Ⅰ+ Ⅱ) and 40 patients had metastatic disease (stage Ⅲ+ Ⅳ). There were 37 patients treated with surgery alone, three receiving radiotherapy alone, five receiving chemotherapy alone and sixteen receiving comprehensive treatment with 5 underwent surgery plus radiotherapy, three treated by surgery plus chemotherapy, four had surgery plus interventional therapy, two had chemoradiotherapy, one had radiotherapy and interventional therapy and 1 had surgery plus chemoradiotherapy and targeted therapy. Five patients received only palliative treatment, and 2 patients lost follow-up after diagnosed. Fifty patients were followed up with a median overall survival time of 8.5 months. The median survival time of patients with metastatic angiosarcoma was 6.6 months, significantly shorter than that of patients with localized disease (15.0 months, P=0.020). The median survival time of patients with cardiac angiosarcoma was 3.0 months, significantly shorter than that of patients with angiosarcoma at other sites (11.5 months, P=0.010). The median survival time of patients receiving comprehensive treatment was 31.0 months, significantly longer than that of patients without comprehensive treatment (5.6 months, P=0.007). Multivariate analysis showed that staging, heart occurrence and comprehensive treatment were independent factors for the prognosis of primary angiosarcoma (all P<0.05). Conclusions: Angiosarcoma is a rare malignancy, and patients with metastatic disease or cardiac occurence have poor prognosis. Comprehensive treatment can improve the prognosis of patients with angiosarcoma.

[Experience of Sun's procedure for chronic type B dissection with aortic arch involvement].

Objective: To study the surgical treatment of chronic type B dissection with aortic arch involvement using Sun's procedure. Methods: Between February 2009 and December 2015, 29 patients [20 males, 9 females, with a mean age of (41±12) years, range 24-64 years] with type B dissection with aortic arch involvement underwent Sun's procedure. Sixteen patient had a history of hypertension. Marfan syndrome was observed in 9 cases, coronary artery disease in 3 cases, mitral regurgitation in 3 patients, cerebrovascular disease in one patient. Twenty-two patients suffered proximal aortic arch disease, 4 cases experienced history of aortic root procedure and 2 subjects had history of pregnancy. Four patients had aortic arch malformation. Results: One case suffered from massive cerebral infarction after surgery and died in another hospital. Concomitant procedures included mitral valve replacement in 3 cases, coronary artery bypass grafting in 3 patients, reconstruction of the right aberrant subclavian artery in one patient. Ventilator support exceeding 24 hours obseved in 2 patients. One of them recieved continuous renal replacement therapy and recovered before discharge. Spinal cord injury was obseved in one case, brain infarction in one patient and pericardial drainage in one case. Two patients required tracheotomy. During 12-94 (43±23) months' follow-up, thoracoabdominal aortic replacment was performed in 4 patients, thoracic endovascular aortic repair (TEVAR) in 2 subjects and repair of perivalvular leakage in one patient. Conclusions: Sun's procedure obtained satisfactory results in patients with chronic type B dissection with aortic arch involvement. Concomitant repair of proximal aortic arch lesions and distal type B dissection can be adopted using Sun's procedure.

Analysis of risk factors of type a aortic dissection (TAAD) operation of frozen elephant trunk and total arch replacement.

OBJECTIVE: To investigate the incidence and risk factors of acute renal failure (ARF) after operation of frozen elephant trunk and total arch replacement for acute thoracic aortic aneurysm and dissection (TAAD) with mild hypothermic circulatory arrest (MHCA), and to analyze the long-term survival rate of the patients with ARF. PATIENTS AND METHODS: From February 2009 to March 2015, patients with acute TAAD accepted operation of frozen elephant trunk and total arch replacement were enrolled. Those patients who were treated with renal replacement treatment (RRT) before the operation were excluded. The age, gender, cardiovascular disease history, preoperative serum creatinine and extracorporeal circulation duration in operation were recorded. On the basis of requiring RRT after TAAD operation, the patients were divided into ARF group and non-ARF group. The risk factors of ARF after TAAD operation were assessed by univariate and multivariate analysis. After completion of clinical follow-up, Kaplan-Meier curve was drawn to analyze five-year survival. RESULTS: A total of 524 patients were included in the study. 51 cases of them got postoperative ARF. The incidence was 9.7%. The mortality rate of ARF group in the hospital was significantly higher than non-ARF group (25.5% vs. 3.6%; p<0.001). Univariate analysis showed that there was statistically significant difference in the age, gender, hypertension history, preoperative serum creatinine ≥200 µmol/L, extracorporeal circulation duration ≥260 min and combined with coronary artery bypass surgery simultaneously (p<0.05). Multiple logistic regression analysis showed that there were three independent risk factors of ARF after the operation, including hypertension (p=0.031, OR=2.377), preoperative serum creatinine ≥200 µmol/L (p=0.005, OR=4.451) and extracorporeal circulation duration ≥260 min (p=0.002, OR=3.295). The total five-year survival rate of ARF group after the operation was 56%. There was no statistically significant difference in the five-year survival rate between preoperative serum creatinine ≥200 µmol/L group and <200 µmol/L group (p>0.05). CONCLUSIONS: The incidence of ARF after the operation was 9.7%. Preoperative serum creatinine ≥200 µmol/L, hypertension history and extracorporeal circulation duration ≥260 min were independent risk factors of ARF after the operation. The five-year survival rate of ARF after the operation was 56%. The preoperative serum creatinine level had no influence on the postoperative long-term survival.

[Application of evoked potentials monitoring in total thoracoabdominal aorta aneurysm repair].

OBJECTIVE: To evaluate the application value of evoked potentials (EP) monitoring in patients undergoing aorta-iliac bypass for total thoracoabdominal aorta aneurysm repair (tTAAAR). METHODS: A prospective study, with a total of 31 patients undergoing tTAAAR and intraoperative EP monitoring from June 2014 to April 2015 was carried out. The results of intraoperative evoked potentials, clinical outcomes and follow-up data of patients were collected for further evaluation. RESULTS: The EP wave disappeared [motor evoked potentials for (55.6±18.1) min, somatosensory evoked potentials for (50.3±18.7) min] after proximal descending aorta being clamped, and gradually recovered after the segment arteries of spine cord were reconstructed. The EP wave was restored to normal level at the end of operation in all the cases. The somatosensory evoked potentials remained unchanged in 2 cases (false negative). One case died after operation. No spinal cord injury occurred. The median follow-up after operation was 10 months (5-14 months). There was no delayed neurological deficit. CONCLUSION: EP provided an on-line monitoring of the condition of spinal cord function, which become an intraoperative protocol to avoid the irreversible injury of spinal cord.

A case-control analysis and laboratory study of the two feet-one hand syndrome in two dermatology hospitals in China.

BACKGROUND: Two feet-one hand syndrome (bilateral plantar tinea pedis with coexistent unilateral tinea manuum) is commonly seen in dermatology clinics, but the cause of the unilateral hand involvement remains unresolved. AIMS: To investigate the unilateral hand involvement in this syndrome. METHODS: This was a case-control study. The experimental group comprised 113 patients with bilateral tinea pedis and unilateral tinea manuum and the control group comprised 44 patients with tinea pedis only, without tinea manuum. Clinical data were recorded and pathogens were identified by fungal examination. The predominant pathogen, Trichophyton rubrum, was genotyped by PCR amplification of tandem repeat elements from the ribosomal DNA nontranscribed spacer region. RESULTS: Scratching habits were significantly different between the groups, and there was a significant relationship between tinea manuum and the hand reportedly used to scratch the feet. In analysis of isolates from the feet and the involved hand, 94.5% of pairs were of the same species, and 80% of pairs had the same genotypes. CONCLUSIONS: Contact between hands and feet probably results in the transmission of dermatophytes from the feet to the scratching hand.

Monoclonal antibodies to plasma high density lipoprotein (HDL) of eel (Anguilla japonica).

Six week-old female mice (Balb/c) injected intraperitonealy with 50 micrograms of eel high density lipoprotein (HDL) emulsified with equal volume of adjuvant three times every two weeks. Three weeks after the third injection, hyperimmunized mice were boosted by injection of 100 micrograms of HDL. After 5 days, the best responding mouse to injected HDL was sacrificed, and spleen cells were fused with mouse myeloma cells (Sp2/O-Ag14), and hybridomas were cultured in a selection medium. Monoclonal antibodies specific to apolipoprotein A-I or A-II (apoA-I or apoA-II) of HDL were obtained by cloning and recloning the hybridomas. Eighteen monoclonal antibodies specific to apoA-I and/or apoApII were isolated. Antibodies in the culture medium were purified by a HiTrap Protein G or an eel-HDL column. These purified antibodies belong to the subclass IgG1. The monoclonal antibodies specific to eel apoA-I and apoA-II secreted by clone 10D12 and 2G3, respectively, interact with serum proteins of some fish species such as red-sea bream and carp. The anti-eel apoA-I antibody of 10D12 did not bind to serum proteins of rat, rabbit, and chicken, while the anti-eel apoA-II of 2G3 antibody did.