Abstract:With the deepened understanding of the biological behaviors of pancreatic cancer, the Pancreatic Cancer Professional Committee of the Chinese Anti-Cancer Society has developed and issued the Guidelines for the Comprehensive Diagnosis and Treatment of Pancreatic Cancer in China (2018 edition) and the Guidelines for the Comprehensive Diagnosis and Treatment of Pancreatic Cancer in China (2020 edition) in 2018 and 2020, respectively. Here, the authors compare and summarize the differences between the two versions of guidelines in terms of the diagnosis and treatment of pancreatic cancer, complemented with analyzing the contents of new methods, new regimens and hot issues proposed in the new guidelines by viewing the latest progress in relevant fields. This paper is expected to provide reference and guidance for continuously standardizing the diagnosis and treatment behavior and improving the diagnosis and treatment level of medical institutions for pancreatic cancer in China.

Abstract:Background and Aims With the development and popularity of laparoscopic techniques, laparoscopic pancreatoduodenectomy (PD) has been gradually adopted in the clinical setting. However, because of the challenging surgical difficulty of LPD, its efficacy and safety have some degree of uncertainty. Therefore, this study was performed to further assess the short-term efficacy and safety of LPD through a retrospective analysis of the clinical data of patients undergoing LPD and those undergoing open pancreatoduodenectomy (OPD) during the same period.Methods The data of patients undergoing LPD and OPD in the Department of General Surgery, Tianjin Medical University General Hospital from February 2019 to September 2021 were collected. The main clinical variables were compared between the two groups of patients.Results A total of 160 patients meeting the eligibility criteria were included for analysis, with 25 cases in LPD group and 103 cases in OPD group. There were no significant differences in terms of age, body mass index (BMI), preoperative testing parameters between two groups (all P>0.05). The median operative time in LPD group was significantly longer than that in OPD group (450 min vs. 400 min，P=0.003), while other surgical variables that included blood transfusion rate, intraoperative blood loss, and lesion size showed no statistical difference between the two groups (all P>0.05). In addition, the BMI of the patients exerted no significant influences on the variables associated with the two procedures (all P>0.05). The median length of postoperative hospital stay was shortened (12 d vs. 27 d, P<0.001) and the incidence of postoperative delayed gastric emptying was reduced in LPD group compared with OPD group (5.6% vs. 33.7%,P=0.002), and there were no statistical differences with regard to the postoperative TNM stage, postoperative pathological results, and concentration of amylase in drainage fluid on postoperative day 3 as well as the incidence rates of other postoperative complications, repeated operation and patients' death between the two groups (all P>0.05). Comparison between patients undergoing portal vein resection and reconstruction in LPD group (8 cases) and OPD group (12 cases) showed that the operative time and length of hospitalization were significantly longer and the intraoperative blood loss was significantly higher in the former than those in the latter (all P<0.05).Conclusion LPD has the similar short-term efficacy and safety with OPD, and moreover, LPD is superior to OPD in terms of postoperative recovery and incidence of postoperative delayed gastric emptying. Nevertheless, LPD requires a prolonged operative time, especially combined with vascular reconstruction, resulting in increased intraoperative blood loss and lengthened postoperative hospital stay. Performing LPD requires high-level surgical skills of the surgeons, which provides great impetus for further development and standardization of this complex surgical procedure.

Abstract:Background and Aims Pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) are considered as the standard procedures for pancreatic tumors. However, it needs to be noted that the endocrine and exocrine pancreatic insufficiency may occur after performing these tow procedures for benign or low-grade malignant tumors. The aim of this study was to investigate the clinical efficacy of central pancreatectomy (CP) for benign or low-grade malignant tumors in the neck and proximal body of the pancreas.Methods The clinical data of 19 patients who underwent CP from June 2009 to August 2020 in the First Affiliated Hospital of Nanchang University were retrospectively analyzed. Among the patients, there were solid pseudopapillary tumor in 8 cases, serous cystadenoma in 4 cases, neuroendocrine tumor in 4 cases, and pseudocyst, paraganglioma and inflammatory granuloma in one case each.Results Fifteen patients underwent open surgery and 4 patients had minimally invasive surgery. The reconstruction methods of the distal pancreatic remnant included duct-to-mucosa pancreaticojejunostomy in 15 cases and pancreaticogastrostomy in 4 cases. The mean operative time was (224.0±40.4) min, and the mean intraoperative blood loss was (173.2±50.9) mL. The incidence rates of overall complications and clinically relevant postoperative pancreatic fistula were 52.6% and 26.3%, respectively. The mean postoperative hospital stay was (11.8±6.5) d. No reoperation and surgery-related death occurred. The mean follow-up time was (59.3±39.0) months, and endocrine or exocrine pancreatic insufficiency occurred in none of them as well as no tumor recurrence was noted.Conclusion CP for the treatment of benign or low-grade malignant lesions in the neck or proximal body of the pancreas can maximally preserve the endocrine and exocrine pancreatic function, but it is associated with a relative high incidence of pancreatic fistula.

Abstract:Background and Aims Adenosquamous carcinoma of the pancreas (ASCP) is a rare exocrine malignant tumor, with a high malignancy grade and a poor prognosis after radical resection. However, the current prognostic model for pancreatic cancer based on TNM stage is not suitable for ASCP, and it is urgent to establish a prognostic model suitable for ASCP by combining with other clinical data. Therefore, this study was conducted to investigate the values of preoperative inflammatory- and immune-related indicators [neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and systemic immune-inflammatory index (SII)] in postoperative prognostic evaluation of ASCP, and establish a prognostic model for ASCP.Methods Clinical data and follow-up records of 129 patients who underwent radical resection for ASCP in the Department of Hepatobiliary Pancreatic Surgery of Changhai Hospital Affiliated to the Naval Medical University of Chinese People's Liberation Army from September 2012 to September 2019 were retrospectively analyzed. The cutoff values of NLR, PLR, LMR and SII were determined by the minimum P-value method. The differences in prognosis between patients grouped based on the cut-off value of each indicator were compared, and the differences in baseline characteristics between high SII group and low SII group were selectively compared. The prognostic factors for patients were determined by univariate analysis and multivariate Cox regression analysis, and then a prognostic index (PI) model for prognosis prediction was established. The abilities to predict two-year survival of patients of the PI prediction model and TNM stage prediction model were analyzed and compared by the receiver operating characteristic (ROC) curve.Results The cutoff values of NLR, PLR, LMR and SII were 3.46, 85.5, 4.1 and 339.7, respectively. The differences in survival between patients grouped based on the cut-off value of each indicator were all statistically significant (all P<0.05). The proportions of cases with tumor located in the pancreatic head and cases with poorly differentiated tumor in high SII group were higher than those in low SII group (47.3% vs. 26.3%; 63.6% vs. 42.1%), but both differences did not reach a statistical significance (both P>0.05). Results of univariate variable analysis showed that T stage, N stage, tumor differentiation, tumor size, vessel tumor emboli, nerve invasion, NLR, PLR, LMR, and SII were all influencing factors for postoperative prognosis of ASCP patients (all P<0.05), and results multivariate Cox regression analysis revealed N stage, tumor differentiation, tumor size, nerve invasion, and SII were independent postoperative prognostic factors for ASCP patients (all P<0.05). The predictive efficacy of PI prediction model constructed based on these independent prognostic factors was superior to that of TNM stage prediction model (AUC: 0.779 vs. 0.625).Conclusions Preoperative NLR, PLR, LMR and SII are of great value in evaluating the postoperative overall survival of ASCP patients. The predictive efficacy of the PI prediction model constructed by integrating SII and other clinical factors has a better predictive efficacy.

Abstract:Background and Aims Pancreatic cancer is characterized by high metastatic potential and invasiveness, and dismal prognosis. However, Mutations in oncogenes and changes in molecular regulatory relationships can affect the malignant biological behaviors of pancreatic cancer. The expression of ubiquitin/ISG15-conjugating enzyme E2L6 (UBE2L6) in pan-cancer and its biological function in pancreatic cancer remain unclear. Therefore, this study was performed to explore the effect of UBE2L6 on the proliferation, migration, and invasion abilities of pancreatic cancer and its underlying molecular mechanism through bioinformatic analysis and experimental verification.Methods The RNA-seq data of TCGA and GTEx were downloaded from UCSC Xena, and the differential expressions of UBE2L6 in pan-cancer were analyzed using the “limma” package of R (4.0.2). The differential expression of UBE2L6 in pancreatic cancer tissue and cell lines was verified by the Gene Expression Omnibus (GEO) datasets and qRT-PCR, respectively. In pancreatic cancer cells after transfection with siRNA targeting UBE2L6, the influences of UBE2L6 on the biological functions of pancreatic cells were analyzed by CCK-8 proliferation, colony formation, Transwell migration and invasion assays. The potential action mechanism of UBE2L6 were explored by the molecular correlation, protein interaction, and gene set enrichment analysis (GSEA). Then, the clinical data of pancreatic cancer were downloaded from the TCGA database to analyze the association of UBE2L6 expression with the clinicopathologic features and its clinical application value.Results Differential expression analysis suggested that UBE2L6 expression was up-regulated in pan-cancer as well as in pancreatic cancer tissue and a variety of pancreatic cancer cell lines such as BxPC-3 (t=33.82, P<0.000 1), PANC-1 (t=7.36, P=0.001 8), AsPC-1 (t=9.61, P=0.000 7), SW1990 (t=10.26, P=0.000 5), and MIA PaCa-2 (t=12.65, P=0.000 2). Cell function assays showed that UBE2L6 promoted the proliferation, migration, and invasion of PANC-1 and AsPC-1 cells. Spearman correlation analysis indicated that BCL2A1 protein had the highest correlation with UBE2L6 (r=0.442). The protein interaction analysis showed that it potentially interacted with HERC6, RPS27A, HERC5, UBA52, ISG15, UBA7, DDX58, UBC, UBB, and ARIH1. Meanwhile, GSEA enrichment analysis suggested that UBE2L6 was closely related to the tumor immune microenvironment. While clinicopathologic correlation analysis showed that the high expression of UBE2L6 was closely correlated with the histopathological grade of pancreatic cancer (χ²=6.966, P=0.031). Next, univariate and multivariate Cox regression analysis showed that age and lymph node metastasis were independent risk factors for pancreatic cancer patients (both P<0.05), and the expression of UBE2L6 was significantly correlated with the prognosis of pancreatic cancer patients (P<0.05), but it was not an independent prognostic factor (P>0.05). Furthermore, ROC curve and Kaplan-Meier survival analysis suggested that UBE2L6 had a high clinical diagnostic value for pancreatic cancer (AUC=0.970, 95% CI=0.950-0.989) and was correlated with the prognosis of pancreatic cancer patients (P<0.05).Conclusion UBE2L6 is highly expressed in pancreatic cancer, and it promotes the proliferation, migration, and invasion of pancreatic cancer cells. Its molecular mechanism may be related to cell apoptosis, ubiquitination, the MAPK signaling pathway, and tumor immune microenvironment. In addition, UBE2L6 is closely associated with the diagnosis and prognosis of pancreatic cancer.

Abstract:Background and Aims Pancreatic cancer is a common tumor of the digestive system and a frequent cause of cancer-related death. Long non-coding RNAs (lncRNAs) have been demonstrated as regulators and specific biomarkers for multiple cancers. Recent evidence has indicated that the novel lncRNA SOX21-AS1 plays an important role in the initiation and progression of a variety of malignant tumors. However, its function in pancreatic cancer remains unclear. Therefore, this study was conducted to investigate the expression of SOX21-AS1 in pancreatic cancer and its function.Methods The expressions of SOX21-AS1 in 20 pairs of specimens of pancreatic cancer and adjacent normal tissue as well as in a range of pancreatic cancer cell lines (PANC-1, CAPAN2, CFPAC-1, BXPC3, and SW1990) and human pancreatic duct epithelial cell line (HPDE) were detected by qRT-PCR method. The relationship between SOX21-AS1 expression and the prognosis of pancreatic cancer patients were analyzed through GEPIA database. The changes in cell viability and proliferative capacity in pancreatic cancer cells after SOX21-AS1 silencing were determined by MTT assay and colony-forming assay. The targeted microRNAs (miRNAs) of SOX21-AS1 and its downstream targeted mRNAs were predicted using DIANA database, and then the interactions among them were validated by a series of function experiments, dual luciferase reporter assays, rescue experiments and correlation analyses.Results The expressions of SOX21-AS1 were upregulated in both pancreatic cancer tissue and cell lines, and the patients with its high expression had a poor prognosis (all P<0.05). In pancreatic cancer cells after SOX21-AS1 silencing, the cell viability and proliferative ability were significantly decreased (both P<0.05). Bioinformatics analysis indicated that there was a target binding sequence in miR-31-5p for both SOX21-AS1 and MMP-16 mRNA, and the interactions among them were confirmed by function experiments, dual luciferase reporter assays and rescue experiments. In addition, the results of correlation analysis showed that there was a negative correlation either between SOX21-AS1 expression and miR-31-5p expression (r²=0.257 1, P<0.05), or between miR-31-5p expression MMP-16 mRNA expression (r2=0.311 3, P=0.010 6).Conclusion The increased expression of SOX21-AS1 is associated with the enhanced viability and proliferation of pancreatic cancer cells, as well as the poor prognosis of pancreatic cancer patients. In terms of mechanism, SOX21-AS1 may competitively bind to miR-31-5p as a competing endogenous RNA (ceRNA) to regulate the expression of MMP-16 mRNA, thereby promoting the progression of pancreatic cancer. SOX21-AS1 may probably be a potential biomarker and therapeutic target for pancreatic cancer.

Abstract:Background and Aims Long non-coding RNA 909 (LINC00909) is a newly discovered long non-coding RNA (lncRNA) with a length of approximately 2 kb, which has been reported to function as an oncogene in gliomas and leukemias. However, the role of LINC00909 in pancreatic cancer has rarely been reported. This study was designated to investigate the expression of LINC00909 in pancreatic cancer and its influence on prognosis of the patients, as well as the impacts of LINC00909 and its regulatory network on the biological behaviors in pancreatic cancer cells.Methods The expressions of LINC00909 in 24 different types of cancers in TCGA datasets were analyzed through UALCAN. LinkedOmics was used to analyze the expressions of LINC00909 and prognosis in 176 pancreatic cancer patients were analyzed through LinkedOmics database. By using the lncRNA-miRNA binding database (starBase) and three miRNA-mRNA binding databases (miRmap, miRanda, and TargetScan), the potential target microRNAs (miRNAs) of LINC00909 and the mRNAs downstream to these miRNAs were predicted, and the LINC00909-miRNA-mRNA network was constructed. The differentially expressed miRNAs between pancreatic cancer and adjacent non-tumorous pancreatic tissues were identified by the "limma" package of R language. The survival analysis and correlation analysis were conducted by using "survival", "survminer", and "ggstatsplot" packages in R language. In pancreatic cancer PANC-1 cells, the influences of LINC00909 on cell proliferation, and migration/invasion abilities were investigated by a knockdown experiment (LINC00909 siRNA transfection), and the targeted relationship between LINC00909 and the potential miRNAs were verified by a rescue experiment (simultaneous transfection of LINC00909 siRNA and miRNA inhibitor). The interactions of the target miRNAs and with LINC00909 and their downstream mRNAs were verified by dual luciferase reporter assay.Results UALCAN analysis revealed that LINC00909 was lowly expressed in pancreatic cancer tissues. Low expression of LINC00909 predicted poor prognosis based on data from LinkedOmics databases (P<0.05). A total of 28 miRNAs potentially binding to LINC00909 were obtained through the starBase. Further analysis of the miRNA expression data in pancreatic cancer from TCGA found that only miR-194-5p was significantly up-regulated in pancreatic cancer. Using the target prediction databases miRmap, miRanda and TargetScan databases, 114 potential downstream target mRNAs of miR-194-5p were obtained. After further expression correlation analysis and survival analysis of the 114 mRNAs, 4 mRNAs (DACH1, SOCS2, STX16 and SNAP91) were identified. Finally, the ceRNA network of LINC00909-miR-194-5p-DACH1/SOCS2/STX16/SNAP91 was obtained. Results of knockdown experiment showed that the proliferation activity, scratch healing rate and the numbers of migrated and invaded cells were significantly higher in LINC00909 low expression group than those in control group (all P<0.05). Results of rescue experiment showed that the expression level of DACH1 mRNA was significantly increased, while and the cell proliferation activity, scratch healing rate, and the numbers of migrated and invaded cells were significantly decreased in rescue group compared with those in LINC00909 low expression group (all P<0.05). Results of dual luciferase reporter assay showed that miR-194-5p mimics significantly suppressed the luciferase activity of the LINC00909 and DACH1 reporter plasmid containing binding sites (both P<0.05).Conclusion Expression of LINC00909 is decreased in pancreatic cancer tissue and it exerts a tumor suppressor function. It may inhibit the proliferation, migration, and invasion of pancreatic cells by targeting and regulating the miR-194-5p/DACH1 axis.

Abstract:Background and Aims Interferon-induced transmembrane protein 1 (IFITM1), a membrane complex transducing homotypic adhesion signals in lymphocytes, is abnormally expressed in pancreatic cancer tissues, but its action mechanism in pancreatic cancer remains unclear. Therefore, this study was conducted as a preliminary investigation to examine the influences of the expression of IFITM1 on biological behaviors of pancreatic cancer cells.Methods The expressions of IFITM1 in the surgical specimens of cancer tissue and adjacent normal tissue from 78 pancreatic cancer patients (32 cases having metastasis, 46 cases not having metastasis) were determined by Western blot analysis. In pancreatic cancer PANC-1 cells after transfection with IFITM1-overxpression plasmids alone (IFITM1 group) or with simultaneous addition of ERK_1/2 pathway inhibitor LY3214996 (IFITM1+LY3214996 group), with untreated PANC-1 cells as control group, the changes in levels of IFITM1 protein and ERK_1/2 protein phosphorylation (ERK_1/2/p-ERK_1/2), proliferative viability and apoptosis as well as migration and invasion abilities were determined by Western blot, CCK-8 assay, flow cytometry, Scratch healing assay and Transwell assay, respectively.Results The relative expression level of IFITM1 protein in pancreatic cancer tissue was significantly higher than that in adjacent normal tissue, and in pancreatic cancer tissue with metastasis was higher than that in pancreatic cancer tissue without metastasis (both P<0.05). Compared with PANC-1 cells in control group, the PANC-1 cells in IFITM1 group showed significantly increased IFITM1 protein and ERK_1/2/p-ERK_1/2 levels, decreased apoptosis rate, increased proliferative viability and enhanced migration and invasion abilities (all P<0.05); except the up-regulated IFITM1 protein level (P<0.05), the PANC-1 cells in IFITM1+LY3214996 group showed no significant changes in all other studied parameters (all P>0.05)Conclusion IFITM1 expression is increased in pancreatic cancer tissue, which is closely related to the malignant behaviors of pancreatic cancer. The mechanism may be possibly associated with its regulating the growth, migration and invasion abilities of the pancreatic cancer cells via phosphorylating and activating the ERK_1/2 pathway.

Abstract:Background and Aims Pancreatic cancer is a digestive system tumor with high degree of malignancy. Early metastasis is the main cause for death of pancreatic cancer patients. Sinomenine is an alkaloid extracted from the dried cane of rattan, which has the pharmacological effects such as analgesic, anti-inflammatory and immunosuppressive properties. Studies have found that the NF-κB signaling pathway is closely related to the metastasis of pancreatic cancer, and sinomenine can inhibit the activation of the NF-κB signaling pathway. Therefore, this study was designated to investigate the inhibitory effect of sinomenine on the migration and invasion of pancreatic cancer cells and its association with the NF-κB signaling pathway.Methods The pancreatic cancer Capan-1 cells were treated with different concentrations of sinomenine (400, 800, and 1 600 mg/L), with untreated Capan-1 cells as control, and then, the changes in migration and invasion abilities were detected by scratch healing assay and Transwell assay, and the expressions of NF-κB protein as well as intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) were determined by Western blot. After that, the influences of the NF-κB signaling pathway agonist TNF-α (20 mg/L) on the actions exerted by sinomenine (1 600 mg/L) were observed.Results In Capan-1 cells after treatment with each concentration of sinomenine compared with control Capan-1 cells, the migration and invasion abilities were all decreased, and the nuclear translocation of NF-κB pancreatic cancer was subdued (cytoplasmic NF-κB increased and nuclear NF-κB decreased), and the expressions of ICAM-1 and VCAM-1 were down-regulated, all of which presented a certain concentration-dependent pattern (P<0.05 or P<0.01). The effects exerted by TNF-α were totally opposite to those of sinomenine on Capan-1 cells, and the effects of inhibiting migration and invasion as well as down-regulating adhesion molecule expressions exerted by sinomenine on Capan-1 cells were partially reversed by simultaneous addition of TNF-α (P<0.05 or P<0.01).Conclusion Sinomenine can inhibit the migration and invasion of pancreatic cancer cells, and the mechanism may be associated with its suppressing the activation of NF-κB signaling pathway, and thereby down-regulating the expressions of downstream adhesion molecules. Sinomenine is probably a potential therapeutic drug for pancreatic cancer.

Abstract:Background and Aims Acute biliary pancreatitis (ABP) is a frequently encountered disease in clinical practice, for which the most common cause is choledocholithiasis. The mainstream view at present is that endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (EST) and endoscopic naso-biliary drainage (ENBD) should be performed as early as possible for patients with ABP in early stage. However, the necessity of synchronous pancreatic duct stent drainage during above treatment is still a matter of debate. Therefore, considering this problem, this study was conducted to further investigate the clinical value of pancreatic duct stent placement in the treatment of ABP by an efficacy comparison between two groups of ABP patients receiving EST plus ENBD with or without pancreatic duct stent placement.Methods The clinical data of 70 ABP patients treated in the People's Hospital of Ningxia Hui Autonomous Region from January 2015 to January 2020 were retrospectively analyzed. Of the patients, 30 cases underwent emergency operation of EST plus ENBD combined with pancreatic duct stent drainage within 72 h after onset with regular conservative treatment (observation group), and 40 cases underwent emergency operation of EST plus ENBD within 72 h after onset with regular conservative treatment. The clinical improvements and overall outcomes of the two groups of patients were compared.Results There were no significant differences in sex, age, time from onset to EST, and preoperative laboratory parameters between the two groups of patients (all P>0.05). The time to pain relief, length of hospitalization, and time for the serum amylase to return to normal in observation group were significantly shorter than those in control group (all P<0.05). The time lengths for normalization of the levels of transaminases and bilirubin showed no statistical difference between the two groups (all P>0.05). Death occurred in one patient (3.3%) in observation group and in two patients (5.0%) in control group; the incidence of complications (peripancreatic fluid collections, pancreatic pseudocyst, pancreatic ascites) was 6.67% in observation group and 17.5% in control group; ultrasound or CT guided puncture and drainage was required in one patient (3.3%) in observation group and in 3 patients (10%) in control group; surgical debridement was performed in none of the patients in observation group and in one patient in control group; ICU admission was required for one patient in observation group and 4 patients in control group. All above clinical outcome variables in observation group were superior to those in control group, but all differences did not reach statistical significance (all P>0.05).Conclusion Application of pancreatic duct stent drainage in the treatment of ABP patients can quickly alleviate the clinical symptoms, and may also decrease the incidence of complications, improve the outcomes and increase the overall efficacy. The pancreatic duct stent placement is recommended during performing EST plus ENBD procedure for ABP patients in early stage.

Abstract:Background and Aims Biliary tract infection is a common acute abdominal disease. It can lead to septic shock and even death if not treated on time. So, knowledge of the bacterial species and their antimicrobial sensitivity patterns are critically important for guiding clinical treatment strategies. This study was conducted to analyze the distribution and drug resistance of pathogenic bacteria in bile culture obtained by endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary tract diseases, so as to provide basis for rational use of antibiotics in patients with biliary tract infection.Methods The data of 1 141 patients undergoing ERCP for biliary tract disease with bile culture and drug susceptibility test in Foshan First People's Hospital from January 2016 to December 2019 were retrospectively analyzed. The identification of microbial strains isolated from the bile samples of the patients and drug susceptibility test were determined by VITEK2-COMPACT automatic microbial identification system. Further, the results between patients with gallstones and those without gallstones were analyzed and compared.Results A total of 745 strains of pathogens were isolated from bile culture, including 488 types of gram-negative bacteria (65.5%), 195 types of gram-positive bacteria (26.2%) and 62 types of fungi (8.3%). The top three pathogens were Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis, accounting for 33.4%, 12.6% and 8.2%, respectively. The Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis showed the highest resistance rate to trimethoprim, ampicillin and clindamycin, respectively. The antibiotic resistance patterns of Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis to different antibiotics varied from 2016 to 2019. The incidence of biliary tract bacterial infection in patients with gallstones was higher than that in patients without gallstones (67.5% vs. 58.8%), but patients without gallstones were more likely to develop antibiotic resistance.Conclusion Both the bacterial species composition and their antibiotic resistance pattern of the pathogens of biliary infection are dynamically changed over time. Clinical treatment should be directed by bile culture and sensitivity test results, so as to ensure rational use of antibiotics, maximizing the benefit of patients and reducing the generation of drug-resistant strains.

Abstract:Pancreatic cancer is a highly malignant tumor with dismal prognosis and poor responses to classical chemotherapeutic agents and targeted drugs. Thereinto, tumor microenvironment of pancreatic cancer plays an important role in the development of drug resistance. Nanomedicines are promising candidates for the treatment of pancreatic cancer, because of the advantages of appropriate size and high stability in circulation as well as the enhanced permeability and retention effect, in combination with the strategies such as photosensitive and pH-response controlled drug release, they can effectively penetrate through the tumor microenvironment and target at the cancer cells. Here, the authors review the strategies for using nanomedicines in the treatment of pancreatic cancer, including ferroptosis-inducing nanomedicines, conventional chemotherapeutic agent- or siRNA-loaded nanocarriers, photodynamic nanoagents and some other strategies, and also summarize the recent progress, relevant clinical trials and current problems.

Abstract:The clinical process of hyperlipidemic pancreatitis (HLP) is different from those triggered by other causes. Its incidence rates of multiple organ dysfunction syndrome (MODS) and recurrence after hospital discharge were higher than those of non-HLP, and the complications affecting the major organs are positively correlated with the level of serum triglyceride (TG). The key to its treatment is to rapidly reduce the TG level and block systemic inflammatory response. Hemoperfusion combined with hemofiltration can effectively remove blood TG and inflammatory factors, and has become an important approach for the treatment of HLP. Herein, the authors address the application progress of combination of hemoperfusion and hemofiltration in the treatment of HLP, so as to provide referential information for clinical use.

Abstract:Severe acute pancreatitis (SAP) is a common acute abdominal disease in clinical practice. It is caused by abnormal activation of pancreatic enzymes, which results in digestion of the pancreas itself and surrounding organs, mainly represented by local inflammatory reaction of the pancreas, and even leads to organ dysfunction. SAP is often complicated by acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), which is one of the major causes for high mortality of SAP. The incidence of SAP-associated ALI ranges from 15% to 55%, and its clinical manifestations vary from mild hypoxemia to ARDS. In addition, ALI/ARDS is the most significant manifestation of extra-abdominal organ dysfunction of SAP, with a mortality rate up to 60% within the first week of onset. In recent years, many studies have found that SAP-associated ALI is inextricably linked to the activation of a variety of signaling pathways, and yet, on the other hand, the stimulation of various inflammatory factors, oxidative stress and cell apoptosis are also the important causes responsible for SAP-associated ALI. Here, the authors address the latest research progress on the mechanism of SAP-associated ALI and the treatment.