Classical approach in duodenopancreatectomy - the key to success of a controversial intervention

Secția IV Chirurgie, Secția Radiologie, Secția Gastoenterologie, Spital ”Sf. Spiridon”, U.M.F. “Grigore T. Popa”, Iași, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Duodenopancreatectomia cefalică (DPC) este considerată tratamentul standard pentru tumorile periampulare. În pofida evoluției în chirurgia pancreatică, morbiditatea postoperatorie după DPC rămâne crescută. În timp ce rata mortalității asociate intervenției chirurgicale a scăzut la mai puțin de 4%, morbiditatea postoperatorie se menține la mai mult de 50%, datorate în special anastomozei pancreaticojejunale, principala vulnerabilitate a chirurgiei pancreatice. Material și metode: Autorii prezintă un studiu pe 5 ani, între ianuarie 2014 și aprilie 2019, pe un lot de 17 pacienți la care s-a practicat DPC cu reconstrucție clasică tip Whipple Child, cu 2 variante de anastomoză pancretico-jejunală. Media de vârstă a fost de 58,5. Rezultate: Mortalitatea imediat postoperatorie în lotul studiat a fost de 0%, iar morbiditatea a fost reprezentată de 1 caz de fistulă pancreatică și 2 cazuri de hemoragii postoperatorii. Supraviețuirea la 1 an a fost de 64,7%, 5 pacienți fiind pierduți din supraveghere și 1 deces. Concluzii: Fistula pancreatică, prin complicațiile cu pericol vital ca de exemplu hemoargia și peritonita, este principala cauză de morbiditate și mortalitate după duodenopancreatectomie cefalică. Factorii care contribuie la această complicație sunt reprezentați de textura moale a țesutului pancratic și de diametrul subțire al ductului pancreatic.Introduction: Pancreaticoduodenectomy (PD) is considered the standard treatment for periampullary tumors. Despite progresses in pancreatic surgery, the postoperative morbidity after PD remains high. While the operation-associated mortality rate of pancreatic surgery has decreased to less than 4%, the postoperative morbidity rate is reported to be as high as 50%, largely due to the pancreaticojejunal anastomosis, the major vulnerability of pancreatic surgery. Material and methods: The authors present a study between January 2014 and April 2019, on a series of 17 patients with PD with classical reconstruction type Whipple Child, with 2 types of pancreaticojejunal anatomosis. The median age was 58,5. Results: Postoperative mortality in the study was 0%, and morbidity was 1 case of pancreatic fistula and 2 postoperative bleeding. The survival at 1 year was about 64,7%, 5 patients were lost under surveillance and one death. Conclusions: Pancreatic fistula, with life-threatening complications, such as postoperative hemorrhage and peritonitis, is the most important cause of morbidity and mortality in PD. Factors contributing to this complication are: soft pancreatic tissue texture and small pancreatic duct diameter

Programmed Cell Death Deregulation in BCR-ABL1-Negative Myeloproliferative Neoplasms

BCR-ABL1-negative myeloproliferative neoplasms are classically represented by primary myelofibrosis, polycythemia vera, and essential thrombocythemia. These entities are stem cell-derived clonal disorders characterized by hematopoietic progenitor autonomy or hypersensitivity to cytokines, most of them presenting mutations in Janus kinase 2 (JAK2), calreticulin (CALR), or myeloproliferative leukemia virus oncogene (MPL). Deregulation of pro- and antiapoptotic genes is also claimed as an important mechanism involved in cell resistance to cell death and accumulation of myeloid cells in myeloproliferative neoplasms. Apoptosis, as one of the best-characterized types of programmed cell death, has a clear role in hematopoiesis control. However, the exact pathways affected in BCR-ABL1-negative myeloproliferative neoplasms have not yet been fully clarified. This chapter will explore the modifications affecting programmed cell death pathways involved in myeloid proliferation and how these alterations might be exploited in single or combined targeted therapeutic strategies

Interleukin-17 -association to silent lupus nephritis and disease activity

ABSTRACT Background: Systemic lupus erythematosus is a multiorganic, chronic immune disease and lupus nephritis, a severe manifestation, represents the strongest predictor of a poor outcome of this pathology. Cytokines play an important role in lupus nephritis and consequently, their use as biomarkers of active systemic lupus erythematosus disease is of particular interest. The purpose of this work was to study the pro-inflammatory role of interleukin-17 in renal involvement in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective study of 87 patients diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics 2012 diagnosis criteria. In this study, we determined the serum levels of interleukin-17 by ELISA. Results: It was observed that 49 patients in the study group presented with positive values of interleukin-17, range (1.12 -23.66) pg/ml. There was a positive correlation of interleukin-17 with active SLE as assessed by the Systemic Lupus Erythematous Disease Activity Index. No association was found between serum interleukin-17 level and renal pathology at the inclusion or in the clinical history of the patients. Patients with leukocyturia and hematuria presented higher values of serum interleukin-17 than those without these manifestations. In the linear regression model, after adjusting for age, gender and treatment we found an independent association between serum IL-17 levels and leukocyturia presence with OR=2.06, 95% CI range (1.22-2.89). Conclusions: A positive correlation has been observed between serum IL-17 and the SLE disease activity as assessed by the SLEDAI score computed without anti-DNA antibodies. Also, the IL-17 levels was strongly associated with the presence of leukocyturia and hematuria, even in patients with no clinical evidence of renal disease that might have silent lupus nephritis usually associated with a benign renal outcome

Replication Study and Meta-Analysis in European Samples Supports Association of the 3p21.1 Locus with Bipolar Disorder

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Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements