Perineural invasion, lymph node metastasis, resection margin status, and tumor differentiation were the significant prognostic factors for the 5-year survival.

Objectives. The aim of our study was to evaluate and compare the results of pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD). Methods. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of PG versus PJ after PD were analyzed. Two reviewers assessed the quality of each trial and collected data independently. The Cochrane Collaboration's RevMan 5.0 software was used for statistical analysis. Proportions were combined, and the odds ratio (OR) with its 95% CI was used as the effect size estimate. Results. Four RCTs published in 1995 or later were included in this meta-analysis, in which 276 patients underwent PG and 277 patients underwent PJ followed PD. In the combined results of PG versus PJ, a significant difference in the morbidity of intra-abdominal complications (OR, 0.34; 95% CI, 0.23–0.49; P < 0.00001) was found, but no significant difference could be found for pancreatic fistula (OR, 0.69; 95% CI, 0.42–1.12 , P = 0.13) mortality (OR, 1.09; 95% CI, 0.42–2.83; P = 0.87), recovery with no complications (OR, 1.26; 95% CI, 0.90–1.78; P = 0.18), biliary fistula (OR, 0.55; 95% CI, 0.22–1.35; P = 0.19), or in delayed gastric emptying (OR, 0.55; 95% CI, 0.33–1.01; P = 0.06). Conclusions. Current RCTs suggest that PG is better than PJ for pancreatic reconstruction after PD.

Distant metastases and positive resection margin are the strongest negative prognostic factors for survival after pancreatoduodenectomy for distal bile duct carcinoma; thus, surgery with curative intent is only warranted in patients with local disease, where R0 resection is feasible.

To investigate patients with severe acute pancreatitis (SAP) by dynamic levels of pro-/anti-inflammatory cytokines and endotoxin (ET) in plasma and the relationship between immunity and infection, organ dysfunction. Seventy-two patients with SAP were recruited. The ET, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), and interleukin-4 (IL-4) were determined on admission and days 3, 7, and 14. For comparison, patients were analyzed through infection group versus non-infection group, multiple organ dysfunction syndrome (MODS) group versus non-MODS group. There were sixteen patients with secondary infection, twenty-two with MODS, and nine deaths. The infection group had higher levels of ET than the non-infection group on days 3 and 7. The dynamic cytokine levels of patients in the MODS group were unanimous with those outcomes in the infection group. The levels of cytokines in the infection group were different from the non-infection group, with more levels of TNF-α, IL-6 on days 3 and 7 and less on days 14, and more levels of IL-10, IL-4 on days 7 and 14. The levels of TNF-α, IL-6 in the MODS group were different from the non-MODS group, with more levels on days 3 and 7, and less levels on days 14. Immune dysregulation may play an important role in infection and organ dysfunction for patients with SAP.

The predominant infections were gram-negative bacterium, gram-positive bacterium, and fungi concomitantly or consecutively. Most of the infected patients had polyinfection. There were many patients with hospital-acquired infection and opportunistic infection. Multiple factors affected the outcome.

Current RCTs suggests that early EN appears safe and tolerated for patients after PD, but does not show advantages in infection and postoperative hospital stay.

There has been a large global outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), representing a major public health issue. In China, combination therapy, including traditional Chinese medicine (TCM) as a treatment for COVID-19 has been used widely. “Fei Yan No. 1” (QFDYG) is a formula recommended by the Hubei Government to treat COVID-19. A retrospective study of 84 COVID-19 patients from Hubei Provincial Hospital of TCM and Renmin Hospital of Hanchuan was conducted to explore the clinical efficacy of QFDYG combination therapy. TCMSP and YaTCM databases were used to determine the components of all Chinese herbs in QFDYG. Oral bioavailability (OB) ≥ 30% and drug-like (DL) quality ≥ 0.18 were selected as criteria for screening the active compounds identified within the TCMSP database. The targets of active components in QFDYG were determined using the Swiss TargetPrediction (SIB) and Targetnet databases. The STRING database and the Network Analyzer plugin in Cytoscape were used to obtain protein-protein interaction (PPI) network topology parameters and to identify hub targets. Gene Ontology (GO) enrichment was conducted using FunRich version 3.1.3, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment using ClueGO version 2.5.6 software. PPI and compound-pathway (C-T) networks were constructed using Cytoscape 3.6.0. Compared with the control group, combined treatment with QFDYG resulted in a significantly higher rate of patients recovering from symptoms and shorter the time. After 14 days of treatment, QFDYG combined treatment increased the proportion of patients testing negative for SARS-CoV-2 nucleic acid by RT-PCR. Compared with the control group, promoting focal absorption and inflammation as viewed on CT images. GO and KEGG pathway enrichment indicated that QFDYG principally regulated biological processes, such as inflammation, an immune response, and apoptosis. The present study revealed that QFDYG combination therapy offered particular therapeutic advantages, indicating that the theoretical basis for the treatment of COVID-19 by QFDYG may play an antiviral and immune response regulation through multiple components, targets, and pathways, providing reference for the clinical treatment of COVID-19.

An early excessive immune response followed by a subsequent immune deficiency is closely related to secondary SAP infection.