Objective To explore the value of a radiomics model based on computed tomography enterography(CTE)in the diagnosis of Crohn's disease(CD)activity.Methods A retrospective analysis was conducted on 166 diseased bowel segments from patients with CD.Lesions were classified into remission and active groups based on the simple endoscopic score for Crohn's disease(SES-CD).Two physicians independently delineated the volume of interest(VOI)for the lesions and extracted radiomics features.The optimal feature subset was selected through dimensionality reduction,and the Radiomics score(Radscore)was calculated.The logistic regression-clinical model(LR-CM)and logistic regression-radiomics model(LR-RM)were established based on clinical and radiomics independent risk factors,respectively.Additionally,machine learning models were established using four different machine learning algorithms.An ensemble model(EM)was established based on the prediction results of LR-RM and the four machine learning models.The area under the curve(AUC)for each model was calculated,and the performance differences between the models were compared.Results Seven optimal radiomics features were selected to calculate the Radscore.The AUC of LR-RM in the training and validation sets were 0.920 and 0.908,respectively.The AUC of EM in the training and validation sets were 0.974 and 0.965,respectively,which were significantly higher than the AUC of LR-RM model(P=0.017,P=0.048).Conclusion The radiomics model demonstrates strong diagnostic efficacy in predicting CD activity.The application of ensemble learning techniques significantly enhances the predictive performance of the radiomics model.

Objective To explore the value of a radiomics model based on computed tomography enterography(CTE)in the diagnosis of Crohn's disease(CD)activity.Methods A retrospective analysis was conducted on 166 diseased bowel segments from patients with CD.Lesions were classified into remission and active groups based on the simple endoscopic score for Crohn's disease(SES-CD).Two physicians independently delineated the volume of interest(VOI)for the lesions and extracted radiomics features.The optimal feature subset was selected through dimensionality reduction,and the Radiomics score(Radscore)was calculated.The logistic regression-clinical model(LR-CM)and logistic regression-radiomics model(LR-RM)were established based on clinical and radiomics independent risk factors,respectively.Additionally,machine learning models were established using four different machine learning algorithms.An ensemble model(EM)was established based on the prediction results of LR-RM and the four machine learning models.The area under the curve(AUC)for each model was calculated,and the performance differences between the models were compared.Results Seven optimal radiomics features were selected to calculate the Radscore.The AUC of LR-RM in the training and validation sets were 0.920 and 0.908,respectively.The AUC of EM in the training and validation sets were 0.974 and 0.965,respectively,which were significantly higher than the AUC of LR-RM model(P=0.017,P=0.048).Conclusion The radiomics model demonstrates strong diagnostic efficacy in predicting CD activity.The application of ensemble learning techniques significantly enhances the predictive performance of the radiomics model.

Objective:To summarize the clinicopathologic features and clinical diagnosis and treatment experience of retroperitoneal paraganglioma.Methods:This study retrospectively analyzed the clinical, pathological and follow-up data of 39 patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from 1 Oct 2012 to 1 Oct 2022 for retroperitoneal paragangliomas undergoing resection.Results:There were 19 males and 20 females with tumor being functional in 11 cases (28%) and non-functional in 28 cases (72%). CT angiography showed that the tumors were distributed around the abdominal aorta and inferior vena cava in most cases. All 39 patients underwent tumor rescetion.Patients in laparoscopic group had shorter operation time and postoperative hospital saty compared with open sugery [(135±66)min vs. (194±67)min, t=-2.529, P=0.016; (6.6±2.2)d vs.(9.6±4.8)d, t=-2.096, P=0.043], while there was no statistically significant difference between the two groups in terms of intraoperative blood loss [(152±151)ml vs. (361±608)ml, t=-1.169, P=0.250]. There were no major postoperative complications in the laparoscopic group, and pulmonary infection in 1 case and intestinal obstruction in 1 case in the open group. Thrity-six cases were followed up, ranging from 2 to 115 months, 1 patient in the laparoscopic group died 1 year after surgery due to recurrence and metastasis. In the open group, 1 case recurred 2 years later and was discharged after the second operation, and 1 case died of recurrence 2 years after surgery. Conclusions:Surgery is indicated for retroperitoneal paraganglioma. Adequate perioperative management is the key to the success of the operation. Laparoscopic surgery is superior to open surgery in terms of operation time and postoperative recovery .

Objective:To investigate the surgical technique and clinical effect of the island flap of dorsal branch of proper palmar digital artery in repair of the soft tissue defect of digits.Methods:From March 2013 to March 2021, 22 cases of digit soft tissue defects were repaired with dorsal branch of proper palmar digital artery island flap. The digit defects involved: 9 thumbs, 5 index fingers, 3 middle fingers, 3 ring fingers and 2 little fingers. The repair of defects covered 8 digit-tips, 7 pulps and 7 dorsal and nail beds. The defected area of soft tissue was 0.8 cm×0.5 cm-1.5 cm×8.0 cm, and the size of flap was 1.0 cm×0.7 cm-1.8 cm×1.0 cm. The donor site in 6 cases was closed directly. The other 16 cases were covered with medium thickness skin graft and pressurised bandaging. The follow-up reviews were carried out via the outpatient clinic visit, telephone or WeChat interview. Results:After operation, 1 flap had cyanosis due to a tight suture and it was relieved after the removal of intermittent suture; Tension blisters appeared in 2 cases and disappeared after 1 week; One case had necrosis at distal flap and healed after dressing change. Other flaps survived successfully and the incision and donor site healed in the first stage. All patients were entered to 6 to 18(mean 10) months of follow-up. At the final follow-up, the appearance and texture of the flaps were good and the protective sensation was restored. The flexion and extension function of the affected digit was normal with the TPD at 7-11 mm. The original shape and function of the digit body were basically reconstructed, except the failure in reconstruction of the special structure of digit body, such as nail, finger pulp thread and fine sensation. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 11 cases were in excellent, 9 in good and 2 in fair. The excellent and good rate was 91%. The function at donor sites was not affected.Conclusion:Repair of digit soft tissue defect with dorsal branch of proper palmar digital artery island flap is easy to operate, and with a low risk, high success rate and satisfactory curative effect.

Objectives: To examine the expression of the long coding RNA GSTM3TV2 in pancreatic cancer tissues and to examine its role and mechanism in chemoresistance of pancreatic cancer cells. Methods: The expression of lncRNA GSTM3TV2 in 15 pancreatic cancer specimens and corresponding adjacent to cancer tissue samples diagnosed by Department of Pathology, Peking Union Medical College Hospital was detected by real-time PCR.And the expressions of GSTM3TV2 in pancreatic cancer cell AsPC-1, BxPC-3, MIAPaCa-2, PanC-1, SU86.86, T3M4, and chemoresistant cells AsPC-1/GR and MIAPaCa-2/GR, and human pancreatic nestin-expressing cells hTERT-HPNE were detected. Pancreatic cancer cell lines were transfected with GSTM3TV2-pcDNA3.1(+)in order to get cells with GSTM3TV2 overexpression.GSTM3TV2-siRNA was transfected into pancreatic cancer cells to knock down GSTM3TV2. The cell chemoresistance was measured by CCK-8 and flow cytometry assay when incubated with nab-paclitaxel. At the same time, subcutaneous xenograft tumor models were established in nude mice to observe the effect of GSTM3TV2 on chemoresistance of tumor growth in nude mice.Western blot assay was also performed to detect the molecular mechanism of chemoresistance of GSTM3TV2. Results: Comparing toadjacent tissues(0.084±0.019), GSTM3TV2 expression was significantly upregulated in the pancreatic cancer tissues(0.493±0.084) (t=5.146, P<0.05). GSTM3TV2 expression were higher in the chemotherapy resistance pancreatic cancer cells AsPC-1/GR(210.799±19.788) and MIAPaCa-2/GR(122.408±23.419) than that in the AsPC-1(3.793±0.615) and the MIAPaCa-2(5.179±1.095)(t=21.800,P<0.05;t=-18.490,P<0.05). The results of in vivo experiments showed that the volume of subcutaneously transplanted tumors in the overexpressing GSTM3TV2 group ((1 059.609±102.498)mm³) was significantly larger than that in the control group((566.414±81.087) mm³) by treated with nab-paclitaxel(t=4.230,P<0.05).Meanwhile, GSTM3TV2 could promote the expression of Cyclin D1, CDK6, Cyclin E1, Vimentin, N-cadherin, ZEB1, Snail and Slug; but decrease cleaved caspase-3, cleaved PARP in pancreatic cancer cells. Conclusions The expression level of GSTM3TV2 in pancreatic canceris higher than that in paired adjacent tissues. GSTM3TV2 may act as an oncogene to promote chemoresistance in pancreatic cancer through regulation of cell proliferation, apoptosis, and epithelial-mesenchymal transition.

Objectives To examine the expression of the long coding RNA GSTM3TV2 in pancreatic cancer tissues and to examine its role and mechanism in chemoresistance of pancreatic cancer cells. Methods The expression of lncRNA GSTM3TV2 in 15 pancreatic cancer specimens and corresponding adjacent to cancer tissue samples diagnosed by Department of Pathology, Peking Union Medical College Hospital was detected by real?time PCR.And the expressions of GSTM3TV2 in pancreatic cancer cell AsPC?1,BxPC?3,MIAPaCa?2,PanC?1,SU86.86,T3M4,and chemoresistant cells AsPC?1/GR and MIAPaCa?2/GR, and human pancreatic nestin?expressing cells hTERT?HPNE were detected. Pancreatic cancer cell lines were transfected with GSTM3TV2?pcDNA3.1(+)in order to get cells with GSTM3TV2 overexpression.GSTM3TV2?siRNA was transfected into pancreatic cancer cells to knock down GSTM3TV2. The cell chemoresistance was measured by CCK?8 and flow cytometry assay when incubated with nab?paclitaxel. At the same time, subcutaneous xenograft tumor models were established in nude mice to observe the effect of GSTM3TV2 on chemoresistance of tumor growth in nude mice.Western blot assay was also performed to detect the molecular mechanism of chemoresistance of GSTM3TV2. Results Comparing toadjacent tissues(0.084 ± 0.019), GSTM3TV2 expression was significantly upregulated in the pancreatic cancer tissues(0.493 ± 0.084) (t=5.146, P<0.05). GSTM3TV2 expression were higher in the chemotherapy resistance pancreatic cancer cells AsPC?1/GR(210.799±19.788) and MIAPaCa?2/GR(122.408±23.419) than that in the AsPC?1(3.793±0.615) and the MIAPaCa?2(5.179±1.095)(t=21.800,P<0.05;t=-18.490,P<0.05). The results of in vivo experiments showed that the volume of subcutaneously transplanted tumors in the overexpressing GSTM3TV2 group ((1 059.609±102.498)mm3) was significantly larger than that in the control group((566.414±81.087) mm3) by treated with nab?paclitaxel(t=4.230,P<0.05).Meanwhile,GSTM3TV2 could promote the expression of Cyclin D1, CDK6, Cyclin E1, Vimentin, N?cadherin, ZEB1, Snail and Slug; but decrease cleaved caspase?3,cleaved PARP in pancreatic cancer cells.Conclusions The expression level of GSTM3TV2 in pancreatic canceris higher than that in paired adjacent tissues. GSTM3TV2 may act as an oncogene to promote chemoresistance in pancreatic cancer through regulation of cell proliferation,apoptosis, and epithelial?mesenchymal transition.

Objectives To examine the expression of the long coding RNA GSTM3TV2 in pancreatic cancer tissues and to examine its role and mechanism in chemoresistance of pancreatic cancer cells. Methods The expression of lncRNA GSTM3TV2 in 15 pancreatic cancer specimens and corresponding adjacent to cancer tissue samples diagnosed by Department of Pathology, Peking Union Medical College Hospital was detected by real?time PCR.And the expressions of GSTM3TV2 in pancreatic cancer cell AsPC?1,BxPC?3,MIAPaCa?2,PanC?1,SU86.86,T3M4,and chemoresistant cells AsPC?1/GR and MIAPaCa?2/GR, and human pancreatic nestin?expressing cells hTERT?HPNE were detected. Pancreatic cancer cell lines were transfected with GSTM3TV2?pcDNA3.1(+)in order to get cells with GSTM3TV2 overexpression.GSTM3TV2?siRNA was transfected into pancreatic cancer cells to knock down GSTM3TV2. The cell chemoresistance was measured by CCK?8 and flow cytometry assay when incubated with nab?paclitaxel. At the same time, subcutaneous xenograft tumor models were established in nude mice to observe the effect of GSTM3TV2 on chemoresistance of tumor growth in nude mice.Western blot assay was also performed to detect the molecular mechanism of chemoresistance of GSTM3TV2. Results Comparing toadjacent tissues(0.084 ± 0.019), GSTM3TV2 expression was significantly upregulated in the pancreatic cancer tissues(0.493 ± 0.084) (t=5.146, P<0.05). GSTM3TV2 expression were higher in the chemotherapy resistance pancreatic cancer cells AsPC?1/GR(210.799±19.788) and MIAPaCa?2/GR(122.408±23.419) than that in the AsPC?1(3.793±0.615) and the MIAPaCa?2(5.179±1.095)(t=21.800,P<0.05;t=-18.490,P<0.05). The results of in vivo experiments showed that the volume of subcutaneously transplanted tumors in the overexpressing GSTM3TV2 group ((1 059.609±102.498)mm3) was significantly larger than that in the control group((566.414±81.087) mm3) by treated with nab?paclitaxel(t=4.230,P<0.05).Meanwhile,GSTM3TV2 could promote the expression of Cyclin D1, CDK6, Cyclin E1, Vimentin, N?cadherin, ZEB1, Snail and Slug; but decrease cleaved caspase?3,cleaved PARP in pancreatic cancer cells.Conclusions The expression level of GSTM3TV2 in pancreatic canceris higher than that in paired adjacent tissues. GSTM3TV2 may act as an oncogene to promote chemoresistance in pancreatic cancer through regulation of cell proliferation,apoptosis, and epithelial?mesenchymal transition.

Objective: To investigate the expression of KLK7 in pancreatic cancer and its clinical significance. Methods: Immunohistochemistry was used to detect the expression of KLK7 protein in pancreatic cancer tissue microarray with 92 samples. Statistical analysis of the relationship between KLK7 and clinicopathological characteristics was finished. Pancreatic cancer cell lines were infected with lentiviuses in order to get cells with KLK7 stable overexpression.KLK7-siRNA was transfected into pancreatic cancer cells to knock down KLK7.Cell proliferation and chemosensitivity were detected by CCK-8 assay; Cell invasion and migration abilities were detected by Transwell assay. At the same time, subcutaneous xenograft tumor models were established in nude mice to observe the effect of KLK7 on tumor growth in nude mice. Data were statistically analyzed by rank sum test, χ² test and Logistic regression analysis. Results: The expression level of KLK7 in pancreatic cancer tissues was higher than that in paired adjacent tissues (P<0.05). KLK7 expression was correlated with vascular invasion(χ²=7.535, P<0.05). Further univariate and multivariate analysis showed that KLK7 expression was an independent risk factor for vascular invasion of pancreatic cancer(χ²=7.535, P<0.05). The overexpression of KLK7 in pancreatic cancer cell lines BxPC-3 and CFPAC can increase their proliferation abilities, reduce the chemosensitivity and promote their migration and invasion behaviour; The results of in vivo experiments showed that the volume of subcutaneously transplanted tumors in the overexpressing KLK7 group was significantly larger than that in the control group (t=4.479, P<0.05). The group of overexpressing KLK7 showed greater tumor weight than the control group(t=2.831, P<0.05). Conclusions The expression level of KLK7 in pancreatic ductal adenocarcinoma was higher than that in paired adjacent tissues and it is an independent risk factor for vascular invasion of pancreatic cancer.KLK7 can promote the proliferation of pancreatic cancer cells, reduce the chemosensitivity and increase the invasion and migration of pancreatic cancer cells.

Objective To explore the short-term outcome of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for pancreatic head cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 108 patients with pancreatic head cancer who were admitted to the Affiliated Tongji Hospital of Huazhong University of Science and Technology between July 2014 and July 2015 were collected.Among 108 patients,47 and 61 who respectively underwent LPD and OPD were allocated into LPD and OPD groups.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) postoperative pathological situations;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect chemotherapy and postoperative survival situations at 1 and 3 years postoperatively up to June 2018.Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using the t test.Comparison between groups of count data was analyzed using the chi-square test.Results (1) Intraoperative situations:operation time in the LPD and OPD groups was respectively (288±24)minutes and (265±29)minutes,with no statistically significant difference between groups (t=5.138,P＞0.05).Volume of intraoperative blood loss in the LPD and OPD groups was respectively (136±14)mL and (388±21)mL,with a statistically significant difference between groups (t=-7.297,P＜0.05).Cases with blood transfusion were respectively 3 and 7 iu the LPD and OPD groups,with no statistically significant difference between groups (x2 =0.325,P ＞ 0.05).(2) Postoperative situations:of 47 patients in the LPD group,16 with postoperative complications were improved by conservative treatment,including 7 with pancreatic fistula (5 with biochemical pancreatic fistula and 2 with grading B and C of pancreatic fistula);4 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment;2 with postoperative bleeding were improved by conservative treatment;2 with intraabdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainagc;1 with biliary fistula was improved by transabdominal percutaneous drainage;there was no wound infection and perioperative death.Of 61 patients in the OPD group,28 with postoperative complications were improved by conservative treatment,including 12 with pancreatic fistula (9 with biochemical pancreatic fistula and 3 with grading B and C of pancreatic fistula);8 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment;3 with intra-abdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainage;2 with postoperative bleeding were improved by conservative treatment;2 with wound infection were c ured by conservative treatment;1 with biliary fistula was improved by transabdominal percutaneous drainage;there was no perioperative death.There was no statistically significant difference in the cases with postoperative complications between groups (x2 =1.546,P＞ 0.05).Duration of hospital stay in the LPD and OPD groups was (13.6±2.1)days and (19.3 ±4.4)days,respectively,with a statistically significant difference (t =-4.354,P＜0.05).(3) Postoperative pathological situations:R0 resection rate was respectively 100.0％ (47/47) and 98.4％ (60/61) in the LPD and OPD groups,with no statistically significant difference (x2 =0,P＞0.05),and there was 1 patient with R1 resection in the OPD group.The total number of lymph node dissected in the LPD and OPD groups was respectively 19±4 and 13±4,with a statistically significant difference (t=-4.126,P＜0.05).The cases with high-and moderate-differentiated tumor and low-differentiated tumor (tumor differentiation),staging T1-T2 and T3-T4 (T stage),staging N0 and N1 (N stage),staging Ⅰ and Ⅱ-Ⅲ (TNM staging) and nerve or vascular invasion were respectively 35,12,28,19,20,27,16,31,21 in the LPD group and 50,11,36,25,36,25,14,47,32 in the OPD group,with no statistically significant difference (x2=0.891,0.003,2.882,1.628,0.643,P＞0.05).(4) Follow-up and survival situations:44 and 55 patients in the LPD and OPD group respectively underwent postoperative adjuvant therapy during the follow-up,with no statistically significant difference (x2=0,P＞0.05).The postoperative 1-year follow-up:47 patients in the LPD group were followed up,37 survived and 10 died;of 61 patients in the OPD group,3 lost to follow-up,and 58 were followed up (43 survived and 15 died);there was no statistically significant difference in survival between groups (x2=0.301,P＞0.05).The postoperative 3-year follow-up:of 47 patients in the LPD group,3 lost to follow-up,and 44 were followed up (21 survived and 23 died);of 61 patients in the OPD group,6 lost to follow-up,and 55 were followed up (23 survived and 32 died);there was no statistically significant difference in survival between groups (x2 =0.346,P＞0.05).Conclusion LPD is safe and feasible for pancreatic head cancer,with advantages of less bleeding,shorter duration of hospital stay and more total number of lymph node dissected,and its survival effect is equivalent to that of OPD.

Objective: To semi-quantify the postoperative complications occurred after laparoscopic pancreaticoduodenectomy(LPD) using Clavien-Dindo score, thereafter exploring its impact factors. Methods: In this retrospective cohort study, the clinical data of 124 patients who had undergone LPD for periampullary tumor from June 2016 to June 2017 at Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected.Malignancy was confirmed based on postoperative pathological reports.Postoperative complications were semi-quantitated using Clavien-Dindo score.Multivariable logistic regression model was applied to explore the factors related to severe complications(Clavien-Dindo Ⅲb-Ⅴ). Results: Of the 124 patients, there were 64 males(51.6%) and 60 females(48.4%), with age of 57 years(range, 23-82 years). In total, postoperative complications occurred in 30 patients(24.2%). Among the 30 patients, 4 patients suffered Clavien-Dindo grade Ⅰ, 18 patients(14.5%) suffered Clavien-Dindo grade Ⅱ, 6 patients(4.8%) suffered Clavien-Dindo grade Ⅲa, 1 patient(0.1%) suffered Clavien-Dindo grade Ⅳb, and 1 patient(0.1%) suffered Clavien-Dindo grade Ⅴ.Intraabdominal hemorrhage occurred in 8 patients, pancreatic fistula was found in 10 patients(7 patients had biochemical leakage and 3 of them had grade B pancreatic fistula), both biliary fistula and gastrointestinal fistula were found in 1 patient.Abdominal infection occurred in 10 patients, both liver failure and renal failure occurred in one patient.Moreover, arrhythmia was found in two patients, and mortality occurred in one patient.Five patients suffered multiple complications.Univariable analysis showed that postoperative complications were associated with body mass index, American Society of Anesthesiologists(ASA) score, intraoperative blood transfusion, and pancreatic texture(P<0.05). In multivariable logistic regression, ASA grade Ⅲ, intraoperative blood transfusion, and pancreatic softness were independently related to postoperative complications after LPD(P<0.05). Conclusions Clavien-Dindo score is feasible to be applied in management of patients with LPD.ASA score, texture of pancreas, and intraoperative blood transfusion were independently associated with postoperative complications.