Malignant obstructive jaundice is a severe pathophysiological disorder characterized primarily by hyperbilirubinemia secondary to biliary obstruction.To mitigate the adverse effects of hyperbilirubinemia and reduce postoperative complications,preoperative biliary drainage(PBD)has long been employed as a perioperative management strategy.Nevertheless,whether PBD confers definitive clinical benefits remains a subject of considerable debate.This review systematically summarizes the current literature,with particular emphasis on the indications,approaches,and clinical value of PBD in relation to obstruction at different anatomical sites,aiming to provide evidence-based guidance for surgical decision-making in patients with malignant obstructive jaundice.

Objective:To explore the application of the suspension culture method in pancreatic cancer organoid construction.Methods:Cell suspensions obtained from 8 pancreatic cancer tissue samples at the Second Hospital of Lanzhou University between July 2023 and March 2024, were prepared by digested pancreatic cancer tumor tissues using mixed enzymes, inoculated into ultra-low adsorption culture plates for suspension culture, and when the organoids were cultured to a certain size, passaging and freezing were initiated, and their structural morphology was observed by inverted microscope. Hematoxylin-eosin (HE) staining showed that pancreatic cancer organoids were lumpy or irregularly tubular, with obvious nuclear atypia, and were remarkably similar in tissue structure to pancreatic cancer tissue.Results:Among the 8 pancreatic cancer tissue samples, pancreatic cancer organoids were successfully constructed in three patients, and HE staining showed that pancreatic cancer organoids had a high degree of structural similarity with tumor tissues. Immunohistochemistry suggested that CK7, CK19, P53, and Ki-67 were expressed in the pancreatic cancer organoids and tumor tissues of case origin in more or less the same way.Conclusion:The suspension culture method is able to construct pancreatic cancer-like organs that are approximately the same as the originating tumor tissues at the tissue level.

Malignant obstructive jaundice is a severe pathophysiological disorder characterized primarily by hyperbilirubinemia secondary to biliary obstruction.To mitigate the adverse effects of hyperbilirubinemia and reduce postoperative complications,preoperative biliary drainage(PBD)has long been employed as a perioperative management strategy.Nevertheless,whether PBD confers definitive clinical benefits remains a subject of considerable debate.This review systematically summarizes the current literature,with particular emphasis on the indications,approaches,and clinical value of PBD in relation to obstruction at different anatomical sites,aiming to provide evidence-based guidance for surgical decision-making in patients with malignant obstructive jaundice.

Objective:To explore the application of the suspension culture method in pancreatic cancer organoid construction.Methods:Cell suspensions obtained from 8 pancreatic cancer tissue samples at the Second Hospital of Lanzhou University between July 2023 and March 2024, were prepared by digested pancreatic cancer tumor tissues using mixed enzymes, inoculated into ultra-low adsorption culture plates for suspension culture, and when the organoids were cultured to a certain size, passaging and freezing were initiated, and their structural morphology was observed by inverted microscope. Hematoxylin-eosin (HE) staining showed that pancreatic cancer organoids were lumpy or irregularly tubular, with obvious nuclear atypia, and were remarkably similar in tissue structure to pancreatic cancer tissue.Results:Among the 8 pancreatic cancer tissue samples, pancreatic cancer organoids were successfully constructed in three patients, and HE staining showed that pancreatic cancer organoids had a high degree of structural similarity with tumor tissues. Immunohistochemistry suggested that CK7, CK19, P53, and Ki-67 were expressed in the pancreatic cancer organoids and tumor tissues of case origin in more or less the same way.Conclusion:The suspension culture method is able to construct pancreatic cancer-like organs that are approximately the same as the originating tumor tissues at the tissue level.

Objective:To investigate the impact of preoperative biliary drainage (PBD) on early postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD) for malignant obstructive jaundice of varying severity.Methods:Clinical data of 346 patients who underwent PD at the Second Hospital of Lanzhou University between January 2019 and December 2024 were retrospectively analyzed, including 229 males and 117 females, aged (62.2±8.9) years. Pathological diagnoses included pancreatic malignancy (121 cases, 35.0%), bile duct malignancy (128 cases, 37.0%), duodenal malignancy (76 cases, 22.0%), and ampullary malignancy (21 cases, 6.0%). Based on a preoperative total bilirubin cutoff of 171 μmol/L, patients were stratified into a mild jaundice group ( n=133, total bilirubin <171 μmol/L) and a moderate-to-severe jaundice group ( n=213, total bilirubin ≥171 μmol/L). Each group was further divided into PBD and non-PBD subgroups. After propensity score matching, 36 pairs were matched in the mild jaundice group and 30 pairs in the moderate-to-severe jaundice group. Intraoperative blood loss, operation time, R 0 resection rate, postoperative complications (pancreatic fistula, bile leakage, postoperative hemorrhage, etc.), severe complications (Clavien-Dindo grade Ⅲ or above), total hospital stay, and total hospitalization costs were compared between the PBD and non-PBD groups. Results:In both the mild and moderate-to-severe jaundice groups, no statistically significant differences were observed between the PBD and non-PBD groups regarding intraoperative blood loss, operation time, or R 0 resection rate (all P>0.05). In the mild jaundice group, the total hospital stay [28.5 (24.0, 37.5) days] and total hospitalization costs [9.4 (7.8, 10.8) wanyuan] in the PBD group were significantly higher than those in the non-PBD group [22.0 (19.0, 29.0) days and 8.1 (7.0, 10.2) wanyuan, respectively)] ( Z=3.94, P<0.001; Z=2.25, P=0.025). In the moderate-to-severe jaundice group, the total hospital stay in the PBD group [28.5 (24.8, 36.0) days] was significantly longer than that in the non-PBD group [21.5 (20.8, 30.8) days] ( Z=2.68, P=0.007). The overall incidence of postoperative complications did not differ significantly between the PBD and non-PBD groups in either jaundice severity cohort (all P>0.05). However, in the moderate-to-severe jaundice group, the incidence of severe complications in the PBD group (16.7%, 5/30) was significantly lower than that in the non-PBD group (43.3%, 13/30) ( χ2=5.08, P=0.024). Conclusion:PBD brought no significant benefit in patients undergoing PD with mild jaundice but increased the financial burden, which may recommended for routine use. In patients undergoing PD with moderate-to-severe jaundice, PBD helped reduce severe complications despite a prolonged hospitalization. which is recommended after comprehensive evaluation.

Objective To investigate the biological behavior of EMP1 in pancreatic cancer cells and the molecular mechanism of EMP1 in promoting tumor progression.Methods A stable EMP1 knockdown cell line was obtained by lentivirus transfection.The effect of EMP1 on the proliferation of cancer cells was determined by CCK-8 and clonal formation assay.The effect of EMP1 on the migration and invasion of cancer cells was detected by scratch test and Transwell test.The influence of EMP1 on downstream signaling pathways was investigated by Western blot.Results The results of qRT-PCR and Western blot showed that EMP1 was highly expressed in pancreatic cancer cells.The results of CCK-8,colony formation,scratch,and Transwell assays indicated that EMP1 promoted the proliferation,migration,and invasion of pancreatic cancer cells.Western blot results revealed that EMP1 might promote tumor progression through the PI3K/AKT signaling pathway.Conclusion This study suggested that EMP1 may activate the PI3K/AKT signaling pathway to promote the proliferation,migration,and invasion of pancreatic cancer cells,thereby positively regulating tumor progression.

Objective:To investigate the impact of preoperative biliary drainage (PBD) on early postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD) for malignant obstructive jaundice of varying severity.Methods:Clinical data of 346 patients who underwent PD at the Second Hospital of Lanzhou University between January 2019 and December 2024 were retrospectively analyzed, including 229 males and 117 females, aged (62.2±8.9) years. Pathological diagnoses included pancreatic malignancy (121 cases, 35.0%), bile duct malignancy (128 cases, 37.0%), duodenal malignancy (76 cases, 22.0%), and ampullary malignancy (21 cases, 6.0%). Based on a preoperative total bilirubin cutoff of 171 μmol/L, patients were stratified into a mild jaundice group ( n=133, total bilirubin <171 μmol/L) and a moderate-to-severe jaundice group ( n=213, total bilirubin ≥171 μmol/L). Each group was further divided into PBD and non-PBD subgroups. After propensity score matching, 36 pairs were matched in the mild jaundice group and 30 pairs in the moderate-to-severe jaundice group. Intraoperative blood loss, operation time, R 0 resection rate, postoperative complications (pancreatic fistula, bile leakage, postoperative hemorrhage, etc.), severe complications (Clavien-Dindo grade Ⅲ or above), total hospital stay, and total hospitalization costs were compared between the PBD and non-PBD groups. Results:In both the mild and moderate-to-severe jaundice groups, no statistically significant differences were observed between the PBD and non-PBD groups regarding intraoperative blood loss, operation time, or R 0 resection rate (all P>0.05). In the mild jaundice group, the total hospital stay [28.5 (24.0, 37.5) days] and total hospitalization costs [9.4 (7.8, 10.8) wanyuan] in the PBD group were significantly higher than those in the non-PBD group [22.0 (19.0, 29.0) days and 8.1 (7.0, 10.2) wanyuan, respectively)] ( Z=3.94, P<0.001; Z=2.25, P=0.025). In the moderate-to-severe jaundice group, the total hospital stay in the PBD group [28.5 (24.8, 36.0) days] was significantly longer than that in the non-PBD group [21.5 (20.8, 30.8) days] ( Z=2.68, P=0.007). The overall incidence of postoperative complications did not differ significantly between the PBD and non-PBD groups in either jaundice severity cohort (all P>0.05). However, in the moderate-to-severe jaundice group, the incidence of severe complications in the PBD group (16.7%, 5/30) was significantly lower than that in the non-PBD group (43.3%, 13/30) ( χ2=5.08, P=0.024). Conclusion:PBD brought no significant benefit in patients undergoing PD with mild jaundice but increased the financial burden, which may recommended for routine use. In patients undergoing PD with moderate-to-severe jaundice, PBD helped reduce severe complications despite a prolonged hospitalization. which is recommended after comprehensive evaluation.

Objective To investigate the biological behavior of EMP1 in pancreatic cancer cells and the molecular mechanism of EMP1 in promoting tumor progression.Methods A stable EMP1 knockdown cell line was obtained by lentivirus transfection.The effect of EMP1 on the proliferation of cancer cells was determined by CCK-8 and clonal formation assay.The effect of EMP1 on the migration and invasion of cancer cells was detected by scratch test and Transwell test.The influence of EMP1 on downstream signaling pathways was investigated by Western blot.Results The results of qRT-PCR and Western blot showed that EMP1 was highly expressed in pancreatic cancer cells.The results of CCK-8,colony formation,scratch,and Transwell assays indicated that EMP1 promoted the proliferation,migration,and invasion of pancreatic cancer cells.Western blot results revealed that EMP1 might promote tumor progression through the PI3K/AKT signaling pathway.Conclusion This study suggested that EMP1 may activate the PI3K/AKT signaling pathway to promote the proliferation,migration,and invasion of pancreatic cancer cells,thereby positively regulating tumor progression.

A domestically produced self-expanding transcatheter aortic valve controllable bending delivery system(VitaFlow? Ⅲcontrollable bending retrievable delivery system)was first used to perform transcatheter aortic valve replacement(TAVR)in a symptomatic severe aortic valve stenosis patient with severe heart failure and high risk of surgery in China on September 22,2023.The patient successfully completed TAVR under general anesthesia,with good valve position and function after the operation.Before discharge and at one month of follow-up,the patient's symptoms and degree of heart failure were significantly improved.The follow-up results of this case showed that the VitaFlow? Ⅲ controllable bending retrievable delivery system for TAVR is safe and feasible,and future prospective,multicenter clinical trials are expected to evaluate its efficacy.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.