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Impaired immune reaction and increased lactate and C-reactive protein for early prediction of severe morbidity and pancreatic fistula after pancreatoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 58-67页

作者： Mario Rodriguez-Lopez Francisco J.Tejero-Pintor martin bailon-cuadrado Asterio Barrera-Rebollo Baltasar Perez-Saborido David Pacheco-Sanchez General and Digestive Surgery Department Rio-Hortega University Hospital

Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable

关键词： Pancreatoduodenectomy Morbidity Pancreatic fistula Biomarker Prediction Score

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Severe morbidity after pancreatectomy is accurately pre dicte d by preoperative pancreatic resection score(PREPARE): A prospective validation analysis from a medium-volume center

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 559-565页

作者： Mario Rodriguez-Lopez Francisco J. Tejero-Pintor Baltasar Perez-Saborido Asterio Barrera-Rebollo martin bailon-cuadrado David Pacheco-Sanchez General and Digestive Surgery Department Rio-Hortega University Hospital

Background: Major morbidity in pancreatic surgery remains high. Different scores for predicting complications have been described. Preoperative pancreatic resection(PREPARE) score is based on objective preoperative variables and offers good predictive accuracy for Clavien ≥ III complications. This study aimed to validate this score and analyze other preoperative variables in a prospective study performed in a medium-volume center. Methods: A total of 50 pancreatic resections were included. Preoperative variables were registered and PREPARE was calculated. The main outcome was severe morbidity(Clavien ≥ III) up to 30 days after discharge. The secondary outcomes were length of stay(LOS) and readmission. Statistical validation was performed to compare severe morbidity rate among the scores categories. Association with other preoperative variables(not included in PREPARE) was also tested. Results: Of the 50 pancreatic resections, the severe morbidity was 34.0%, with median LOS of 11 days. Readmission rate was 25.5%. Severe morbidity rates according to PREPARE categories were 18.5% in lowrisk group, 41.7% in intermediate-risk group, and 63.6% in high-risk group, respectively( P = 0.023). The accuracy was 72%(Hosmer–Lemeshow, P = 0.86). ROC curve was obtained both for PREPARE score expressed as incremental values and categorized as the three risk groups, showing an area under curve(AUC) of 0.736(95% CI: 0.586–0.887; P = 0.007) and 0.712(95% CI: 0.555–0.869; P = 0.015), respectively. PREPARE was significant in multivariate analysis. Median LOS was statistically higher as PREPARE category increases(9, 11 and 15 days in low-, intermediate-and high-risk groups, respectively; P = 0.009). Readmission was not associated with any variables. Conclusions: PREPARE behaves as an independent risk factor for severe morbidity after pancreatic surgery. Score validation shows good accuracy prediction. Increasing PREPARE category is also associated with longer LOS.

关键词： Pancreatic surgery Morbidity Complications Preoperative pancreatic resection score Validation

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Preoperative pancreatic resection score:a preliminary prospective validation from Spain

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 667-668页

作者： Mario Rodriguez-Lopez martin bailon-cuadrado Francisco J Tejero-Pintor Baltasar Perez-Saborido Enrique Asensio-Diaz Asterio Barrera-Rebollo General and Digestive Surgery Department Rio Hortega University HospitalDulzaina 247012ValladolidSpain

To the Editor：We read with outstanding interest the article by Celik et al. It is the first external description of the Hamburg＇s preoperative pancreatic resection （PREPARE） score since it was published in 2014 by Uzunoglu et al. According to the latter authors, it is necessary to stratify risk of major morbidity and mortality before performing a pancreatic resection, and PREPARE score is a simple index, validated in a multicenter cohort of patients undergoing this group of technically demanding procedures.

关键词： Preoperative pancreatic resection score

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Bean yellow disorder virus： Parameters of transmission by Bemisia tabaci and host plant range

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Insect Science 2011年第1期18卷 50-56页

作者： German martin Isabel Maria cuadrado Dirk Janssen Instituto Andaluz de Investigacion y Formacion Agraria y Pesquera Centro La Mojonera Almeria Spain

Bean yellow disorder virus （BnYDV） was recently identified as the first crinivirus （family Closteroviridae） that infects members of the family Leguminosae. It was first observed during the autumn of 2003, causing heavy losses in French bean （Phaseolus vulgaris L.） grown commercially in Spain. The virus is transmitted by the sweetpotato whitefly, Bemisia tabaci （Hemiptera： Aleyrodidae） Q-biotype, and disease symptoms resemble nutritional disorders consisting of interveinal mottling and yellowing in leaves, combined with stiffness or brittleness, and are typically produced on the middle to lower parts of the plant. Transmission experiments showed that 50% and 100% of B. tabaci adults acquired the virus after a feeding period of 3 and 7 h, respectively. Viruliferous whiteflies infected 66% and 100% ofP. vulgaris plants after a feeding period of 12 and 24 h, respectively. The transmission efficiency of single whiteflies was 37% and persistence of BnYDV in the vector lasted up to 2 weeks with a half-life of 9 days. BnYDV was transmitted to P. vulgaris, Pisum sativum L., Lens culinaris Medik., and Vicia faba L., but not to Vigna unguiculata L., Glycine max （L.） Merr., Cicer arietum L., and to crop species belonging to families of the Solanaceae and Cucurbitaceae. No virus was detected in field samples collected from 30 different species from Boraginaceae, Asteraceae, Geraniaceae, Lamiaceae, Leguminosae, Malvaceae, Scrophulariaceae, Thymelaeaceae and Verbenaceae. The restricted host range and efficient management of crops regarding whitefly infestation may be key elements in the control of BnYDV.

关键词： bean Closteroviridae Crinivirus disease vector whiteflies

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