Hyperechoic Retroperitoneal Fat in a Cat with Systemic Coagulopathy.

Adequate resuscitation and definitive hemostasis are both important in the management of hemorrhage related to pelvic fracture. The goal of this study was to analyze the relationship between the amount of blood transfused before transcatheter arterial embolization (TAE) and the clinical outcome later in the disease course. Patients with pelvic fractures who underwent TAE for hemostasis from January 2018 to December 2019 were studied. The characteristics of patients who received blood transfusions of >2 U (1000mL) and ≤2 U before TAE were compared. The mortality rate, blood transfusion-related complications, and length of stay were compared between these two groups. Among the 75 studied patients, 39 (52.0%) received blood transfusions of ≤2 U before TAE, and the other 36 (48.0%) patients received blood transfusions of >2 U before TAE. The incidence rates of systemic inflammatory response syndrome, sepsis, and coagulopathy were significantly higher in the >2 U group (97.2% vs 81.1%, P = .027; 50.0% vs 27.0%, P = .045; and 44.4% vs 5.4%, P < .01, respectively). After nonsurvivors were excluded, the >2 U group had a significantly higher proportion (43.8% vs 14.7%, P < .001) of prolonged intensive care unit (ICU) length of stay (7days or more) and a longer hospital length of stay (33.8 ± 15.1 vs 21.9 ± 94.0, P < .01) than the ≤2 U group. Pre-TAE blood transfusion >2 U serves as an independent risk factor for prolonged ICU length of stay and increased hospital length of stay. Early hemostasis for pelvic fracture-related hemorrhage is suggested to prevent pre-TAE blood transfusion-associated adverse effects of blood transfusion.

Blood transfusion is associated with increased morbidity and mortality in cardiac surgery patients, but the cause and effect relation remains unknown. We hypothesized that blood transfusion is associated with changes in pulmonary and systemic inflammation and coagulopathy, occurring in patients who do not meet the clinical diagnosis of transfusion-related acute lung injury (TRALI).

Clinical Study on Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis in Pancreaticoduodenectomy

Liver biopsy is an important diagnostic tool in the management of patients following orthotopic liver transplant. We evaluated complications following percutaneous liver biopsy in a group of liver transplant patients who had Roux-en-Y choledochojejunostomies fashioned as part of their biliary reconstruction during liver transplantation. Complications were divided into two major groups: septic complications (including fever, symptomatic bacteremia, cholangitis, infected hematoma and hypotension related to sepsis) and bleeding (defined as hypotension requiring volume expansion greater than 500 cm3 or blood transfusion, hemothorax, intrahepatic or peritoneal hemorrhage and hemobilia occurring within 1 wk of liver biopsy). One hundred ninety-two biopsies were performed in 46 patients with choledochojejunostomies, and 118 biopsies were carried out in an age- and sex-matched control group of patients with choledochocholedochostomy biliary anastomosis. There were no septic complications in the choledochojejunostomy patients and one (0.32%) septic complication in the choledochocholedochostomy patients (NS). Eight bleeding complications occurred (2.6%) in eight patients (8.3%). Five (2.6%) occurred in five (10.8%) of the choledochojejunostomy patients, vs. three (2.5%) in three (6.5%) choledochocholedochostomy patients (NS). None of the bleeding complications required surgical intervention or was fatal. We conclude that liver biopsy in posttransplant patients with Roux-en-Y choledochojejunostomies is a safe procedure and that the incidences of complications were similar in our two groups. The negligible incidence of septic complications in the choledochojejunostomy patients does not appear to warrant the administration of prophylactic antibiotics, as has been previously suggested.

Objective To investigate the clinical value of penetrating-suture type pancreaticojejunostomy (PPJ) after pancreaticoduodenectomy (PD).Methods The clinical data of 77 patients who received pancreaticoduodenectomy from Taixing People's Hospital from June 2002 to March 2012 were retrospectively analyzed.Of all the patients,34 received PPJ after PD (PPJ group),and the other 43 patients received PJ anastomosis (control group) based on the texture and size of the pancreas,pancreatic duct diameter (duct-to-mucosa pancreaticojejunostomy for pancreatic duct diameter ≥ 4 mm,end-to-end or binding pancreaticojejunostomy for pancreatic duct diameter ≤3 mm).Pancreatic fistula was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula,including grade B or C pancreatic fistula with clinical value.Patients were followed-up through outpatient examination and telephone interview till May 2012.Data were presented by x ± s or median (range) and the t-test and Wilcoxon rank-sum test were used to evaluate quantitative data with or without normal distribution,respectively.Qualitative data were analyzed using Pearson x2 test or Fisher's exact test.Results The mean diameter of the pancreatic duct was 3 mm for both the PPJ group and the control group.The external drainage via the pancreatic duct stent was not used in the PPJ group,compared with 4 cases in the control group,showing a statistically significant difference between the 2 groups (x2=3.632,P ＜ 0.05).The duration of pancreaticojejunostomy was 12 minutes (range,8-25 minutes) in the PPJ group,while no records in the control group.The operation time and intraoperative blood loss in the PPJ group and the control group were (304 ± 60)minutes and (475 ± 75) mL,(304 ± 60) minutes and (500 ± 97) mL,respectively.Twenty-four (70.6％) patients in the PPJ group and 29 (67.4％) patients in the control group received intraoperative blood transfusion,with volume of 400 mL (range,300-800 mL) and 600 mL (range,300-1 200 mL),respectively.The median duration of postoperative hospital stay were 18 days (range,11-32 days) in the PPJ group and 20 days (range,9-44 days) in the control group.None of these comparisons were statistically significant between the 2 groups (t =1.293,0.619,x2=0.088,Z =0.165,0.074,P ＞0.05).The rate of grade B or C pancreatic fistula were 0 for the PPJ group and 27.9％ (12/43) for the control group,and the mortality rate of patients who had pancreatic fistula were 0 and 11.6％ (5/43) for the PPJ group and the control group,with statistical significance (x2=11.232,4.237,P ＜0.05).The overall incidence of bile leakage,peritoneal bleeding and delayed gastric emptying in the PPJ group and the control group were 5.9％ (2/34),2.9％ (1/34),5.9％ (2/34) and 11.6％ (5/43),7.0％ (3/43),14.0％ (6/43),with no significance difference (P ＞0.05).Fifty-six patients were followed up after operation from 9 months to 5 years.Pancreatic duct dilation was detected by imaging examination for 26 patients in the control group.Conclusions PPJ is a simple and feasible approach with better clinical efficacy after PD. Key words: Pancreaticoduodenectomy; Pancreaticojejunostomy; Penetrating-suture type pancreaticojejunostomy; Pancreatic fistula

BACKGROUNDHospitalized and severely ill coronavirus disease 2019 (COVID-19) patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites. Life-threatening bleeding complications include spontaneous iliopsoas hematoma, peritoneal bleeding, and extra-abdominal manifestations such as intracranial hemorrhage.CASE SUMMARYBleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding. In our case series of 9 patients, we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia. Contrast-enhanced computed tomography (CE-CT) is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach, whether interventional, surgical, or conservative management.CONCLUSIONWe present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling. Finally, we provide a brief review of the literature.

COVID-19: a complex multisystem disorder

IntroductionSevere coronavirus disease 2019 (COVID-19) is characterised by hyperinflammatory state, systemic coagulopathies, and multiorgan involvement, especially acute respiratory distress syndrome (ARDS). We here describe our preliminary clinical experience with COVID-19 patients treated via an early initiation of extracorporeal blood purification combined with systemic heparinisation and respiratory support.MethodsFifteen patients were included; several biomarkers associated with COVID-19 severity were monitored. Personalised treatment was tailored according to the levels of interleukin (IL)-6, IL-8, tumour necrosis factor alpha, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, thrombocyte counts, D-dimers, and fibrinogen. Treatment consisted of respiratory support, extracorporeal blood purification using the AN69ST (oXiris®) hemofilter, and 300 U/kg heparin to maintain activation clotting time ≥ 180 seconds.ResultsTen patients presented with severe to critical disease (dyspnoea, hypoxia, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). The median intensive care unit length of stay was 9.3 days (interquartile range 5.3-10.1); two patients developed ARDS and died after 5 and 26 days. Clinical improvement was associated with normalisation (increase) of thrombocytes and white blood cells, stable levels of IL-6 (< 50 ng/mL), and a decrease of CRP and fibrinogen.ConclusionContinuous monitoring of COVID-19 severity biomarkers and radiological imaging is crucial to assess disease progression, uncontrolled inflammation, and to avert irreversible multiorgan failure. The combination of systemic heparin anticoagulation regimens and extracorporeal blood purification using cytokine-adsorbing hemofilters may reduce hyperinflammation, prevent coagulopathy, and support clinical recovery.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, responsible for the coronavirus disease 2019 (COVID-19), has been linked to coagulation abnormalities and a prothrombotic state. Characteristic findings in COVID-19 patients include an increased d-dimer concentration and prolongation of the prothrombin time, which are more common in severe forms of the disease and have been associated with an increased risk of death (Levi et al. 2020). Diabetes mellitus has also been associated with worse outcomes due to a pre-existing pro-inflammatory state and the downregulation of the angiotensin-converting enzyme 2 (ACE2) (Pal & Bhadada 2020), the SARS-CoV-2 internalization receptor (Liu et al. 2020). Angiotensin-converting enzyme 2 (ACE2) converts angiotensin II to angiotensin 1–7, acting as a vasodilator and a counter regulator of the renin–angiotensin system (Liu et al. 2020). A downregulation of ACE2 during COVID-19 viral infection has been reported, which results in a state of hypertension, inflammation and increased risk of thrombosis, these being more frequent in patients with a previous downregulation of this enzyme, such as diabetes (Liu et al. 2020). We present a 30-year-old female patient with maturity-onset diabetes of the young who complained of bilateral blurred vision and myodesopsias since she had been discharged after COVID-19 pneumonia. The patient was undergoing regular endocrinology check-ups and ocular fundus evaluation without any sign of diabetic retinopathy (Fig 1). During hospitalization, she had significantly increased values of C-reactive protein, fibrinogen, ferritin, platelets and d-dimer. Her glycated haemoglobin reached 13%, while in her last check-up it was 7.8%. Best-corrected visual acuity was 0.7 in both eyes. Fundus examination showed bilateral dilatation of retinal veins, exudates and extensive deep blot and flame-shaped haemorrhages throughout the retinal parenchyma and some vitreous bleeding (Fig. 1). Fluorescein angiography showed microaneurysms, dilated veins, ischaemic areas and distal vasculitis (Fig. 1). There was no evidence of retinal neovascularization. All these findings supported the diagnosis of bilateral central retinal vein occlusion and a rapidly worsening diabetic retinopathy. SARS-CoV-2 infection is causing a major global health and economic impact worldwide. Although the main clinical manifestations of COVID-19 involve respiratory, neurological and gastrointestinal symptoms, increased risk of thromboembolic complications and blood coagulation disorders has been reported within SARS-CoV-2 infection (Levi et al. 2020). In these patients, the internalization of ECA2 and TMPRSS2 when the SARS-CoV-2 enters the host's cell decreases their activity and leads to an imbalance of the ACE2/Angiotensin pathway. Angiotensin II produces vasoconstriction and enhanced inflammation, and ECA2-reduced expression in vessels can lead to an endothelial dysfunction, becoming pro-adhesive and pro-coagulant (South et al. 2020). In SARS-CoV-2 infection, the hyperinflammatory response is thought to contribute to the hypercoagulability state, with a laboratory pattern and associated with increased levels of fibrinogen and excessive fibrin polymerization (Spiezia et al. 2020). Many complications associated with this pro-coagulant status have been described, such as pulmonary thromboembolism and large-vessel occlusions (Liu et al. 2020). Retinal vein occlusions (RVO) are a heterogeneous group of disorders with an impaired venous return from the retinal circulation. They have been associated with systemic coagulopathies and prothrombotic states. In COVID-19, the retinal vasculature could be altered by thromboembolisms, a prohaemostatic state, hypoxia and endothelial injury, causing RVO (Klein et al. 2000). The symptom onset, RVO and worsening of the diabetic retinopathy diagnosed after COVID-19 infection led us to hypothesize that the downregulation of ACE2 associated with her diabetes, the SARS-CoV-2 infection and the worsening of her metabolic control caused a fast deterioration of her diabetic retinopathy. This situation, added to the vast inflammatory response with significantly increased inflammatory markers, such as CRP, fibrinogen, ferritin or d-dimer, resulted in a prothrombotic state that triggered the bilateral central RVO. This is the first documented case of bilateral central RVO within SARS-CoV-2 infection. Physicians should be aware of how patients with cardiovascular risk factors and severe SARS-CoV-2 infection are at a higher risk of RVO and worsening of pre-existent retinopathies.

Simple SummaryDuring the past decades, bacterial infections have been a serious problem in aquaculture that causes very large economic losses. Currently, antibiotics are the most common method of disease prevention and control. A combination of water quality monitoring, early detection of fish infections, and other preventive biosecurity measures in fish farms can help prevent the spread of infection. We investigated the natural bacterial infection in fish farms and characterized the parameters of the health status of rainbow trout Oncorhynchus mykiss (Walbaum, 1792) during disease. Depending on the course of the disease (severity of the pathology, leukocyte profile, and expression of immune-related genes), three subpopulations of fish with severe damage, a moderate course of the infectious process, and asymptomatic fish were characterized. An unexpected result was a small metabolic difference between fish with moderate symptoms and fish with weak signs of pathology. Thus, we have described the characteristics of a trout subpopulation with a mild course of infection which has potential for recovery after infection.This article describes the clinical manifestation of natural Vibrio anguillarum infection in rainbow trout (Oncorhynchus mykiss) during an outbreak on a fish farm. (i) Using an integrated approach, we characterized the pathogenesis of vibriosis from the morphological, hematological, and biochemical points of view. The molecular mechanisms associated with the host immune response were investigated using mass spectrometric analysis of trout plasma proteins. (ii) According to the severity of infection (the extent of tissue damage, the level of expression of pro-inflammatory genes, and changes in the leukocyte profile) three fish populations were identified among infected trout: fish with severe lesions (SL), fish with the moderate infectious process (IP) and asymptomatic fish (AS). (iii) Lymphopenia, granulocytosis, and splenomegaly were strong trends during the progression of infection and informative indicators of severe manifestation of disease, associated with hemorrhagic shock, metabolic acidosis, and massive tissue damage. (iv) As expected, pro-inflammatory interleukins, complement components, acute phase proteins, and antimicrobial peptides were implicated in the acute pathogenesis. Systemic coagulopathy was accompanied by increased antithrombotic reactions. (v) Reconstruction of metabolic pathways also revealed a high energy requirement for the immune response in severely affected fish. (vi) An unexpected result was a small difference between fish with moderate symptoms and fish with no or minor external signs of pathology (putatively resistant to infection). Increased production of antiproteases and enhanced blood coagulation cascade were observed in healthier fish, which may underlie the mechanisms of a controlled, non-self-damaging immune response to infection. (vii) Depending on the progression of the disease and the presence of the pathogen, a stepwise or linear change in the abundance of some plasma proteins was revealed. These proteins could be proposed as molecular markers for diagnosing the health and immune status of trout when cultured in fish farms.

Envenoming syndrome is a systemic reaction induced by inoculation of large volumes of Hymenoptera venom. The clinical manifestations range from skin allergic reactions to multiple organ failure. Vespid venom-induced toxic reactions and anaphylaxis are the most common lethal mechanism of death, involving acute respiratory failure, acute liver failure, rhabdomyolysis, acute kidney injury, and severe coagulopathy. Multiple organ failure as a consequence of severe venom toxicity is a rare but dangerous complication in victims. Delay of intervention to correct vespid venom-induced toxic reactions may cause catastrophic complications. Here, we describe a case presenting a rare vespid venom-induced multiple organ failure with systemic coagulopathy after massive Vespa attack.

Objective To investigate the clinical effect and prognostic factors of intraoperative radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC) with severe cirrhosis. Methods The retrospective case-control study was conducted. The clinicopathological data of 188 HCC patients with severe cirrhosis who were admitted to the Zhongshan Hospital of Fudan University between January 2009 and December 2013 were collected. According to intraoperative exploration, tumor condition and liver cirrhosis situations, partial hepatectomy combined with intraoperative RFA or single RFA was selected. Observation indicators: (1) operation situations: operation time, volume of intraoperative blood loss, blood transfusion, hepatic inflow occlusion, number of tumors of surgical resection and number of tumors removed by RFA; (2) postoperative recovery situations: postoperative complications and duration of postoperative hospital stay; (3) follow-up; (4) factors analysis affecting tumor-free survival. Follow-up using outpatient examination and telephone interview was performed to detect tumor damage and survival of patients up to March 2016. Measurement data with normal distribution were represented as ±s. The survival rate was calculated by the Kaplan-Meier method. The univariate analysis was done by the the Log-rank test, and multivariate analysis was done using the COX regression model. Results (1) Operation situations: all the 188 HCC patients underwent successful operations, including 74 undergoing partial hepatectomy with intraoperative RFA and 114 undergoing single RFA. Of 188 patients, 11 were combined with cholecystectomy, 6 with right adrenalectomy and 1 with subtotal gastrectomy, without perioperative death. Operation time and volume of intraoperative blood loss in 188 patients were (2.3±1.4)hours and (64±4)mL, without blood transfusion and hepatic inflow occlusion. Numbers of patients with 1 tumor of surgical resection and with 2 tumors of surgical resection and total number of tumors of surgical resection were 61, 13, 87 in 74 patients undergoing partial hepatectomy with intraoperative RFA. Numbers of patients with 1, 2, 3 and 4 tumors removed by RFA and total number of tumors of RFA were 123, 58, 6, 1 and 261 in 114 patients undergoing single RFA. (2) Postoperative recovery situations: of 188 patients, 19 with severe complications were improved by symptomatic treatments, including 7 with massive pleural effusion, 5 with massive intra-abdominal effusion, 3 with intra-abdominal bleeding, 3 with severe local infection and 1 with massive pleural and intra-abdominal effusion. Duration of postoperative hospital stay was (7.61±0.20)days. (3) Follow-up: 182 of 188 patients were followed up for 21-85 months, with a median time of 41 months. Patients received enhanced rescans of magnetic resonance imaging (MRI) at 1 month postoperatively, 174 had complete tumor damage, with a tumor damage rate of 92.55%(174/188). During the follow-up, 46 patients died. The overall median survival time, 1-, 2-, 3-year overall survival rates, median tumor-free survival time and 1-, 2-, 3-year tumor-free survival rates were 38 months, 99%, 96%, 86%, 31 months, 92%, 77% and 41%, respectively. (4) Factors analysis affecting tumor-free survival: results of univariate analysis showed that preoperative alpha-fetoprotein (AFP), number of tumors and surgical procedures were relative factors affecting tumor-free survival of HCC patients with severe cirrhosis (χ2=5.623, 4.744, 7.293, P 20 μg/L and partial hepatectomy with intraoperative RFA were independent risk factors affecting tumor-free survival of HCC patients with severe cirrhosis after open RFA (RR=1.523, 1.615, 95% confidence interval: 1.056-2.198, 1.006-2.594, P<0.05). Conclusions Intraoperative RFA is safe and feasible in treatment of HCC with severe cirrhosis, with advantages of less postoperative complications and rapid recovery, and it can provide better long-term survival for patients. Preoperative AFP>20 μg/L and partial hepatectomy with intraoperative RFA are independent risk factors affecting tumor-free survival of HCC patients with severe cirrhosis after open RFA. Key words: Carcinoma, hepatocellular; Liver cirrhosis; Radiofrequency ablation; Hepatectomy; Prognosis

Objective To investigate the clinical efficacy of laparoscopic hepatectomy and summarize its experiences. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 2 048 patients who underwent laparoscopic hepatectomy in the Southwest Hospital of the Third Military Medical University from March 2007 to October 2016 were collected. The resectability of lesions and liver functional reserve were preoperatively evaluated, and then laparoscopic hepatectomy was conducted. Observation indicators: (1)surgical and intraoperative situations; (2) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the patients′ postoperative survival up to June 2017. Measurement data with normal distribution were represented as ±s. Count data were evaluated by the percentage. The survival rate was calculated by the Kaplan-Meier method. Results (1) Surgical and intraoperative situations: all the 2 048 patients received successful laparoscopic hepatectomy, including 1 985 undergoing traditional laparoscopic hepatectomy and 63 undergoing Da Vinci robot-assisted and laparoscopic hepatectomy. Non-anatomical and anatomical hepatectomies were respectively applied to 1 052 and 996 patients. The rate of conversion to open surgery of 2 048 patients was 6.738%(138/2 048). Operation time, volume of intraoperative blood loss and rate of intraoperative blood transfusion in 2 048 patients were (225±27)minutes, (455±152)mL and 5.615%(115/2 048), respectively. The incidence of postoperative complications was 11.816%(242/2 048), 42.149%(102/242) of postoperative complications included reactive pleural effusion and effusion in the resection margin, and other postoperative complications included peritoneal effusion, pulmonary infection, abdominal infection, bile leakage, bleeding, incision liquefied, thrombus and acute liver injury. The incidence of postoperative severe complications was 0.488%(10/2 048), including 6 with intraperitoneal bleeding, 1 with acute respiratory distress syndrome, 1 with cardiac failure, 1 with hepatic failure and 1 with renal failure. Of 242 patients with postoperative complications, 6 with intraperitoneal bleeding received reoperations and were improved, 1 died of extensive thrombus of portal vein system induced liver failure, and 235 were improved by conservative treatment. Duration of hospital stay in 2 048 patients was (10.7±1.0)days. (2) Follow-up situations: 912 of 1 070 patients with malignant liver tumors were followed up for 8-120 months, with a median time of 51 months. The 1-, 3- and 5- year overall survival rates and 1-, 3- and 5- year tumor-free survival rates in 912 patients with malignant liver tumors and follow-up were 94.1%, 82.2%, 53.6% and 82.3%, 61.3%, 32.8%, respectively. Conclusions Laparoscopic hepatectomy is safe and feasible, with definite effects. In the premise of breakthroughs of technical bottlenecks in the bleeding control and exposure of special liver segment, the indications for laparoscopic hepatectomy have been expanded and there is no restricted area. Key words: Hepatic neoplasms; Hepatolithiasis; Hepatectomy; Laparoscopy

The aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs), based on own material. MATERIAL AND METHODS. In the period from 2005 to 2009, in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice, there were 27 patients (15 males and 12 females) treated surgically for pancreatic neuroendocrine tumours, constituting 65.86% (27/41) of all gastroenteropancreatic neuroendocrine tumours. Prior to the surgery, the following diagnostic examinationswere performed: laboratory tests and imaging examinations (abdominal ultrasound and CT scan). The following tumour localisation was established: head of the pancreas - 14, body of the pancreas - 4, tail of the pancreas - 5, body and tail of the pancreas - 1, retroperitoneal space - 4. There were found 24 (88.89%) primary tumours and 3 (11.11%) recurrences. The following methods of surgical treatment were applied: pancreatoduodenectomy - 11, distal pancreatic resection with splenectomy - 6, middle segment resection with anastomosis between the pancreatic tail and jejunal loop: Roux-Y procedure - 1, pancreatic resection by Beger procedure - 1, pancreatic head and body resection with splenectomy - 1, tumour enucleation or local excision - 4, exploratory laparotomy with specimen collection - 3. The mean hospitalisation period was 25 days (4-78 days). The mean procedure duration was 4.2 hours (1.15-9.15 hours). Early post-operative complications were observed in 10 patients (37.04%). The following early complications were observed: intra-abdominal abscess - 2, wound suppuration - 2, pancreatic fistula - 1, acute pancreatitis - 1, pancreaticojejunal anastomosis leak - 1, peritoneal cavity haemorrhage - 1, acute cholangitis - 1, adhesion obstruction - 1, subobstruction - 1, portal vein thrombosis - 1, sepsis - 1, fluid in pleural cavity - 1, acute heart failure - 1. There were performed 2 (7.41%) repeat surgeries: one due to adhesion obstruction and one due to peritoneal cavity haemorrhage. Death of 1 patient (3.71%) was recorded in the post-operative period due to acute heart failure. Pancreatic neuroendocrine tumours constituted the majority of gastroenteropancreatic neuroendocrine tumours in the analysed patient group. Most commonly, PNETs were localised in the head of the pancreas. In the presented material, the mortality rate does not exceed 4%, similarly as in other renowned centres.

Objective To explore the influencing factors of rapid postoperative recovery in young(≤40 years old) lung cancer patients. Methods Retrospective analysis was performed on 82 young patients with lung cancer diagnosed by postoperative pathology admitted to the department of thoracic surgery of the first affiliated hospital of Zhengzhou University from March 2013 to March 2019, the patients were divided into two groups according to their postoperative hospitalization time(hospitalization time≤7d, hospitalization time >7d). The preoperative medical history and examination data, intraoperative(operative method, embedding materials), postoperative complications and postoperative treatment and other data of the enrolled patients were collected to analyze the relationship between various factors and postoperative hospitalization time.Univariate analysis used t test or Fisher exact probability method, multivariate analysis used logistic regression model to analyze the data . Results All 82 patients successfully completed the operation, and no death occurred during the perioperative period. There were no significant differences(P>0.05)according to the two groups of patients in the preoperative pulmonary function(FEV1) operation history, history of hypertension, diabetes, history of preoperative chemotherapy and surgery in the patients' position, blood transfusion, pleural adhesion, Czech, nai d, the use of xanthan gum, operation time, the maximum diameter and postoperative tumor thermal perfusion, fever, vomiting, choking cough, abdominal distension, etc.And it has significant differences(P<0.05). In the preoperative antibiotic use(P=0.002), the improvement of lung function(P=0.018), smoking history(P=0.024), medical reasons(P=0.011) and the operation(P<0.001), the lymph node excision scope(P<0.001), the lymph node dissection(P=0.017), hemostatic material use(P=0.023), blood loss(P=0.001) and postoperative average white blood cell count(P=0.033). Conclusion Preoperative and postoperative prophylactic use of antibiotics and drugs to improve pulmonary function were beneficial to postoperative recovery.Smoking was an independent risk factor for prolonged postoperative hospital stay.Minimally invasive operation and application of hemostatic materials can effectively shorten the postoperative hospitalization time of patients. Key words: Carcinoma, non-small-cell lung; Youth; Postoperative recovery; Influence factors