Search

Total pancreatectomy (TP) and islet cell autotransplantation (IAT) are complex operations that require intensive postoperative monitoring with standardized protocols. There are few studies detailing immediate perioperative management. The purpose of this study was to describe the perioperative management of post-pancreatectomy patients in the first week following surgery to guide clinicians in addressing salient points from different organ systems. This is a retrospective cohort review of prospectively collected data from September 2017 to September 2022 at a single institution, including patients 16 years and older who underwent TP or TPIAT for chronic pancreatitis. Patients were maintained on a heparin drip (TPIAT), insulin drip, and ketamine infusion. Primary outcomes were complications in the first 5 days following surgery and ICU length of stay (LOS). Secondary outcomes included overall LOS and mortality. Of 31 patients, 26 underwent TPIAT, and 5 underwent TP. Median ICU LOS was five days (IQR 4–6). The most common immediate postoperative complications were reintubation [n = 5 (16%)] and bleeding [n = 2 (6%)]. Median insulin drip use was 70 h (IQR 20–124). There was no mortality. Patients were extubated quickly and progressed well on the protocol. Immediate postoperative complications were generally minor and without long-term effects.

A 14 ka vegetation and climate history is reconstructed based on a high-resolution pollen record from an arid to semiarid region in north-central China. Nine major episodes of paleovegetation are reconstructed in the record in response to climate changes: sparse-wood grassland, steppe, sparse-wood grassland, steppe, mixed conifer broad-leaved forest, sparse mixed conifer and broad-leaved forest, conifer forest, conifer forest with some broad-leaved, and steppe. Between 14 and 11.2 ka, mild and dry conditions after the glaciation are revealed, and a three-phased monsoonal oscillation interval (cold-dry, cold-humid, and cool-dry) corresponding with the Younger Dryas has been identified from 11.2 to 10 ka. A warm, humid climate is evident between 10 and 7 ka, when broad-leaved trees were abundant. The East Asian monsoon was enhanced during this period and brought in more precipitation to the study area. After 7 ka, with the weakening of the East Asian monsoon, the climate became less moist, and more arid vegetation developed. Conifer forest was well developed between 4.8 to 3.4 ka but was then replaced by steppe.

The Staphylococcus aureus toxin, α-hemolysin, is an important and well-studied virulence factor in staphylococcal infection. It is a soluble monomeric protein that, once secreted by the bacterium, forms a heptameric pore in the membrane of a broad range of host cell types. Hemolysin was recently discovered to bind and activate a disintegrin and metalloprotease 10 (ADAM10). In epithelial and endothelial cells, ADAM10 activation is required for the toxin’s activity against these cells. In host monocytic cells, α-hemolysin activates the nucleotide-binding domain and leucine-rich repeat containing gene family, pyrin domain containing 3 (NLRP3) inflammasome leading to production of pro-inflammatory cytokines and cell death. We now show that ADAM10 is critical for α-hemolysin-mediated activation of the NLRP3 inflammasome in human monocytes as siRNA knockdown or chemical blockade of ADAM10-α-hemolysin interaction leads to diminished inflammasome activation and cell death by reducing the available ADAM10 on the cell surface. Unlike epithelial cell and endothelial cell damage, which requires α-hemolysin induced ADAM10 activation, ADAM10 protease activity was not required for NLRP3 inflammasome activation. This work confirms the importance of ADAM10 in immune activation by α-hemolysin, but indicates that host cell signal induction by the toxin is different between host cell types.