Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach

BACKGROUND

Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation.

METHODS

This retrospective, observational study documented patients who had undergone a step-up MARPN between 1 January 2010 and 31 December 2016. A minimum follow-up of 1 year was required for inclusion. The step-up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN.

RESULTS

Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step-up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1-7) and 1 (1-6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths).

CONCLUSION

A step-up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.

Selecting representative microsatellite loci for genetic monitoring and analyzing genetic structure of an outbred population of orange tabby cats in China

We optimized a panel of microsatellite markers from cat and tiger genetic data for efficient genetic monitoring and used it to analyze the genetic structure of an outbred cat stock in China. We selected a set of rich polymorphic microsatellite loci from 131 cat microsatellite loci and 3 Sumatran tiger microsatellite loci using agarose gel electrophoresis. Next, the set of optimized genetic markers was used to analyze the genetic variation in an outbred population of orange tabby cats in China by simple-tandem repeat scanning. Thirty-one loci rich in polymorphisms were selected and the highest allele number in a single locus was 8. Analysis of the orange tabby cat population illustrated that the average observed number of alleles, mean effective allele number, mean Shannon's information index, mean expected heterozygosity, and observed heterozygosity were 3.8387, 2.4027, 0.9787, 0.5565, and 0.5528, respectively. The 31 microsatellite markers used were polymorphic and suitable for analyzing the genetic structure of cats. The population of orange tabby cats was confirmed to be a well-outbred stock.

The identification of NP25: a novel protein that is differentially expressed by neuronal subpopulations

A novel gene encoding a 25-kDa neuronal-specific protein, here named 'NP25', has been isolated as a cDNA clone from rat brain. The sequence of the NP25 cDNA reveals a single open reading frame that encodes a primary translation product of 206 amino acids. A search of the protein sequence databank indicates that NP25 is significantly homologous with three recently discovered muscle proteins: SM22 alpha, mp20 and calponin. The gene is specifically and ubiquitously expressed in the rat brain and has conserved sequences among chicken, rat, mouse and human. Rat brain NP25 was identified by Western blot using an antiserum elicited against trpE-NP25 fusion protein. On pH gradient electrophoresis, NP25 was separated into at least two isoforms with similar molecular weights. Immunocytochemistry and in situ hybridization demonstrated that NP25 was differentially expressed by neuronal subpopulations of the rat central nervous system. The highest concentration of NP25 protein was localized in central amygdaloid nuclei and glomeruli in the granule layer of cerebellum. The wide and differential distribution of NP25 in the brain suggests that it may play a particular important role in the function of specific neuronal systems.