Pancreatic trauma, while uncommon, presents challenging diagnostic and therapeutic dilemmas
to trauma surgeons. Indeed, injuries to the pancreas have been associated with reported
morbidity rates approaching 45%.
The disease 's characterization at a specific therapeutic level will allow for a better
management of patients treated. To do so, the strategy is to integrate precise prospective
clinical records extensive clinical treatment data in a large cohort of patients.
All the clinical departments, participating in the study, include patients, with a tight
collaboration between Trauma, Intensive Care and Surgery departments. Demographics and
clinical parameters are collected in a database.
Once after the diagnosis is confirmed, the inclusion of patients is performed, before a
scheduled hospital management, and after eligibility criteria checking, and consent form
signature. During clinical management, several samples are collected: blood samples and
surgical specimens. As usual practice, post-operative treatment will be prescribed at
investigator's discretion, with help of a pre-established algorithm. Several samples are also
collected during this exam (blood and biological tissue sample).
At the same time as these managements, clinical data regarding medical history, pre-hospital
treatment history, surgical history, treatments history, post-operative treatment if
prescribed, treatments history between surgery and imageological diagnosis are recorded.
Clinical data are also collected 12 months after discharge during a scheduled visit organized
as usual practice, for long-term study.
Several studies will be performed along the cohort setting-up:
Comparison of operative and non-operative treatment of pancreatic trauma:
Comparison of the diagnosis time and treatment time of patients with pancreatic trauma
and whether or not the treatment is missed
Study of specific treatment of patients with pancreatic trauma
Study of surgical methods and intraoperative conditions in patients with pancreatic
trauma
Study of ICU resuscitation treatment of patients with pancreatic trauma
Study of endoscopy and other conservative treatments for patients with pancreatic trauma
Study of nutritional support treatment for patients with pancreatic trauma
Study of treatment methods for damage control and non-damage control in patients with
severe pancreatic trauma
All the biologic samples are stored on sites at -80°C, or at room temperature depending on
the samples: Samples collected in tubes, are sent immediately, at room temperature, to the
central pathology department in Jinling Hospital, Nanjing, China. All the other samples,
stored at -80°C, are sent to the Research Institute of General Surgery, Medical School of
Nanjing University, China.
Samples analyses are performed by dedicated research center: DNA, and RNA extraction for
transcriptome analysis, histological analyzes, etc:
Histological analyzes: Analysis of the structure of the excised pancreas or intestinal
tissue.
Molecular Biology: Whole genome expression analyses are performed using microarray and
followed by Gene Ontology and clustering analyses.
Microbiota: Bacterial composition of the ileal mucosa-associated microbiota is analyzed at
the time of surgery using 16S (MiSeq, Illumina) sequencing. The obtained sequences are
analyzed using the Qiime pipeline to assess composition, alpha and beta diversity.
Immunology: Phenotype of immune cells: Immune cells are extracted from blood and fresh
mucosal tissues. The phenotype of these cells is analyzed by cytometry.
Analysis of neutrophil extracellular traps:
The concentrations of cell-free DNA, cell-free nucleosomes, neutrophil elastase (NE) and
myeloperoxidase (MPO) were measured in sera and plasma by Human Cell Death Detection ELISA or
sandwich ELISA.
Pancreatic tissue was removed rapidly and divided into different parts for later analyses.
One was used for confocal microscopy and one third was snap-frozen in liquid nitrogen for
biochemical quantification of pancreatic myeloperoxidase (MPO), histone 3, and histone 4
levels, etc. One was fixed in formalin for histologic analysis.