Jefferson Investigates: Complications after Pancreatectomy, AI tool to Predict Cancer Treatment Side Effects, Cold Plasma for Wound Healing

After undergoing a total pancreatectomy, where the pancreas is surgically removed in its entirety, many patients face potentially life-threatening endocrine complications like hypoglycemia and diabetic ketoacidosis. This is because the pancreas plays a key role in regulating blood sugar levels. It is unclear, however, whether those complications differ between the different types of total pancreatectomy. In a publication in Surgery, researchers at Thomas Jefferson University found that patients who received a single-stage total pancreatectomy, where the entire organ is completely removed, faced higher rates of endocrine complications than those who had a completion or two-stage pancreatectomy, where the remainder of the pancreas is removed after a previous partial pancreatectomy.

To assess this, the team led by surgeon Avinoam Nevler, MD, analyzed data from two sources: TriNetX, a multi-institutional research network that compiles data from millions of patients, and Jefferson’s own highly-detailed database. The researchers found that the single-stage total pancreatectomies were 2.9 times more likely to lead to endocrine complications compared with completion pancreatectomies.

The team also found that most endocrine events in both groups occurred within the first three months after the procedure. They hypothesize the disparity in complications relates to a difference in experience and preparedness to manage complications like diabetes, rather than an actual biological difference between the two groups.

“For the patients who lose all of their pancreas all at once,” says Dr. Nevler, “it's just like pushing someone into the deep end of the pool.” Patients who previously lost a part of their pancreas may have had more time to learn to manage and live with their diabetes before it became more severe. 

The study’s findings indicate that closer monitoring of patients after a total pancreatectomy, along with improved patient education, could help reduce these endocrine events and save patients’ lives.

The study was carried out by two medical students at Sidney Kimmel Medical College, Matthew Kraft and Michael Chang. “It was rewarding to work on research that can help improve how we prepare and support patients during recovery,” says Kraft.

By Zoe Cunniffe

Radiation therapy is a cornerstone of lung cancer treatment. But even when delivered with precision, radiation can damage healthy lung tissue.

“Try as we might, when we deliver radiation to a cancer, some goes to surrounding organs and patients can have side effects including lung inflammation, coughing and feeling short of breath,” says medical physicist Yevgeniy Vinogradskiy, PhD.

Now, Dr. Vinogradskiy and a team of students, clinicians and computer scientists have developed a tool to help identify who might be at risk for those side effects before radiation treatment begins.

The study, published in Reports of Practical Oncology and Radiotherapy, focuses on the lung’s natural subunits, called lobes. Rather than treating the lung as a single organ, researchers have found that the radiation dose administered to specific lobes matters. Damage to certain lobes, particularly the lower ones, raises the risk of lung toxicity and side effects.

To know how much radiation each lobe receives, clinicians draw the outline of each lobe by hand on CT scans. The process can take three to four hours per patient. As a result, lobe-level analysis is often skipped, even though it could provide more accurate predictions of side effects.

To solve this problem, Dr. Vinogradskiy and colleagues trained a machine learning model to automatically identify and outline all five lung lobes on a scan. The team trained the AI using scans from 40 lung cancer patients from two institutions where specialists had already identified each lobe. Then the researchers tested the model on 10 scans it had never seen before. The results were promising.

“A machine learning model can identify lung lobes just as accurately as a clinician,” says Dr. Vinogradskiy. “But instead of hours, it takes less than a second.”

By making lobe-level analysis practical, the tool opens the door to better predicting side effects from radiation in lung cancer patients.

“Knowing the future is powerful,” says Dr. Vinogradskiy, a member of Sidney Kimmel Medical College. “If we can identify which patients are at higher risk, we can intervene earlier and potentially prevent serious complications.”

By Roni Dengler

Cold plasma devices are increasingly used across surgical procedures, including skin rejuvenation, scar remodeling, liposuction and diabetic wounds. A recent study from Thomas Jefferson University found that using an FDA-approved cold plasma device can enhance tissue healing after surgery by activating a wound-healing response.

“Anecdotally, after receiving cold plasma treatment for dermatology procedures, patients have reported firmer and ‘younger’ feeling skin in the treatment area,” according to senior author Theresa Freeman, PhD. While several published reports support the idea that cold plasma could activate healing in cells, there was little evidence in living organisms. This motivated Dr. Freeman and her team to figure out what was happening when injured muscle tissue was treated with a cold plasma device.

“We found that cold plasma produces bursts of ‘reactive species,’ which are molecules that can directly communicate with the immune cells and trigger them to start the healing process,” says Carly Smith, a recently graduated doctoral student in Dr. Freeman's lab and first author on this study.

Researchers treated rat surgical wounds with cold plasma, and within six hours, immune cells called neutrophils — the ‘first responders’ of wound healing — increased in number and began repairing the wound. Cold plasma seemingly uses the natural wound-healing response to its advantage.

To understand how this spike in neutrophils could affect healing, the researchers compared cold plasma-treated to untreated rat muscle tissue at different time points. Repairing injured muscle tissue involves replacing it with new muscle or fat. Dr. Freeman notes, “After six hours, plasma-treated tissue increased the expression of pathways and genes related to repairing and restoring muscle tissue. Fourteen days after treatment, plasma reduced the accumulation of fat in the healing muscle tissue. This could explain why patients said their skin feels firmer after cold plasma treatment.”

In addition to promoting healing, cold plasma can kill bacteria. In future studies, Dr. Freeman hopes to combine cold plasma with standard-of-care antibiotics used in surgery to boost the healing process and prevent infections. “If we can show this combined treatment is effective, it can be used by clinicians to improve surgical outcomes,” says Dr. Freeman.

By Moriah Adde