Abstract:Objective:To study the clinical features of hyperlipidemic severe acute pancreatitis.Methods:From January 2 000 to June 2008, 114 cases of severe acute pancreatitis treated in our hospital were divided into hyperlipidemia group(HLgroup,21cases) and nonhyperlipidemia group(NHLgroup,93 cases).Clinical features, complications, and outcome were assessed and compared.Results:There were no differences in gender composition, age and ranson score (P＞0.05), between the two groups,but in body mass index ［(24.451±3.752) vs (22.468±2.434), P=0.030］, previous history of pancreatitis (23.8% vs. 7.5%, P=0.046) and bloody ascites (95.24% vs. 46.24%, P<0.001) in HLgroup were higher than those in NHLgroup. The rates of the complications,such as abdominal abscess, ARDS, renal failure, stress ulcer, DIC,and pseudocyst were of no statistical difference between the two groups(P＞0.05). MODS rate was higher in HLgroup (52.4% vs. 29%, P=0.04). The two groups had similar operation rates(66.7% vs 80.6%, P=0.178), hospitalization days ［(25.476±14.383) vs (22.796±7.191), P=0.216］ and mortality rate (28.6% vs.11.8%, P=0.069).Conclusions:Hyperlipidemic severe acute pancreatitis has the characters of heavier weight habitus,history of frequent recurrence,high incidence of bloody ascites and prone to develop MOF.

Abstract:Objective: To study the clinical characters, diagnosis and principles of treatmentof acute pancreatitis during pregnancy.Methods:Fortyeight cases of acute pancreatitis during pregnancy treated in the recent 8 years were retrospectively analyzed, 38 cases had nonsurgical treatment (of which 36 cases were cured); 10 cases had surgical treatment to remove necrotic tissue and mainly termination of pregnancy.Results:Most of the cases in this group had simple pancreatitis, which accounted for 64.58% (31/48).There were 5 cases of maternal (10.42%) death and three cases of fetal (6.25%) death, and all were in patients with severe pancreatitis. Fatality rate of pregnant women with severe pancreatitis was 29.41%.Conclusions:Acute pancreatitis during pregnancy is a serious disease with low prevalence rate,but has high fatality rate, and is the primary cause of death in acute abdomen of pregnancy. Nonoperative treatment is the first choice of treatment in this condition.In severe cases,timely surgical intervention is warranted,and the surgical indications should not be altered because of the pregnancy.The safety of both the pregnant woman and the fetus must simultaneously be kept into mind during therapy.

Abstract:Objective:To evaluate different scoring systems in predicting outcome of severe acute pancreatitis(SAP).Methods:A retrospective study was carried out in 168 SAP patients treated in our hospital within the past 10 years. We evaluated the prognostic value of the Sequential Organ Function Assessment (SOFA),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEII),and Computed Tomography Severity Index(CTSI). The area under a receiver operating characteristic(ROC) curve and univariate and multivariate analysis methods were used.Results:The area under the ROC curve of SOFA,APACHEII,CTSI was 0.846,0.809 and 0.779,respectively. The difference between SOFA and CTSI had statistical significance(Z=2.68,P＜0.01),but the ones between APACHEII and SOFA,CTSI did not have statistical significance(Z=1.079,P＞0.05; Z=0.693,P＞0.05).Univariate analysis showed SOFA, APACHEII, CTSI, age and pancreatic infection were related to prognosis of SAP. Multivariate analysis revealed that only SOFA, APACHEII, CTSI were independent prognosisrelated factors of SAP.Conclusions:SOFA,APACHEII,CTSI all have good predictive ability for prognosis of SAP during dynamic inhospital observation, and combination of the three factors has greater ability for prognosis of outcome of SAP.

Abstract:Objective:To investigate the influence of tumor necrosis factor-α inhibitor on kidney injury in rats with severe acute pancreatitis (SAP).Methods:60 SD rats were randomly divided into 3 groups(n=20 in each group),including sham group, SAP group, and TNF-α Ⅰ treatment group. After the models established, the rats were killed after 48h. The levels of serum amylase, tumor necrosis factor-α, urea nitrogen and creatinine were detected. Apoptotic cells were detected by TUNEL.Nuclear-κB was detected by immunohistochemical method. The expression ofET-1 mRNA was detected by RT-PCR.Results:All of the indicators in sham group were significantly lower than those in treatment group and SAP group (P＜0.05). The levels of tumor necrosis factor-α,serum amylase, urea nitrogen, creatinine and nuclear-κB IOD were （185.36±10.95）ng/L,（7 257.30±361.20）U/L,（17.28±0.87）mmol/L,（78.83±3.02）μmol/L, 316.25±20.90 in the SAP group and （124.32±15.11）ng/L,（6182.60±291.63）U/L,（13.66±0.88）mmol/L,（68.68±3.38）μmol/L,241.90±19.04 in treatment group,the difference was statistical between the 2 groups (P＜0.05), while the apoptotic index in the SAP group (3.33±0.49) was markedly lower than that in the treatment group(7.04±0.41) (P＜0.05). The expression of ET-1 mRNA in the SAP group was higher than that in the treatment group and sham proup (P＜0.05).Conclusions:The tumor necrosis factor-α inhibitor can promote the cell apoptosis of kidney, ameliorate the kidney injury caused by inflammation, and improve kidney function.

Abstract:Objective:To explore the changes of plasma endotoxin and D-lactate during intestinal mucosal barrier injury of acute pancreatitis.Methods:Wistar rats were randomly divided into sham-operation(SO)group,and severe acute pancreatitis (SAP)group. Plasma endotoxin and D-lactate were determined at 1,3,6 and 12 hour after operations.Results:The plasma endotoxin and D-lactate in SAP group increased obviously with time,and the difference betueen the 2 groups was significante(P<0.05).Endotoxin and D-lactate were positively correlated.Conclusions:The plasms endotoxin and D-lactate are increased during gut injury of SAP,and can be used as indexes to evaluate the function of the intestinal mucosal barrier.

Abstract:Objective:To study the protective effect and the possible mechanisms of shenfu injection(SFI) on hepatic injury in rats with severe acute pancreatitis (SAP).Methods:Forty-two male Wistar rats were randomly divided into 3 groups. Sham operation group(SO, n=6) underwent laparotomy only; SAP group,the model was established by retrograde injection of 50% sodium taurocholate into the bili-pancreatic duct in Wistar rats; SAP+SFI group, SAP rats were given SFI 10 ml/kg body wt intraperitoneally 2 h before SAP model established. Rats were sacrificed at 3, 6 and 12 hours after operation. The liver and pancreas tissues were obtained to observe their pathological changes with light microscope. The quantity of ascites was also recorded. The serum levels of alanine aminotransferase (ALT) and amylase were determined at three time points (6 rats for each time point). The expression of tumor necrosis factor alpha(TNF-α) mRNA in the liver was detected by reverse transcription polymerase chain reaction(RT-PCR). The activity of NF-kappaB in liver was examined by immunohistochemical methods.Results:The serum levels of ALT and amylase increased significantly in groups SAP compared with those in group SO at all the three time points(P＜0.01). The expression of TNF-α mRNA in group SAP was increased significantly at 3 to 6 hours, and reached peak at 6 hours, and then decreasd at 12 hours. However, the level of TNF-α mRNA in groups SAP were still significantly higher than that in group SO at all the three time points(P＜0.01 or P＜0.05). The activity of NF-kappaB was higher in groups SAP than that in group SO at the 3 time points (P＜0.01 or P＜0.05). Liver and pancreas pathological damages were severer in groups SAP than in group SO. In SAP+SFI groups, the serum levels of ALT decreased significantly compared to that of groups SAP(P＜0.01 or P＜0.05), and the expression of TNF-α mRNA was also significantly lower than that in groups SAP at all the three time points(P＜0.01 or P＜0.05). The activity of NF-kappaB in groups SAP+SFI was lower than that in groups SAP at the 3 time points (P＜0.01 or P＜0.05). Liver and pancreas pathological damages were milder in groups SAP+SFI than that in groups SAP.Conclusions:These experimental results suggest that NF-kappaB and TNF-α play an important role in the pathogenesis of liver injury in rats with SAP. SFI can reduce pathological damage of SAP and SAP on the liver. Its mechanism might be related to inhibition of activity of NF-kappaB and to decrease in release of inflammatory mediators such as TNF-α.

Abstract:Objective:To investigate the cytotoxic and chemo-sensitivity enhamcement effect of cucurmosin（CUS） on pancreatic cancer cell line PANC-1 in vitro.Methods:The cytotoxic effect of the different concentrations of CUS on PANC-1 cells in different time periods (24, 48 and 72 hours) was detected by means of MTT assay，and the chemo-sensitivity enhancement effect of CUS on gemcitabine(GEM) was evaluated by combination-index method of Chou and Talalay.Results:Cucurmosin significantly inhibited the proliferation of pancreatic cancer cell line PANC-1 in dosage-and time-dependent manner. After exposure to 0.3125,0.625,1.25,2.5,5.0,10.0,20.0,40.0 and 80 μg/mL of CUS, the inhibitory rate of the cell growth at 24 hours was 9.16％,11.9％,14.4％,20.2％,32.0％,36.4％,44.1％,50.3％and 58.6％respectively. The 50% inhibitory concentration (IC 50) at 24、48 and 72 h was 40.24 μg/mL,8.24 μg/mL and 1.17 μg/mL respectively. The combination of CUS and GEM at different concentrations showed synergic effect on inhibiting PNCA-1 cell growth (CI<1).The 50% inhibitory concentration (IC 50) of GEM decreased from 36.76 nmol/L to 12.14 nmol/L(less than 67.0%) when combined with CUS.Conclusions:Cucurmosin can significantly inhibit the proliferation of PANC-1 cells in dosage-and time-dependent manner in vitro,and combination with gemcitabine increases its cytotoxic action and provides chemo-sensitivity enhancement effect on pancreatic cancer cell line PANC-1.

Abstract:Objective:To study the effects of hSSTR2 gene transfection for downstream proteins in pancreatic cancer cells Panc-1 in vitro and its clinical significance.Methods:The full length hSSTR2 cDNA was introduced into pancreatic cancer cell line Panc-1 by adenovirus mediated transfection.Comprehensive analyses of proteins were focused on total protein spots exhibiting statistical alternations between the experimental group and vector control by fluorescent two-dimensional difference gel electrophoresis analysis.Proteins were identified by peptide mass fingerprinting with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.Western blotting was performed to verify the differential expression of vimentin.Immunohistochemistry was performed to detect the expression of vimentin in pancreatic carcinoma tissue, and its clinical significance was analyzed.Results:There were 21 statistically significant different protein spots.Of them, 18 different points were selected(greater then 1.3-fold); of the 18 protein spots,13 proteins including the regulatory proteins of translation, metabolic enzymes, the associated proteins about cell communication and signal transduction, the cell structural proteins, molecular chaperones, the proteins with the GTPase activity, and power protein were identified by mass spectrometry.Western blot results revealed that the downregulation of vimentin in pancreatic cancer cells with transfected hSSTR2 gene.Immunohistochemistry results revealed that vimentin was highly expressed in poorly differentiated pancreatic cancer cells.Conclusions:These differential expressed proteins, such as vimentin, may serve as new sensitive therapeutic targets in pancreatic cancer.Vimentin may also serve as a biomarker for predicting the degree of malignancy of pancreatic cancer.

Abstract:Objective:To investigate the effect of 2-Deoxy-D-glucose on the growth, cell cycle and apoptosis of pancreatic cancer cell panc-1 under hypoxic condition.Methods:The panc-1 cell was cultured under hypoxic condition with in vitro model for 48h.MTT, Hochest and PI staining, and fluorescence microscopy were used to detect the inhibition of the growth、apoptosis and cell cycle effect of 2-DG (0 mg/mL, 0.5 mg/mL, 1 mg/mL, 2 mg/mL and 3 mg/mL).Results:2-DG had sgnificant concertration-dependent inhibition on the growth, apoptosis and cell cycle of pancreatic cancer cell(P<0.05). Flow cytometry(FCM) and Hochest showed that the proportion of the apoptosis increased gradually, and was concertration-dependent(P<0.05).Conclusions:2-DG can inhibit the growth of human panc-1 cell by blocking the cell cycle and induce apoptosis under hypoxic condition.

Abstract:Objective:To study an improved automated method for isolation and purification of large amounts of human pancreatic islets from large mammals, and try to create conditions for preparation and isolation of large amounts of human islets.Methods:An improved automated system was used to isolate and purify panreatic islets of sogs. Under the general anaesthesia(GA) condition, the pancreas of the dogs was via in situ vascular perfused using cold HC-A solution and then removed en bloc with duodenum and spleen. Then they were placed in cold UW aolutian. Intraductal collagenase-Ⅴ and pefabloc (4 ℃) was delivered with controlled perfusion. lslets were dissociated in system of Ricordi Chamber and purified islets separated with Ficoll density gradient centrifugation under controlled temperature. Digestion time, islets remaining trapped in exocrine tissue,final islet purity, insulin and C-pep secretory activity, and islet recovery were observed. The purified islets were observed under light microscope and electronic microscope after 24 h culture.Results:The digestion time rate was (25.0±6.0) min,islets remaining trapped in exocrine tissue was(9.4±2.4)%, final islet purify rate was (89.7±3.5)%, islet recovery after digestion was(17.2±3.6)×104 IEQ/pancreas. Islet recovery after purification was (8.3±2.0)×104IEQ/pancreas. Insulin and C-pep secretory activity of the purified islets and their ultrastructure after 24 h culture were ideal.Conclusions:Our improved automated method and facilities for isolation of canine pancreatic islets are reliable, The morphology and function of the procured islets are excellent and they can foreseeably be used for large-scale preparation of huma islets for clinical use.

Abstract:Objective:To study the correlation of early glucose metabolism and inflammatory factors in rats with acute peritoneal infection.Methods:Rats were randomly divided into 4 groups:A group,rats subjected to cecal ligation plus puncture(CLP); B group, to intraperitoneal injection of lipopolysaccharide(LPS);C group, to CLP combined with intraperitoneal injection of LPS C;D group,control group.A、B、C group all were to produce acute peritoneal infection. The blood glucose, TNF-α and IL-6 and insulin were detected, and insulin resistance index(IRI) was calculated to evaluate the extent of insulin resistance.Results:Blood glucose level and IRI were elevated in the early stage in A、B、C groups,and reached a peak level at 6 h. IRI changes in the early stage had a positive correlation with TNF-α and IL-6. The rats that received LPS injection presented (B、C groups) mainly had a higher level of IL-6. And 1L-6 evaluated persisted longer than TNF-α did.Conclusions:Our results suggest that insulin resistance can occur in the early stage of acute peritoneal infection. Although differences exist in their action time, both TNF-α and IL-6 have a positive relationship with insulin resistance.

Abstract:Objective:To study the differentially expressed genes in the vascular tissue of diabetic gangrene toot and the possible mechanism of diabetic gangrene.Methods:The differentially expressed genes in the vascular tissue of diabetic gangrene foots were screened by the functional classific gene chip.Reverse transcription polymerase chain reaction (RT-PCR) detection was used to verify the differentially expressed 3 genes.
Results:In the detected 113 genes, 13 of the gene expression level increased more than 2 times, 3 of the gene expression level decreased more than 2 times. Three genes were verified with RT-PCR detection,which were results similar to those with chip testing.Conclusions:The abnormal expression in a variety of genes in tissues of vascular lesions plays an important role in the course of development and progression of diabetic gangrene. Analysis of differential gene expression can contribute to understanding of the possible mechanisms of diabetic gangrene.

Abstract:Objective:To investigate the effect and the mechanism of intragastric administration of gentamicin and lactulose on stress ulcer in rats with obstructive jaundice.Methods:Forty male Wistar rats were divided into 4 groups: Jaundice (Ligation of the bile duct) and intragastric administration of gentamicin and lactulose （group A）, jaundice with intragastric glucose（group B），sham operation with intragastris gentamicin and lactulose（group C）; and sham operation with intragastric glucose（group D）. Two weeks after the operation,the respective intragastric administration was given for 7 days,and then the water immersion and restraint stress induction procedures were performed in the 4 groups.Endotoxemia levels in portal vein were measured by the Limulus test and the ulcer index was calculated.Results:Group A showed significantly lower ulcer index and lower level of endotoxemia compared to group B,while the levels of endotoxemia and ulcer index in group B were increased, and group C and D also showed lower ulcer index and lower level of endotoxemia.Conclusions:Endotoxemia is an important aggravating factor for stress ulcer in obstructive jaundice.Intragastric administration of lactulose and gentamicin can decrease the level of endotoxemia which is beneficial to reduce the incidence of stress ulcer in rats with obstructive jaundice.

Abstract:Objective:To study the value of pancreaticoduodenectomy in combination with portal vein (PV) resection and reconstruction in the treatment of pancreatic carcinoma.Methods:The clinical data of 21 patients who received pancreaticoduodenectomy in combination with PV resection and reconstruction in the treatment of pancreatic carcinoma in our hospital in the past 6 years were retrospectively analyzed.Results:Perioperative complication incidence was 19.04% (4/21) and mortality rate was 4.76% (1/21). The major complications included delayed gastric emptying (9.52%), gastrointestinal bleeding (4.76%) and disruption of wound (4.76%), but no pancreatic leakage was observed. The survival time of 20 subjects ranged from 6 to 67 months ［mean (20.38±9.36) month］. The survival rate at 1y, 3y and 5y of the 21 subjects in this study were respectively 65.9%,16.0%,10.2%.Conclusions:Conduction of en bloc resection with the invaded PV/ SMV is safe and feasible for patients with locally advanced pancreatic adenocarcinoma. Major vascular resection can increase the resection rate, improve life quality and extend patient survival time.

Abstract:Objective:To investigate the effect of various operative methods for pancreatic cancer on patient′s quality of life and survival time.
Methods:The clinical data of 142 patients with pancreatic cancer admitted into our hospital between 1997 and 2007 were analyzed retrospectively.The patients were divided into 3 groups:Undergoing radical resection(RR,n=38), palliative resection(PR,n=15) and biliary-jejunostomy(BJ,n=89). The BJ patients were subdivided into cholecystojejunostomy group(n=56)、 choledochojejunostomy group(n=33), gastrojejunostomy group(n=32) and no-gastrojejunostomy group(n=57) according to the differen methods of anastomosis. SPSS13.0 software package was used for survival analysis, the recurrence rate of jaundice and obstruction of duodenum.Results:The median survival time in patients undergoing RR、PR and BJ was 13.6、10.7 and 7.8 months respectively. RR group had longer survival time than PR and BJ group (P<0.01). Meanwhile,PR group had longer survival time than BJ group,but the difference was no statisfical (P>0.05) The patients receiving choledochojejunostomy had longer survival time than the patients undergoing cholecystojejunostomy(P<0.05). Moreover, the former had lower recurrence rate of jaundice than the latter(P<0.01). The gastrojejunostomy group had lower rate of duodenumal obstruction(P<0.05).Conclusions:Radical resection should be regarded as the first choice for the patients with pancreatic cancer. For those patients who cannot urdergo radical resection, the selection of biliary-jejunostomy and gastrojejunostomy(double bypass) is more conducive to better quality of life and longer survival time.

Abstract:Objective:To explore the CT manifestations of non-functional islet cell tumor（NFICT）Methods:The findings of plain and enhancement CT scanning from 17 cases with NFICT, which were confirmed by the surgeries and pathological sections, were analyzed retrospectively. Ninty ml of non-ioniodine contrast reagent with 3ml/s injection flow rate was employed as the enhancer for measuring the arteriovenous double phase CT value of the pancreas and tumor.Results:Tumors were found in all the cases who received CT scan. Compared with pancreatic substance in the CT plain scan, tumors with low density were found in 2 cases, tumors with mixed low density in 11 cases and tumors with isodensity in 4 cases. Local calcification in tumor was found in 5 cases. Various degrees of strengthening were showed in 17 cases with enhancement scanning. Obvious enhancement in arterial phase presented in 5 cases, moderate enhancement in 6 cases and slight enhancement in 6 cases.
Conclusions:CT plain scan of NFICT shows that the tumor margins are clear and some tumors have calcification. All tumors in the CT enhancement scanning show various degrees of enhancement, the persistent enhancement from arterial phase to portal vein phase is the characteristic manifestation of NFICT.