Abstract:Abstract:Objective To summarize our experience in diagnosis and surgical treatment of nonfunctioning pancreatic neuroendocrine carcinoma (NPNEC).
Methods The clinical data of 18 cases of NPNEC, including Group A those with liver metastasis, n=8; Group B those without liver metastasis, n=10, from 1985 to 2004 were retrospectively reviewed. Operations were performed in 16 cases, interventional procedures in 15 cases, and nonoperative treatment in 2 cases respectively. The markers of neuroendocrine cell (CgA, NSE, Syn) and the main peptide hormones (insulin, gastrin, glucagon, VIP, and somatostatin) were examined in tumor samples with immunohistochemistry method.
Results Group A and B were similar with respect to age (year) and tumor diameter (cm) at diagnosis (40.50±12.54 vs 51.60±12.85, and 8.45±5.12 vs 6.26±3.65, respectively; P>0.05). Positive expression of 2 or all 3 markers of neuroendocrine cell was detected in all 16 samples; negative expression of all 5 peptide hormones was observed in only 25% of samples. At a mean followup of 44.2 months (range 4 months-7 years ), the mean time from resection to relapse or metastasis was 29.8 months; 7 cases survived more than 5 years, of which 2 have survived for 7 years. Two cases, who subjected nonoperative treatment, survired 39,61 months, respectively.
Conclusions Clinical manifestations of NPNEC are nonspecific. Only a few tumors in NPNEC patients do not yield peptide hormones. Treatment of NPNEC (including patients with liver metastasis) with aggressive surgical resection followed by interventional methods can result in excellent overall longterm survival.

Abstract:Abstract:Objective To explore the diagnosis and treatment of nonfunctioning islet cell tumors.
Methods The clinical data of 16 patients with nonfunctioning islet cell tumor admitted from 1990 to 2006 were analyzed retrospectively.The tumor was located in the head of pancreas in 4 patients, and in the body or tail in 12 patients. The average diameter of the tumor was 12cm.
Results Six patients underwent tumor enucleation,3 patients were subjected to pancreatoduodenectomy, 3 patients underwent distal partial resection of tumor bearing pancreas with splenectomy, and 3 patients had distal partial resection of tumor bearing pancreas without splenectomy.The curative resection rate was 93.75%(15/16).There was no operative mortality.In one case the tumor was unresectable because of widespread of the tumor and the patient died 5 months later. At 2-16 years followup, the 11 cases with benign tumor were alive. In 3of 4 cases with malignant tumor who underwent resection, the survival time was 1,2 and 6 years, respectively, and the other case has survived for 12 years and 8 months.
Conclusions Gastrointestinal barium meal exam,ultrasonography, CT, MRI and ERCP are essential for the diagnosis.Surgical resection is the treatment of choice for nonfunctioning islet cell tumors, and the outcome is satisfactory.

Abstract:Abstract:Objective To study the clinicopathologic features,diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma.
Methods A retrospective clinicopathologic analysis was made on 17 cases of pancreatic cystadenoma and cystadenocarcinoma admitted from June 1996 to March 2007.
Results Pancreatic cystic neoplasms had no specific clinical features. Ultrasonography and CT can be used to discover tumor ，but they can not be used for tumor differentiation.Tumor enucleation was performed in 7 cases of serous cystadenomas; for 6 cases of mucinous cystadenoma，pancreaticoduodenectomy was performed in 1 case，and resection of body and tail resection of pancreas in 5 cases. Four cases of cystadenocarcinoma were treated by pancreaticoduodenectomy plus lymphadenectomy in 1 case，resection of body and tail of pancreas in 2 cases， and resection of body and tail of pancreas plus splenectomy in 1 case. Fifteen cases were followed up with a median period of 42（1-129） months and without tumor recurrence.One elderly patient with cystadenocarcinoma who underwent resection of body and tail of pancreas plus splenectomy died 6 months after operation. Others had survived and without tumor recurrence on ultrasound exam, but one had diabetes mellitus.
Conclusions Ultrasonography and CT scan are helpul in the diagnosis of pancreatic cystic neoplasms. Increase in the knowledge of the clinicopathologic features of this disease is the key to improve the level of diagnosis and treatment.Surgical resection gives good therapeutic results.

Abstract:Abstract:Objective To summarize the experience of diagnosis and treatment of solidpseudopapillary tumor of pancreas (SPTP).
Methods The clinical data of 15 patients with SPTP who were treated in our hospital from March,2003 to March,2006 were analyzed retrospectively.
Results The 15 cases were all women， and the average age was 29.4 years.The chief manifestations were abdominal mass, abdominal pain or other abdominal discomfort. None of the 15 cases had history of pancreatitis or abdominal trauma, and no long history of drinking or smoking. Six cases were negative for CEA,CA50,CA199,CA125 and other tumor markers.Solid and solidcystic masses in pancreas or solid and solidcystic tumors in retroperitoneum were found both by Bmode ultrasonography and CT examinations. Preoperative fasting blood sugar was within normal limits. The tumor in 8 cases was located in the pancreatic head, in 6 cases was in the body and tail of pancreas, and in 1 case was in the neck of pancreas. The diameter of the tumors was 2.5-10 cm. No metastasis was found in the abdominal cavity or liver. Local excision was performed in 6 cases, distal pancreatectomy was performed in 5 cases, including 2 cases combined with splenectomy, and pancreaticoduodenectomy was performed in 3 cases, segmental pancreatectomy was performed in one patient with tumor in the neck of pancreas. The 15 cases showed typical pathologic manifestation of SPTP by microscopy. At followed up for 16-52 months, no evidence of recurrence or metastasis in these cases was found.
Conclusions Solidpseudopapillary tumor of pancreas primarily affects young women, and it may be located in any part of pancreas. Surgical resection is recommended as the treatment of choice, and the prognosis is good.

Abstract:Abstract:Objective To establish a gemcitabineresistant rat pancreatic cancer cell line RPC/ GEM and investigate its biological characteristics.
Methods A gemcitabineresistant rat pancreatic cell line was obtained by gradient increase of concentration, and repeated exposure to high doses of gemcitabine for 10 months. The morphological features and growth characters of RPC/GEM were examined. Flow cytometry assay was used to evaluate the cell cycle distribution of both RPC/GEM and its parental cell line RPC. Its sensitivity of drug resistance and cross resistance were observed by MTT assay.
Results A gemcitabineresistant rat pancreatic cell line RPC/GEM was succeeded in establishing. Both RPC/GEM and RPC cells were observed by light microscope，that showed there were larger numbers of malformed nuclei in RPC/GEM cells. RPC/GEM cells grew more slowly than RPC cells and their population double time was 7.9 hours, which was longer than RPC cell line. Cell cycle distribution of RPC/GEM cells was changed compared with the parental cells. The percentage of cells in G0/ G1phase increased to 68.82 %±1.42 %, and G2/ M phase decreased to 4.35 %±1.71 %. The resistance index of RPC/GEM cells to etoposide was 37.1 and the cells showed various cross resistance to 5Fu、MTX and CTX.
Conclusions A multidrug resistant rat pancreatic cancer cell line RPC/GEM was established. RPC/GEM cell line was found to possess the basic characteristics of drug resistance and can be used for further experiments.

Abstract:Abstract:Objective To explore the expression and action of tissue factor pathway inhibitor 2 (TFPI-2) in pancreatic carcinoma (PC).
Methods Tissue specimens from 41 pancreatic cancers were used to detect the expression of TFPI-2, Ki67, VEGF and MVD tagged with CD34 by immunohistochemistry.
Results The positive expression of TFPI-2 in stage Ⅰand Ⅱ PC (17/26) was higher than that in stage Ⅲ and Ⅳ (2/15) PC. The positive expression of TFPI-2 in welldifferentiated PC (12/19) was also higher than that in moderate and poorlydifferentiated PC (7/22)(P< 0.05). The cell proliferation index in stage Ⅰ,Ⅱ(24.45±6.19) and welldifferentiated PC (24.42±6.29) was lower than that in stage Ⅲ, Ⅳ (30.84±6.70) and moderate, and poorlydifferentiated PC (28.84±7.12)(P< 0.05). The positive expression of VEGF in stage ⅠandⅡ PC (16/26) was higher than that in stage Ⅲ and Ⅳ (14/15). The positive expression of VEGF in welldifferentiated PC (11/19) was also higher than that in moderate and poorlydifferentiated PC (19/22)(P< 0.05). The value of MVD in stage Ⅰ,Ⅱ(26.92±1.06) and welldifferentiated PC (19.00±2.58) was lower than that in stage of Ⅲ, Ⅳ (28.47±2.23)  and moderate and poorlydifferentiated PC (16.68±1.79), (P< 0.05). The expression of TFPI-2, Ki67 and VEGF was negatively correlated. The MVD was related to the expression of TFPI-2.
Conclusions TFPI-2 can inhibit cell proliferation of PC, and by reducing the expression of VEGF can inhibit the angiogenesis of new vessels in PC, which may play an important part in inhibitory effect on invasion and metastasis of PC.

Abstract:Abstract:Objective To investigate the role of PI3K/PKB signal transduction pathway in the injury of pancreas during severe acute pancreatitis.
Methods Thirty adult healthy SD rats were randomized into three groups: control group, SAP group（group S） and SAP+wortmannin group （group S+W）.SAP models were established by retrograde injection of 5% sodium taurocholate into pancreatic duct.Rats from each group were killed at 6h after SAP models had been established.Pancreas water content, MPO and pancreatic histology were measured, meanwhile, protein and mRNA levels of TNF-α and IL-1β in pancreas were examined by ELISA and RT-PCR respectively.Levels of phosphorylated PKB(p-PKB) and total PKB were examined by western blotting.
Results Pancreatitis（group S and group S+W）resulted in elevated pancreas water content, increased MPO, and worsened histologic condition（P<0.01）.Protein and mRNA levels of TNF-α and IL-1β from SAP rats were much higher than those in shams（P<0.01）.p-PKB activity presented similar tendency（P<0.01）.In S+W group pancreas water content markedly decreased, MPO reduced, and degree of pancreatic injury reduced（P<0.01）.At the same time, wortmannin inhibited the activation of p-PKB and decreased protein and mRNA levels of TNF-α and IL-1β（P<0.01）.
Conclusions The activation of PI3K/PKB is one important aspect of the signaling event that contributes to the injury of pancreas during severe acute pancreatitis.

Abstract:Abstract:Objective To discuss the mechanism of apoptosis of alveolar macrophages(AM) in severe acute pancreatitis (SAP)induced by gadolinium chloride(GdCl3).
Methods Forty-eight SD rats were randomized into three groups(n=16 for each group): normal control group, SAP group, and GdCl3treatment group. Rat SAP model was induced by retrograde intraductal administration of 5% sodium taurocholate. Alveolar macrophages(AM) were obtained by bronchoalveolar lavage. Tumor necrosis factor-alpha (TNF-α) and interleukin 1β（IL-1β）of bronchoalveolar lavage fluids (BALF) were evaluated. The lung tissue and pancreas tissue were examined by histology.The apoptosis of AM was checked by transmission electric microscopy and cytometry Annexin V/FITC and propidium iodide (PI) double stained method. The expression of FasL in AM was analyzed by immunohistochemistry.
Results Transmission electric microscopy showed the typical apoptotic morphologic feature of AM in GdCl3 treatment group. The levels of TNFα and IL-1β in GdCl3 treatment group were (7.84±0.75)pg/mL，(8.57±5.64)pg/mL respectively, were significanty less than SAP group (P<0.05). Moreover, the rates of apoptosis of AM and expression of FasL in GdCl3 treatment group［(22.48±1.44)%, (41.67±11.69)% respectively］were obviously increased compared with the other two groups (P<0.05). The apoptosis rate of AM had positive correlation with the positive expression of FasL（r＝0.835，P<0.001）.
Conclusions GdCl3 could induce the apoptosis of AM by activating expression of FasL, and then can ameliorate the lung injury associated with SAP.

Abstract:Abstract:Objective To observe the protective effect of pretreatment with wortmannin against pancreas and liver injuries indued by severe acute pancreatitis(SAP) in rats and investigate its mechanism.
Methods Fifty-four SD rats were randomly divided into 3 groups: control group（C group）,SAP group（P group） and SAP＋wortmannin group（PW group）(n=18 per group). SAP model was induced by retrograde infusion of 50g/L sodium taurocholate into the biliopancreatic duct of rats,except C group in which sodium taurocholate was replaced by normal saline. Serum level of tumor necrosis factor-alpha(TNF-α)、 alanine aminotransferase（ALT）、aspartate aminotransferase（AST）、and nuclear factor-kappa B（NF-κB）in liver were detected. Histopathology of liver and pancreas was studied.
Results In P group, serum levels of TNF-α、ALT、AST and NF-κB in liver were significantly elevated(P<0.01);the liver and pancreas injuries were gradually aggravated with disease progression. All the indicators of PW group were also elevated compared with C group, but still significantly decreased as compared with P group(P<0.01).
Conclusions Pretreatment with wortmannin could decrease pancreas and liver injury in pancreatitis rats. The mechanism may be related to the inhibition on the activation of NF-KB and on the release of TNF-α and other inflammatory factors.

Abstract:Abstract:Objective To study the early prediction of infection in acute pancreatitis in rats by plasma procalcitonin (PCT) and c-reactive (CRP) detection.
Methods Eighty SD rats were randomly assigned into acute infected pancreatitis group (I, n=20), pancreatitis control group (C, n=40) and sham-operated group (S, n=20). Blood samples were collected pre- (0h) and post-operatively (12h, 24h and 48h). Plasma CRP was analyzed by ELISA. Plasma and liver PCT was detected by Western blot.
Results (1). Ascitic infection occurred in all the group B rats and 16 of 40 rats of group C (analyzed as group C1), and did not occur in the other 20 of 40 rats of group C (analyzed as group C2) and group S. (2). The plasma CRP concentrations elevated gradually after the model setup in group B and C1, which were significantly higher at 48h than those in group C2 and group S. (3). PCT was detected in high levels in plasma and liver tissues in group B and C1 at 48h post-operatively, and they were sighificantly higher than those in group C2 and group S.
Conclusions PCT can predict early infection of acute pancreatitis, and detection of PCT combined with plasma CRP may help in the differentiation of acute infected pancreatitis. The liver may be an important organ for synthesis of PCT.

Abstract:Abstract:Objective To study the relationship between Th1/Th2 cytokine profiles and the survival time of cardiac allografts in mice.
Methods The ventral heterotopic cardiac transplantation models were divided into three groups: rejection group, treated group, isograft group, each group with 20 recipients. Mean survival time(MST), pathologic histological changes, the mRNA expression of IFN-γ,IL-2,IL-4 and IL-10 were measured.
Results MST of heart allografts in rejection and treated group was (7.8±0.77)d, and (14.80±1.01)d respectively. The survival time of grafts in isograft group were all more than 28d. The difference among the three groups was significant. In rejection group, the number of infiltrating cells was much more than that in the other groups, and also, the extent of pathologic histological changes was more severe. The mRNA expression of IFN-γ and IL-10 in graft and spleen in rejection group was much stronger than that in the others. There was no obvious mRNA expression of IL-2 and IL-4 in grafts of all three groups. The mRNA expression of IL-2 in the spleens of rejection group was the strongest, while the mRNA expression of IL-4 in the spleens of treated group was the strongest.
Conclusions The dynamic equilibrium of Th1/Th2 cytokines plays an important role in the survival time prolongation of cardiac allografts in mice. IL-10 can also participate in the process of graft rejection.

Abstract:Abstract:Objective To study the distributions of gallbladder stellate cells (GSCs) and the expressions of TGFβ1mRNA, CTGFmRNA in gallbladder adenocarcinoma, pericancerous tissues, and chronic cholecystitis, and their clinicopathological significance.
Methods EnVisionTM immunohistochemistry of αSMA monconal antibody for GSCs or in situ hybridization for TGFβ1mRNA and CTGFmRNA was used in paraffinembedded sections of the specimens of gallbladder adenocarcinoma (n=108), pericancerous tissues (n=46) and chronic cholecystitis (n=35).
Results The positive expression rates and scores of αSMA, TGFβ1mRNA, CTGFmRNA were significantly higher in specimens of gallbladder adenocacrcinoma than those in pericancerous tissues or chronic cholecystitis (P<0.01). The positive expression rates and scores of αSMA, TGFβ1mRNA and CTGFmRNA were significantly higher in the cases of malignant adenoma, maximal diameter of tumor <2cm，with no lymphnode metastasis, and no invasion of regional tissues compared to those in cases of lowdifferentiated adenocarcinoma, maximal diameter of tumor ≥2cm, with lymphnode metastasis, and invasion of regional tissues (P<0.05 or P<0.01). High and close positive correlations were found among the expression scores of αSMA,
TGFβ1mRNA and CTGFmRNA in gallbladder adenocarcioma (αSMA vs TGFβ1mRNA, r=0.82; αSMA vs CTGFmRNA, r=0.75; TGFβ1mRNA vs CTGFmRNA, r=0.78).
Conclusions The expressions of αSMA, TGFβ1mRNA and CTGFmRNA might be important biological markers for reflecting the carcinogenesis, progression, biological behaviors and prognosis of gallbladder adenocarcinoms. TGFβ1 and CTGF might have important regulatory effects on the activation of GSCs.

Abstract:Abstract:Objective To discuss the choice of operative method for pancreatic carcinoma.
Methods The clinical data of 209 cases of pancreatic cancer treated within 8 years were retrospectively analysed. Among the cases, 149 cases of tumor of haed of pancreas, 54 cases of tumor of body and tail of pancreas, and 6 cases of cancer of entire pancreas. The operations performed were radical pancreaticoduodenectomy in 59 cases, palliative pancreaticoduodenectomy or distal pancreatectomy with splenectomy in 15 cases, and internal drainage in 64 cases.
Results After radical excision of pancreatic cancer, the 1-,3-,and 5-year survival rate was 42.37 %, 13.56 % and 6.78 %, respectively, which was higher than the 20.00 %, 6.60 % and 0 %, respectively, after palliative resection. After internal drainage, the 1-and 3-year survival rate was 9.38 % and 0 %,respectively, which was not different from cases without operation, but their quality of life was improved.
Conclusions Marked increase in postoperative survival rate and improvement in quality of life can be achieved by correct pre-operative assessment and staging of pancreatic cancer by CT and MRI studies and correct selection of operative method.

Abstract:Abstract:Objective To study the experiences of severe acute pancreatitis (SAP) treated by combmation of traditional Chinese and western medicine.
Methods Two hundred and forty patients with SAP were divided into A and B groups randomly,140 patients of group B were treated by combination of traditional Chinese and western medicine;100 patients of group A were treated by western medicine.
Results After treatment in group B, the serum and urine amylase, and c-reactive protein,signiflcantly decreased.The complication rate of group A and group B was 55.00 % and 12.86 %（P<0.01）,The mortality of A and B was 27.00 % and 8.57 % respectively（P<0.01）.The operation conversion rate of group A and B group was 10.00 % and 4.29 % respectively(P<0.01).
Conclusions Compared to use of western medicine alone, combination of traditional chinese and western medicine can effectively treat SAP, and can significantly decrease the complication and mortality rate of SAP.

Abstract:Abstract:Objective To evaluate the clinical features and outcome of liver transplantation (LT) in the elderly patients over sixty years of age.
Methods Clinicopathological data and treatment results of 31 elderly patients (≥=60 yr) with HCC (HCC group)and 26 elderly patients with benign hepatic disease (BHD group ) who received liver transplantation between Dec 2003 and Dec 2005 were retrospectively collected and compared.
Results Of 31 elderly patients in HCC group, 28 were male and 3 were female, with a mean age of 63.5+3.2 years，whereas in BHD group, 22 were male and 4 were female, with a mean age of 64.8+3.26 years. There was no difference between the two groups regarding recipients age or sex, pre-LT comorbidity, pre-LT HBsAg positive rate, blood loss, major infections and post-LT complication rate (P>0.05). Compared with BHD group,HCC group had better liver function as assessed by Child-Pugh scores. Postoperatively, the period of artificial respiration was shorter in HCC group(P<0.05). the 1-,2-y overall survival rates were 77.4% and 71.0% for HCC group, and 69.2% and 69.2% for BHD group respectively (P>0.05). Elderly HCC patients meeting Milan criteria(n=12) had 1-,2-y overall and disease-free survival equivalent to patients exceeding Milan criteria (n=19).
Conclusions Liver transplantation is safe and feasible in elderly patients. The prognosis of elderly patients with HCC after LT is comparable to those with benign hepatic disease. Milan criteria for selecting HCC patients for LT may be too restrictive and could be expanded in the elderly over sixty years of age.

Abstract:Abstract:Objective:To summarize the methods of diagnosis and results of surgical treatment of pancreatic insulinoma.
Methods:The clinical data of 137 patients with insulinoma treated in our hospital during the past twentysix years were reviewed retrospectively.
Results:There were 77 males and 60 females. All of them were characterized by the Whipple′s triad. The sensitivity of ultrasonography, CT and MRI for localization was 35.1%, 67.9% and 58.1% respectively. One hundred and tweentysix patients underwent operation. Of them, 102 cases had tumor enucleation, 4 cases had pancreaticoduodenectomy, 16 cases had distal panreatectomy, and the other 4 cases had only laparotomy. Of the 122 patients, who underwent resection, the tumor was benign in 118(96.7%) and malignant in 4(3.3%). The diameter of the tumor was less than 2cm in 86.9% of cases. In 98.4% of cases the tumors were single and in 1.6% of cases were multiple. 13.1% of the tumors located in the head, 46.7% in the body, and 40.2% in the tail.
Conclusions:Whipple′s triad and the measurement of fasting glucose, IRI, IGR, Cpeptide, and proinsulin levels contribute to the diagnosis of insulinoma. However, the preoperative tumor localization is still difficult. Tumor enucleation is the technique of choice when feasible. Patients in whom tumor localization is unsuccessful at operation should be carefully evaluated to be certain of the diagnosis, and in general should not undergo blind resection.

Abstract:Abstract:Objective: To investigate a detective methods of choledocholithiasis.
Methods :Using retrospective study methods, a logistic regression descriminant analysis of 16 factors related to choledocholithiasis was made and a relative discriminant model was constructed.
Results:Logistic regression analyses that had sex, history of jaundice or jaundice, the widest inner diameter of choledochus, AST,ALT and the history of cholecystectomy, cholecystolithiasis and pancreatitis included into discriminant model, gave the best predictive result. A test sample showed the discriminant model had a sensitivity of 89.4％, and a specificity of 80.0%.
Conclusions:Discriminant analysis of logistic regression with clinical data is helpful for diagnosis and treatment of choledocholithiasis.It can also increase the accuracy of the predicion of cholecystolithiasis and serve as a clinical guide.