Abstract:Abstract:Objective:To investigate the timing of endoscopic therapy of obstructive acute biliary pancreatitis.
Methods :Three hundrend and sixty cases of obstructive acute biliary pancreatitis treated by endoscopy were analyzed.The patients were divided into two groups: One hundred and sixty-eight cases received emergency endoscopic therapy (EE group） within 48 hours from the onset of symptoms，including endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy（ERCP+ES）, with or without stone extraction and endoscopic naso-biliary drainage（ENBD）;192 cases received delay endoscopic therapy（DE group）after initial 48 hours of conservative management.
Results:The total success rate of therapeutic endoscopy was 96.9 %. The time for disappearance of abdominal pain, the time for serum amylase level、serum bilirubin level and WBC count to return to normal, and the length of hospitalization were significantly shorter in EE group than those in DE group（all P<0.05-0.001）.In cases with severe acute biliary pancreatitis,the morbidity in the EE group was significantly lower than DE group（9.6 %vs28.9 %,P<0.05）, but the difference in mortality rate between the two groups was not significant（P>0.05）. In cases of mild acute biliary pancreatitis, morbidity and mortality rate between the EE and DE groups were not significantly different（P>0.05）.
Conclusions:This study shows that in severe acute biliary pancreatitis patiens with biliary tract obstruction, emergency endoscopic therapy should be performed within 48 hours from the onset of symptoms; patients with mild acute biliary pancreatitis shoud also undergo prompt endoscopic therapy after ineffective conservative management or appearance of symptoms of acute biliary tract infection.

Abstract:Abstract:Objective:To explore the therapeutic modalities and clinical characters of acute pancreatitis (AP) in the middle or late stage of pregnancy.
Methods :There were 26 cases of AP in the middle or late stage of pregnancy, among which 18 cases (69.2 %) received conservative therapy, and 8 cases (30.8 %) underwent operation for removal of necrotic tissue and termination of pregnancy.
Results:Two cases of both fetus and mother death occurred, whereas 24 mothers were cured. 15 (57.7 %) fetuses were healthy but 11(42.3 %) died.
Conclusions:The women in middle and late stage of pregnancy are inclined to pancreatitis because of hormonal changes, especially in those with history of cholecystitis and cholelithiasis. The main method of management is active non-operative therapy and surgical intervention when necessary, so as to decrease the tragedy of both maternal and fetal death.

Abstract:Abstract:Objective:To observe the potential therapeutic effect of tacrolimus against lung injuries induced by severe acute pancreatitis(SAP) in rats and investigate its mechanism.
Methods :Fifty-four female SD rats were randomly divided into 3 groups: Control group(group C), SAP group(group S) and SAP+ tacrolimus treatment group(group ST) (n=18 each group). Serum levels of tumor necrosis factor-alpha(TNF-α) and matrix metalloproteinase-9(MMP-9), myeloperoxidase(MPO) activity of lung tissue and the protein content of bronchoalveolar lavage fluids(BALF) were evaluated 3,6, and 12h after operation. The survival rates of 3 groups were also evaluated, and histopathologic changes of lung and pancreas were observed.
Results:In group S, serum level of TNF-α and MMP-9, MPO activity of lung tissue, and the protein content of BALF were significantly increased than those in group C (all P<0.01). All the indicators of group ST were significantly decreased 12h after operation as compared with group S ［TNF-α：（171.31±19.58）vs（243.17±26.19）;MMP-9：(1 658.32±27.49)vs(2 987.34±34.53);MPO：（2.75±0.22）vs（11.27±0.49）; BALF：（631.58±57.25）vs（1 987.39±158.34）］ (P<0.01). Histopathology showed that the lung and pancreas injuries in group S were gradually aggravated with disease progression, and alleviated obviously with tacrolimus treatment.
Conclusions:Tacrolimus can relieve the severity of lung injuries of pancreatitis rats, increase survival rate, and provide a certain therapeutic effect for SAP rats. The mechanism of tacrolimus effect may be related to the reduction of lung blood capillary permeability, and the inhibition of serum level of TNF-α and MMP-9, lung MPO, and other inflammatory factors.

Abstract:Abstract:Objective:To explore the effects of ethyl pyruvate (EP) on high mobility group box-1 protein (HMGB1) expression in severe acute pancreatitis (SAP) rats.
Methods :Ninety male wistar rats were divided randomly into three groups: Group A (SAP group); group B (SAP rats received ethyl pyruvate therapy); group C (control group). Specimens from rats in the three groups were taken at 3, 6, 12, 24 and 48 h after operation respectively. The concentration of plasma amylase and D-lactate the activity of malonyl dialdehyde (MAD) in the intestinal tissue were determined. The changes of morphological damage of intestinal tissue was observed by microscopy. The expression of HMGB1 in intestinal mucosa was observed by SP immunohistochemistry and the activity of HMGB1 was determined by western blot.
Results:Compared with group A, Ievels of plasma amylase, and D-lactate in group B decreased markedly (P<0.05). Compared with group C, MDA in group A increased significantly (P<0.01). Compared with group A, the pathological lesion of intestinal mucosa was improved and the expression of HMGB1 was obviously down regulated in group B (P<0.05). The expression of HMGB1 in bowel tissues in group A was increased significantly at 6h and maintained to 24h after SAP model was induced; whereas in group C, HMGB1 expression was significantly lower than that in group A at each time point (P<0.05).
Conclusions:HMGB1 can mediate an increase in penetrability of intestinal mucosal barrier in SAP. EP can down-regulate HMGB1 expression in intestinal tissues of SAP rats, improve the function of intestinal mucosal barrier, and protect intestine from injury induced by SAP.

Abstract:Abstract:Objective:To discuss the effect of anti tumor necrosis factor α(TNF-α) treatment on NF-κB signaling in lung injury in severe acute pancreatitis(SAP) in rats.
Methods :SD rats were randomized into three groups：Control group，SAP group and anti TNF-α antibody treatment group。Each group was divided into 1, 3, 6 and 12 h postoperation subgroups(each,n=6). SAP rat model was induced by intraductal administration of 5% sodium taurocholate. Alveolar macrophages(AM) were obtained by bronchoalveolar lavage. The protein content of bronchoalveolar lavage fluids(BALF), the myeloperoxidase(MPO) of lung tissue and generation of TNF-α by AM were detected. The expression of TNF-αmRNA was measured by RT-PCR technique. The histology of lung was also checked as well as the expression of NF-kappa B was detected by immunohistochemistry.
Results:The activation of NF-kappa B was seldom seen in AM of control group lung tissue, while it could be observed in SAP groups, and NF-kappa B moved from cytoplasm into nuclei with time prolongation.A slight amount of NF-kappa B activation was still observed in anti TNF-α antibody treatment group. The lung injury was increasingly aggravated with disease progression. The level of myeloperoxidase of lung tissue and protein content of BALF were also increased with time prolongation, and the maximum level occurred at 12h［(10.78±0.58) U/g for MPO and (2 011.0±105.5)μg/mL for protein respectively］. The generation of TNF-α by AM was gradually elevated and peaked at 6 h ［（1 624.2±149.2) pg/mL］, but decreased at 12h. The change of expression of TNF-αmRNA was similar to TNF-α. All the indicators of SAP group compared with control group had the statistical significance (P<0.05). All indicators in anti TNF-α antibody treatment group were significalltly increased compared with the control group (P<0.05), however, they were decreased compared with the SAP group (P<0.05). The generation of TNF-α by AM had close relation to the level of MPO of lung tissue and protein content of BALF(r=0.65, 0.76 respectively, P<0.01).
Conclusions:Anti TNF-α antibody treatment could inhibit the feedback effect of TNF-α on the activation of NF-κB of AM, and directly decrease the secretion of TNF-α, which can ameliorate the lung injury in SAP in rats.

Abstract:Abstract:Objective:To explore the therapeutic effects and mechanisms of somatostatin on liver injury in acute hemorrhagic necrotizing pancreatitis(AHNP) in rats.
Methods :Murine model of AHNP was established by retrograde injection of artificial bile into the biliopancreatic duct.The animals were divided into sham operation group(S group), AHNP saline injection group(AHNP group), and AHNP octreotide treated group. TLR2,4 mRNA expressions and NF-κB expressions in the liver tissue at 3,6 and 12h after operation were measured.
Results:TLR2,4 mRNA in liver tissue in the AHNP group began to rise at 3h，and peaked at 12 h（P<0.01）;NF-κB expression in liver tissue also began to rise at 3h, and peaked at 6h. In contrast, in the groups treated with Somatostatin,TLR2,4 mRNA and NF-κB expression in the liver tissue decreased at each time point (P<0.05).
Conclusions:Somatostatin has a protective effect on AHNP. The mechanism may be by inhibition of the secretion and activation of elastase, inhibition of Toll receptor and NF-κB expression and decrease of inflammatory reaction, and decrease the liver injury.

Abstract:Abstract:Objective:To investigate the protective effects of sphingosine-1-phosphate (S1P) on lung injury (L1) in acute necrotizing pancreatitis rats.
Methods :Thirty-six Wistar rats were allocated to sham operation group, acute necrotizing pancreatitis model group and S1P pretreatment group. Bronchoalveolar lavage fluid (BALF) and tissues from the left lung and pancreas were collected 6h after the model induction. BALF protein content, BALF leucocyte and neutrophil count, and lung tissue myeloperoxidase (MPO) activity were examined. Serum amylase and lipase were determined. In addition, histopathological changes of the pancreas and lung were observed under light microscope.
Results:BALF protein content, BALF leucocyte and neutrophil count, and lung tissue myeloperoxidase (MPO) activity were all reduced significantly in S1P pretreatment group compared to those in acute necrotizing pancreatitis model group (P<0.01).The pathological injury of the lung was obviously less severe in S1P group compared to that in model group. The serum amylase and lipase levels and the pathological damage of the pancreas were not reduced in S1P group.
Conclusions:S1P has a significant protective effect on LI in SAP rats,and it may be used as a clinical therapeutic strategy for acute necrotizing pancreatitis.

Abstract:Abstract:Objective:To investigate the role of the spleen in the pathogenesis of acute pancreatitis(AP).
Methods :The studied rats were divided randomly into four groups:Sham operation group, splenectomy group, AP group and AP with splenectomy group.The rats were sacrificed at 3h,6h and 12h after operation, and spleen and pancreas were removed for examination. Light microscopy was used to examine pancreatic tissues for pathologic change and to assess pathology score. Immunohistochemical method was used to observe the activity of splenic NF-κB(p65) in the rats with AP.
Results:The pancreas pathology score in the AP with splenectomy group was significantly lower than that in AP group at 6h(7.83±0.753vs 9.67±1.211) and 12 h (9.67±0.816 vs13±0.894) after operation (P<0.01). The positive expression of splenic NF-κB(p65) began to be intensified at 3 h(46.967±1.148),peaked at 6h(56.333±1.588),attenuated at 12h(36.900±0.756) in the rats with AP, and all showed significant differences compared with that in sham operation group(3.400±0.800).
Conclusions:The spleen can significantly promote the production and release of inflammatory mediators in AP, which plays an important role in the pathogenesis of AP.

Abstract:Abstract:Objective:To investigate the effect of inducible nitric oxide synthase inhibitor aminoguanidine on transplanted pancreas in rats.
Methods :The models of pancreas transplantation were established in 30 rats.The streptozotocin induced diabetic male Wistar rats were randomly assigned to 3 groups: (1) Blank control group(n=6), the rats underwent shamsurgery; (2) transplant control group (n=6), the rats received pancreas transplantation only; (3) aminoguanidine group(AG group) (n=18), aminoguanidine (a dose of 60, 80, or 100 mg/kg weight) was added to the intravascular infusion before reperfusion of the transplanted pancreas. At 4h after reperfusions, serum nitric oxide（NO） level, blood sugar, and amylase activity were detected. cNOS and iNOS activity of pancreas were detected Pancreas sections were evaluated by light microscopic examination with HE staining and immunohistochemistry staining.
Results:As compared with transplant control group, the serum NO level and amylase activity decreased significantly, and pancreas injury was much less in AG groups, especial in AG-80 mg/kg sub-group showed the most significant difference（P＜0.01）.The expression and activity of tissue iNOS activity, and blood sugar in AG-80 mg/kg sub-group were much lower than those in transplant control group（P＜0.01）.
Conclusions:Selective iNOS inhibitor-aminoguanidine has protective effect on the transplanted pancreas in rats. The possible mechanisms may be inhibition of overproduction of NO, and reduction the cytotoxicity as free radicals of NO.

Abstract:Abstract:Objective:To explore the methode to screen for relatively specific markers in serum of pancreatic cancer patients using surface-enhanced laser desorption and ionization time of fight mass spectrometry（SELDI-TOF-MS）.
Methods :Serum samples from 20 pancreatic cancer patiants,20 healthy volunteers and 18 patients with other pancreatic diseases were examined. WCX magnetic beans and PBSⅡ-C protein chips reader (ciphergen Biosystems Ins.) were used to detect the protein fingerprint expression of all the serum samples, and the resulting profiles were analyzed with Biomarker Wizard system.
Results:Four differently expressed potential biomarkers were identified with the relative molecular weights of 5 705Da,4 935Da,5 318Da and 3 243Da respectively. Compared with control group, two proteins with m/z 5 705Da and 5 318Da were down-regulated, and two proteins with m/z 4 935Da and 3 243Da were up-regulated in pancreatic cancers.
Conclusions:SELDI technology is a quick, easy and practical method to screen for specific biomarkers in serum of patients with pancreatic cancer. Four different proteins identified in this study may be as specific serum biomarkers of pancreatic cancer.

Abstract:Abstract:Objective:To investigate relation of the MV, count of tumor associated macrophage (TAM) and mast cell (MC) in pancreatic cancer tissues and non-cancerous tissues of rats.
Methods :Immunohistochemical method of ABC was used for detecting the MV TAM, MC counts on the routinely paraffin-embedded sections of 17 cases of pancreatic cancer tissues of rats, 22 cases of non-cancerous pancreatic tissues of rats and 10 cases of normal pancreatic tissues of rats.
Results:In 36 rats, 17 cases of pancreatic ductal adenocarcinoma(47.2 %) within 3-5 months in 36 rats with implanted DMBA. The mean cunt of MV, TAM and MC in the 17 cases of pancreatic adenocarcinoma tissues of rats was 76.56±19.93, 15.54±5.93 and 14.87±5.19 respectively, which was significantly higher than that in the 10 cases of normal pancreatic tissues (30.63±14.77, 11.01±4.99 and 11.04±5.03), which was also higher than those in the model group of non-cancerous pancreatic tissues (24.42±11.32，10.99±4.9 and 9.31±4.64). The counts of TAM and MC of rats of pancreatic cancer within five months were higher than that within 3-4 months (P＜0.01）. The closely positive correlations were also found among the counts of MV, TAM and MC（MV vs TAM, r=0.788; MV vs MC, r=0.832; TAM vs MC, r=0.635）.
Conclusions:A high incidence of pancreatic cancer can be obtained in a short time by use of DMBA directly implanted into the parenchyma of pancreas in rats. TAM and MC might have important effect on angiogenesis of pancreatic cancer of SD rats.

Abstract:Abstract:Objective:To construct and appraise a series of shRNA eukaryotic expression plasmid which contains vary spots of human SKP2 gene.
Methods :Three pairs of hairpin-like oligonucleotide sequences specific for human SKP2 gene were designed and synthesized. They were cloned into the eukaryotic expression pSIREN-RetroQ plasmid. The recombinated plasmids were confirmed by PCR and sequencing.
Results:The shRNA sequences were constructed successfully, and could be inserted into the eukaryotic expression vector pSIREN-RetroQ.
Conclusions:Three shRNA transcripting plasmids pSIREN-RetroQ are successfully constructed, and form a basis for research in cancer gene target therapy against SKP2 gene.

Abstract:Abstract:Objective:To discuss the clinical manifestations of ampullary carcinoma with pathologic cholecystointestinal fistula, so as to improve the rate of preoperative diagnosis.
Methods :The clinical data of 12 cases of ampullary carcinoma admitted to our hospital in recent nine years, and with cholecystointestinal fistula diagnosed at operation, were analyzed retrospectively.
Results:None of the patients had clinical manifestations of obstructive jaundice preoperatively. Ultrasonography suggested ampullary space occupying Flesion with dilatation of extrahepatic and intrahepatic bile ducts, and atrophic gallbladder with indefinite outline and adherence of gallbladde to surrounding tissues in all the cases; the diagnosis of cholecystointestinal fistula was made during operation. There were 7 cases of cholecystoduodenal fistula and 5 cases of cholecystocolonic fistula. The fistula ranged from 0.4 to 2.8 cm in diameter. Four cases underwent radical operation and 8 cases had palliative surgery. Postoperative pathologic examination verified the diagnosis of ampullary carcinoma.
Conclusions:The above-mentioned ultrasonggraphic features in elderly patients with no manifestations of obstructive jaundice, usually indicate the presence of pathologic cholecystointestinal fistula.

Abstract:Abstract:Objective:To analyze the causes, prevention, and treatment of postoperative complications of pancreaticoduodenectomy(PD).
Methods :A retrospective review of 154 consecutive patients who underwent PD with pancreaticojejunostomy in recent 5 years was carried out.In 105 cases, a single-layer invaginated pancreaticojejunostomy was used, and in 49 cases a double-layer invaginated pancreaticojejunostomy was used.
Results:The total complication rate after PD was 22.7 %. The surgery-related complication rate was 18.1 %（19 of 105)in single-layer anastomosis group, while it was 32.7 %(16 of 49,P=0.045) in the double-layer anastomosis group. The pancreatic fistula rate in the single-layer group was 4.8 %（5 of 105）and in the double-layer group was 16.4 % (8 of49,P=0.016).The mean length of hospital stay after PD was longer in the double-layer group ［(22.75±9.73） d］ as compared to the single-layer group ［(18.45±7.11） d］ （P=0.002）. Uni-and multivariate analysis showed 3 independent risk factors for pancreatic fistula formation:(1)male gender; (2)soft pancreatic gland;(3)not using a single-layer invaginated pancreaticojejunostomy.
Conclusions:The appropriate type of pancreaticojejunostomy and perioperative treatment can effectively decrease postoperative complications after PD.

Abstract:Abstract:Objective:To discuss the diagnosis and treatment of insulinoma.
Methods :The clinical data of 30 patients with insulinoma were reviewed.
Results:All patients had Whipple′s triad.Accurate preoperative localization rate of B ultrasonography, CT and MRI was 34.8 %(8/23),58.3 %(7/12) and 71.4 %(5/7)，respectively. Localization rate of intraoperative ultrasonography (IOUS) was 87.5 %(7/8). The tumors were single in 27 cases,and multiple in 3 cases. In the location of single tumor,8 of them were in the head,7 in the body, and 12 in the tail; while for multiple tumors, 2 tumors were both located in the body in 1 patient,and 2 tumors were separately located in the body and tail respectively in 2 patients. Local enucleation was performed in 21 cases, distal pancreatectomy in 6 cases,distal pancreatectomy plus splenectomy in 2 cases,and duodenopancreatectomy in 1 case. The tumor was benign in 29 cases, and malignant in 1 case.Pancreatic fistula developed after operation in 4 cases, and in all cases, it healed after drainage. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 27 cases, 1 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor; the malignant tumor case, recurred and died of metastasis of abdominal cavity 3 years after operation.
Conclusions:Whipple′s triad, and the ratio of immunoreactive insulin to blood glucose （IRI/G）are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Enucleation is the main mode of surgical treatment of insuinoma.

Abstract:Abstract:Objective:To study the surgical treatment of pancreatolithiasis.
Methods :The clinical data of thirty-seven patients with pancreatolithiasis admitted to our hospital from 1994 to 2007 were reviewed.
Results:According to the results of imaging examination (BUS,CT,ERCP) and finding during surgery, pancreatolithiasis was classified into three types: TypeⅠ,the stones were mainly located in the head of pancreas, and Whipple procedure was the treatment of choice. TypeⅡ, the stones were mainly located in the body and tail of pancreas, and resection of the tail of pancreas alone or combined with splenectomy was the management of choice. TypeⅢ, the stones were diffusely scattered in the main duct from the head to tail of pancreas, and pancreatoduodenectomy，together with pancreatolithotomy and pancreatojejunostomy with wide anastomotic stoma was the choice of management. There was no mortality in this series. Within 2 weeks after treatment, symptoms ameliorated to different degrees in all the patients. Thirty one patients were followed up for 6 to 72 months, the results were satisfactory.
Conclusions:The individualized strategy, based on the type of stone location, is of great importance in the management of pancreatolithiasis. The key of surgical treatment of pancreatolithiasis is as follows: removal of pancreatoliths, excision of diseased pancreas, and adequate pancreatic drainage.

Abstract:Abstract:Objective:To sum up the harvesting and trimming (bench surgery) experience of simultaneous pancreas-kidney (SPK) transplantation.
Methods :Retrospectively analysis of the methods of harvesting and skill of trimming in 19 cases of SPK transplantation was made.
Results:No injury of allograft occurred. Exogenous insulin was discontinued within 9 day after operation in 18 patients, and their fasting blood sugar was normal, and urine sugar was negative or(+). Serum creatinine and urea nitrogen became normal at 2-4 d postoperatively. Three transplanted kidney and 2 transplanted pancreas had acute rejection (AR), and all the AR were disappeared after anti-rejection therapy. The SPK grafts in 1 patient was excised on 11 d postoperatively due to accelerated rejection.
Conclusions:The skill of procurement and bench surgery trimming of allograft in one of the key factors for successful SPK.

Abstract:Abstract:Objective:To evaluate the effects of continous portal vein infusion chemotherapy combined with hepatectomy for treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombi(PVTT) during operation.
Methods :From Apr 2001 to Apr 2004, 38 patients with HCC and PVTT were randomly divided into two groups:19 patients(group A) received continous portal vein infusion chemotherapy combined with hepatectomy, and removal of tumor thrombi;19 patients(group B) underwent only hepatectomy and removal of tumor thrombi. After operation, the two groups had treatment with hepatic artery chemotherapy (HAC) and / or portal vein chemotherapy(PVC).
Results:The AFP negative rate of group A at 7 d and 30 d after operation was significantly higher than that of group B(P>0.05). The 1- and 3-year recurrence rate of group A was significantly lower than that of group B (P>0.05), and the 1- and 3-year survival rate of group A was significantly higher than that of group B (P<0.05).
Conclusions:Continuous portal vein chemotherapy with hepatectomy and removal of tumor thrombi during operation, and postoperative HAC with or without PVC is an effective approach for treatment of HCC with poratal vein tumor thrombi.