Abstract:

Objective:To investigate the effect of adjuvant therapy on the treatment of stage Ⅱ pancreatic carcinomas.
Methods:The clinical data of 139 patients with stage Ⅱ pancreatic carcinoma were analyzed tetrospectively.
Results:The overall 1, 3 and 5-year cumulative survival rate of 139 patients was 40%, 6% and 3% respectively, and the median survival time (MST) was 279 days. The MST was  390 days for the radical resection group, 270 days for the bypass operation and laparotomy group, and 132 days for the non-surgical group;  and 399 days for those with adjuvant therapy, 210 days for those without adjuvant therapy; The adjuvant therapy did not significantly prolong the survival time nor decrease the liver metastasis rate in the patients with stage Ⅱ carcinoma undergoing radical resection (P＞0.05). However, in the patients undergoing bypass operation, laparotomy or non-surgiery, the adjuvant therapy improved the survival significantly (P＜0.05), but the survival rate was not significantly different between systemic venous chemotherapy, radiation therapy, interventional therapy and combination therapy (P＞0.05); and was also not significant difference between gemcitabine (GEM) regimen and 5-fluorouracil regimen (P＞0.05), or between GEM monotherapy and GEM combined with platinum/capecitabine (P＞0.05).
Conclusions:The proper adjuvant therapy can be suggested for the patients after radical resection for stage Ⅱ pancreatic carcinoma according to patient′s condition. Chemotherapy combined with radiation should be applied aggressively for the patients whose cancer was not radically resected. The clinical efficacy of GEM combined with platinum/capecitabine is relatively better than GEM alone.

Abstract:

Objective:To explore the efficacy of pancreatoduodenectomy complemented with side-to-side jejunojejunostomy for prevention of postoperative complications.
Methods:The clinical data of 97 cases undergong pancreatoduodenectomy in our hospital from 2002 to 2006 were retrospectively analyzed. Pancreatoduodenectomy complemented with side-to-side jejunojejunostomy was performed in 43 cases, and 54 cases underwent traditional reconstruction.
Results:In the cases with and without jejunojujunostomy, pancreatic fistula developed in 2 and 11 cases (χ2=5.097,P=0.024), bile leakage in 1 and 2 cases(χ2=0.000,P=1.000), pulmonary infection in 7 and 12 cases(χ2=0.537,P=0.464), abdominal infection in 6 and 12 cases(χ2=1.083,P=0.298), incision site infection in 3 and 8 cases(χ2=0.787,P=0.375), and upper gastrointestinal hemorrhage in 18 and 20 cases (χ2=0.234,P=0.629), respectively.
Conclusions:Pancreaticoduodenectomy complemented with side-to-side jejunojejunostomy can reduce the incidence of pancreatic fistula.

Abstract:

Objective:To evaluate the influence of an improved end-to-end pancreaticojejunostomy on the occurrence of pancreatic fistula after pancreaticoduodenectomy (PD).
Methods:We retrospectively analysied 71 cases of pancreaticoduodenectomy and compared the occrrence rate of pancreatic fistula between different types of pancreaticojejunostomy.
Results:The overall morbidity rate of pancreatic fistula was 18.3% (13/71). The occurrence rate of pancreatic fistula after improved end-to-end pancreaticojejunostomy (0%, 0/22) was significantly lower than that of traditional end-to-end anastomosis (27.6%, 8/29) (P<0.05) and that of end-to-side anastomosis (25%, 5/20) (P<0.05)，but there was no significant difference between traditional end-to-end anastomosis and end-to-side anastomosis (P>0.05).
Conclusions:This improved end-to-end pancreaticojejunostomy can significantly reduce the occurrence rate of pancreatic fistula after PD.

Abstract:

Objective:To summarize the experience and lessons of reoperation in management of postoperative complications of pancreaticoduodenectomy (PD). 
Methods:The cause, surgical procedure and outcome of reoperation in 239 patients undergoing PD between Janunary 2001 and June 2009 were retrospectively analyzed.
Results:The total mobidity was 30.5% and the mortality was 4.4% in the 239 patients. Twelve (5.0%) patients underwent reoperation, including 6 cases of intra-abdominal hemorrhage, 2 incision dehiscence, 1 pancreatic fistula combined with intra-abdominal infection, 1 pancreatic fistula combined with intra-abdominal hemorrhage, 1 pancreatic cut surface hemorrhage and 1 intra-abdominal infection. The time of reoperation was  1h to 13d postoperatively. The mortality of reoperation was 25.0%.
Conclusions:Hemorrhage, pancreatic fistula and incision dehiscence are the major causes of reoperation after PD. Timely and decisive reoperation is an important method in management of postoperative complications of PD, but is accompanied with a rather high mortality.

Abstract:

Objective:To study the methods used for diagnosis and surgical treatment of insulinoma.
Methods:We retrospectively analyzed 55 cases of insulinoma treated in our hospital from 1988 to 2009.
Results:Of the 55 cases, 7 of non-functional insulinoma, 48(87.27%) had typical Whipple′s triad and the IRI/G was greater than 0.3, and were diagnosed as functional insulinoma. The diagnostic sensitivity of transabdominal ultrasonography was 83.64%(46/55),  CT was 62.07%(18/29),  MIR was 40.00%(4/10), endoscopic ultrasonography was 100%(8/8), intraoperative ultrasonography was 90.00%(9/10) and DSA was 40%(2/5). Simple enucleation was performed in 48 patient-times, resection of pancreatic body and tail(or just tail) in 5 cases, resection of pancreatic body and tail plus the spleen in 3 cases, central resection of pancreas in 1 case and pancreaticoduodenectomy in 1 case. The diameter of 95.00% (57) of tumors was ≤2 cm, and  23.33% (14) tumors were located in the head of the pancreas, 33.33% (20) in the body, and 43.33% (26) in the tail. Three patients had multiple tumors.  All of the 55 cases were diagnosed as insulinoma pathologically. None was malignant. After operation, blood glucose became normal in all cases but pancreatic fistula occurred in 1 case.
Conclusions:Whipple′s triad and IRI/G>0.3 is the main basis for the qualitative diagnosis of insulinmoma. Combined methods including Ultrasonography, CT, MIR, and endoscopic ultrasonography should be used for localization diagnosis before operation. The positive localization rate of endoscopic ultrasonography is the highest. The application of intraoperative palpation and intraoperative ultrasonography shows great significance for insulinoma localization. Simple enucleation is the most common and optimal surgical method. 

Abstract:

Objective:To explore the efficacy of central pancreatectomy for patients with benign pancreatic lesions.
Methods:The clinical charactesistics, operative methods and therapeutic results of twelve patients with benign pancreatic lesions were retrospectively analyzed.  Seven patents with islet cell tumor and 3 patients with true pancreatic cyst underwent central pancreatectomy, closure of the proximal pancreatic stump and Roux-en-Y anastomosis of the distal segment of pancreas; two patients with pancreatic calculi underwent calculi extraction, central pancreatectomy and Roux-en-Y pancreato-jejunostomy of the proximal and distal pancreatic segments.
Results:There were no deaths, pancreatic fistula or other complications in this series. No abdominal pain, fever or hypoglycemia at 6 montns to 3 years  follow-up period.
Conclusions:Central pancreatectomy is an effective method for treatment of patients with benign central pancreatic lesions.

Abstract:

Objective:To investigate the effect of herbs extracts Qingyi granules on the expression of  claudin-1 of ileum in rats with severe acute pancreatitis (SAP).
Methods:Ninety-six healthy male Wistar rats were randomly divided into sham operation group, SAP model group and SAP+Qingyi granules (treatment)group. SAP model was induced by retrograde injection of  3.5% sodium deoxycholate into the biliopancreatic duct of rats, while the sham operation group were treated only with saline. Treatment group was given orally Qingyi granules at 2 hours before induction of SAP and Q12h after SAP. At 6, 12, 24 and 48 h after SAP, the histopathology of terminal ileum tissue was examined by HE staining, and the expression of  claudin-1 was detected by using immunohistochemistry and real-time PCR respectively.
Results:Compared with SAP  group, the pathological damage of ileum tissue was reduced at 24 and  48 h, the protein and mRNA expression of claudin-1 were all increased at 6, 12, 24 and 48 h after SAP in treatment group (P＜0.05).
Conclusions:Qingyi granules can increase the expression claudin-1 protein and mRNA, and thus can protect the intestinal mucosa and maintain the function of intestinal mucosal barrier.

Abstract:

Objective:To  study the combined hyperbaric oxygen (HBO)  and ulinastatin treatment on plasma endotoxin, sCD14and  plasma endotoxin inactivation capacity (EIC)  in acute necrotizing  pancreatitis (ANP) in rats, and its effect on prognosis.
Methods:SD rats were divided into control group (group A), sham operation group(group B),  ANP group (group C),   ANP+HBO group (group D), ANP+unlinastatin group (group E), and ANP+HBO+unlinastatin group (group F) randomly.  Rat ANP model was made by retrograde injection of 3.5% sodium taurocholate (2.5 ml/kg) via the pancreatic duct;  5  min after model had been made, group E and group F were injected  with unlinastatin (20 000 U/kg) via portal vein; 30 mins after model had been made, group D and group F were given hyperbaric oxygen treatment for 2h, 3h, 6h and 10h, after which, the plasma endotoxin, sCD14, EIC, TNFa and survival time in each group were examined individually.
Results:(1) Endotoxin and sCD14: At 3h and 6h after model had been made, the levels of plasma endotoxin and sCD14 in group D and group E were significantly lower than those in group C（P<0.05）. At 3h, 6h and 10h after model had been made, the levels of plasma endotoxin and sCD14 in group F were significantly lower than those in group C,  group D and group E （P<0.05）. (2) EIC: At 3h, 6h and 10h after model had been made, the levels of EIC in group D, group E and group F were significantly higher than those in group C, group D and group E （P<0.05）. the level of EIC in group F was significantly higher than that in group C and group D（P<0.05）. (3) TNF-α: At 3h, 6h and 10h after model had been made, the level of TNF-α in group D, group E and group F was  significantly lower than that in group C（P<0.05）. the level of EIC in group F was  significantly lower than that in group D and group E（P<0.05）. (4)Survival time: the survival time in group D, group E and group F was  significantly longer than those in group C（P<0.05）. the survival time in group F was longer than that in group D and group E significantly（P<0.05）.
Conclusions:Hyperbaric oxygen or ulinastatin is individually effective in ANP, and combined hyperbaric oxygen and ulinastatin treatment is much more effective than either of them.

Abstract:

Objective:To investigate the expression of NF-κB (nuclear factor-κB) and PUMA(p53 upregulated modulator of apoptosis)in severe pancreatitis-acute lung injury(SAP-ALI) and the effect of proline dithiocarbamate (PDTC) therapy.
Methods:SD rats weighing 200-250g were randomly divided into three groups: Sham operation group(A group，n=24)，SAP-ALI group(B group，n=24),  SAP+PDTC treatment group(C group,n=24).The model of SAP was established by injecting 1ml/kg of 5% sodium taurocholate into the pancreatic capsule of the rats in B group. On the basis of B group, C group was treated by PDTC at 1h after modeling. Eight rats of each group were killed in the following 6,12 and 24 h. The histopathologic changes in lung and pancreas were observed. The expressions of NF-κB, PUMA and caspase-3 in the lungs were detected by Western blotting, the expressions of TNF-α、MIP-2 and ICAM-1 mRNA in the lungs were detected by RT-PCR. The pulmonary injury was determined by myeloperoxidase (MPO) activity and TUNEL detection.
Results:Pathologic scores of lung in B group (6-24 h)were significantly higher than those in A and C group (P<0.05).The expressions of NF-κB p65,PUMA,Caspase-3 and TNF-α,MIP-2,ICAM-1 mRNA in B group in differant time point（12,24 h） were all higher than those in A and C group(P<0.05). NF-κB was correlated strongly with PUMA （r=0.987, P<0.01）.Higher activity of MPO and caspase-3 active were seen in B group than that in  A and B group. DNA ladder was easily seen in group B.
Conclusions:PDTC treatment can inhibit apoptosis of alveolar epithelial cells in SAP-ALI by inhibiting the activation of NF-κB, by which  the PUMA was down-regulated, the bcl-2 was up-regulated and caspase-3 was down-regulated. On the other hand, PDTC can inhibit the activation of NF-κB,which in turn decreases the lung injury by inhibiion of the cytokine and inflammation medium.

Abstract:

Objective:To evaluate the effect of gastric bypass on  fasting blood glucose levels in  Goto-Kakizaki(GK) rats. 
Methods:Thirty-two GK  type 2 diabetic rats were devided into four groups with different fasting blood glucose level: Group A,（<10 mmol/L）;Group B,（10~15 mmol/L）; Group C,（15~20 mmol/L）; Group D,（>20 mmol/L）.Rats were observed for 24 weeks after gastric bypass(GBP) surgery. Fasting blood glucose level and fasting insulin level were measured at 0, 1, 3, 6, 12 and  24 wks postoperatively.  The 24-week descend ratio of glucose after operation was calculated by formula.
Results:The glucose descend ratio of each groups was 35.4%, 44.3%, 40.3% and 30.1%, respectively. But, campared to pre-operation, the insulin level of all groups showed no significant change (P>0.05).
Conclusions: In spontaneous type 2 diabetes mellitus rats, gastric bypass operation was effective in all the groups in terms of glucose control. But the effect on glucose control varied among the groups. These findings suggest that there is more marked effect when the preoperative fasting blood glucose level between 10  mmol/L and 20 mmol/L.

Abstract:

Objective:To investigate the mechanism of the cell cycle-associated gene expression regulated by Apr-1 gene in QBC939 cholangiocarcinoma cells. 
Methods:Apr-1 gene was transfected into QBC939 cells by using liposomes to establish a QBC939 cell model (QBC939-Apr-1) stably expressing Apr-1 gene. Then, the regulatory effect of Apr-1 gene on the expression of cell cycle-associated genes was investigated in QBC939 cells before and after Apr-1 transfection using the cell cycle gene microarrays. 
Results:Apr-1 mRNA was expressed in QBC939 cells transfected with Apr-1 gene, suggesting successful establishment of the QBC939 cell model stably expressing Apr-1 gene. The cell cycle gene microarrays demonstrated that the expression of Skp2 and UBE1 was up-regulated, while the expression of MRE11A、CKS2、CDK8 and CDC45 was down-regulated by more than 3 folds. 
Conclusions:The cell cycle gene microarray analysis revealed multiple alterations of the cell cycle-associated genes that were regulated by Apr-1 gene, which may help further understand the mechanism by which Apr-1 gene contributes to the regulation of cell cycle.

Abstract:

Objective:To explore the availability of targeted against polo-like kinase 1 (PLK1) gene in the therapy of hepatocellular carcinoma.
Methods:After Hep G2 hepatocellular carcinoma cells were transfected with small interfering RNA (siRNA) against PLK1, real-time RT-PCR and Western blotting were used to examine PLK1 gene expression in all cancer cells. The proliferation and growth of cancer cells in vitro were studied. Apoptosis of cancer cells was evaluated by terminal uridine deoxynucleotidyl nick end labeling (TUNEL) and agarose gel electrophoresis, respectively.
Results:Transfection of PLK1 siRNA resulted in significant inhibition of hepatocellular carcinoma cells in vitro. Expression of PLK1 in HepG2 hepatocellular carcinoma cells transfected with siRNA was down-regulated significantly. Obvious DNA ladder was shown. Cancer cells exhibited marked apoptosis in a time-dependent manner.
Conclusions:RNA interference PLK1 can inhibit proliferation through inducing apoptosis of human hepatocellular carcinoma cells. It provides a new route of treatment of hepatocellular cancer targeted against PLK1gene.

Abstract:

Objective:To observe the effects of galectin-3 on proliferation of endothelial cells induced from bone marrow mesenchymal stem cells.
Methods:The cultured mesenchymal stem cells in vitro were isolated and purified from Sprague-Dawley rats bone marrow by gradient centrifugation on lymphocytes separation medium. Cells of passage 3 were differentiated into endothelial cells by vascular endothelial growth factor(VEGF)and basic fibroblast growth facotr(bFGF).These cells were identified as endothelial cells by immunohistochemistry stain and electronic microscopy 14 days after induction.Then, the cells were cultivated with the galectin-3 for 24 hours with centrations of 0.1μg/mL，1μg/mL and 5μg/mL.The proliferation of endothelial cells induced from bone marrow mesenchymal stem cells was measured by MTT, and flow　cytometry was applied to observe cell cycle.
Results:(1)Moderate and high concentrations(1μg/mL and 5μg/mL) of galectin-3 promoted proliferation of endothelial cells (P<0.05);(2) Flow cytometry showed that S phase cells increased obviously in every group (P<0.05)and G2M phase increased in the concentrations of 1μg/mL and 5μg/mL(P<0.05).
Conclusions:Galectin-3 can promote the proliferation of endothelial cells induced from bone marrow mesenchymal stem cells.

Abstract:

Objective:To investigate the non-surgical treatment  of severe non-biliary pancreatitis.
Methods:A retrospective analysis  of 125 cases of severe non-biliary pancreatitis was undertaken. Of these, 105 patients had non-surgical treatment and 20 patients had surgical treatment.
Results:In 105 patients with severe non-biliary pancreatitis treated conservatively,103 cases were cured and 2 patients died, while 2 of 20 patients died after surgery.
Conclusions:The majority of cases of severe non-biliary pancreatitis  can be cured by non-surgical treatment, but if the condition increases in severity, surgical treatment should be considered.

Abstract:

Objective:To investigate the value of fast track surgery (FTS) applied in emergency cholecystectomy of old patients.
Methods:To compared the effect of  FTS and traditional methods in the treatment of old patients who were treated with emergency cholecystectomy in our hospital, and to observe gut function, hospitalization time, C-reactive protein, procalcitonin and postoperative complications of the two groups.
Results:All the patients were cured without abdominal complications. In  traditional therapy group,  level of C-reactive protein and procalcitonin was higher, and return time of gut function and hospitalization time was longer, compared with that in FTS therapy group, while the postoperative complications of the two groups showed no difference.
Conclusions:Fast track surgery is effective in emergency cholecystectomy of old patients, which can reduce the stress, shorten hospitalization time, and promote the recovery of patients.

Abstract:

Objective:To summarize long-term effects of surgical treatment with double devascularization on portal hypertension complicated with  upper gastrointestinal bleeding (UGIB).
Methods:A total of 367 patients with UGIB due to portal hypertension underwent double devascularization from1989 to 2008, and were followed up for 1 to 19 years (average 16 years). Three hundred and nine cases underwent elective surgery and 58 cases underwent emergency surgery.
Results:Bleeding was controlled in all 58(100%) cases after emergency operation. The average portal pressure reduction was 4.3 cm H2O. Follow-up at 6-19 years showed rebleeding in 8 cases(2.5%).The survival rate at 1-5, 6-10 and 11-19 years was 83.05%, 91.85% and 92.80%  respectively.
Conclusions:Double devascularization is a safe and effective treatment for portal hypertension complicated with UGIB becauce it has high, emostasis rate, fewer complications, low rebleeding rate and high long-term survival.

Abstract:

Objective:To observe the clinical effect of closed negative pressure drainage on refractory wounds.
Methods:Seventy-eight patients with refractory wound were randomly divided into 2 groups; The treatment group (38 patients) was treated with closed negative pressure drainage ;the control group (40 patients) was treated by conventioal methods.The time for wound surface to enter into the red stage, the 1-week wound healing rate, and the overall healing time between the 2 groups were compared.
Results:Treatment group was significantly better than control group in the time for wound surface to enter into the red stage, the 1-week wound healing rate,and the overall healing time (all, P＜0.05).
Conclusions: The closed negative pressure drainage therapy is better than conventional treatment for refractory wound because it can promote wound healing and its use is convenient, and thus it is advocated for widespread use.