Abstract:Objective: To investigate the characteristics of paralytic ileus (PI) during the course of severe acute pancreatitis (SAP) and its influence on the prognosis. Methods: The clinical data of 45 patients with SAP admitted from February 2011 to March 2012 were reviewed. Of the patients, 19 cases were complicated with PI (SAP+PI group) and 26 cases without PI (SAP group). The clinical characteristics of SAP with associated PI and its prognosis were analyzed. Results: CT scan showed the incidence of the accumulation of gas and fluid in small intestine and colon, hugely distended bowel loop and bowel wall edema in SAP+PI group was 100%, 73.7% and 78.9% respectively, while in SAP group, the first two signs were not obvious and the incidence of bowel wall edema was 50% (P=0.048). Compared with SAP group, the gastric retention volume, incidence of feeding intolerance (FI) and jaundice, and the intra-abdominal pressure (IAP) as well as the extent of IAP change were significantly elevated in SAP+PI group (all P<0.05). In addition, the length and cost of hospitalization, and mortality rate were increased in SAP+PI group compared with SAP group (all P<0.05). Univariate analysis indicated that FI, IAP (>15 mmHg), jaundice and gastric retention volume (>250 mL/d) were important factors affecting the prognosis of SAP patients (all P<0.05). Conclusion: The predominant signs of SAP with PI in CT images are the accumulation of gas and fluid and hugely distended bowel loop. SAP patients with associated PI are frequently complicated by intra-abdominal hypertension, jaundice, FI and gastric retention, which may contribute to the increased mortality of these patients.

Abstract:Objective: To investigate the clinical efficacy of continuous regional arterial infusion (CRAI) combined with blood purification therapy in treatment of severe acute pancreatitis (SAP). Methods: A historical comparative analysis was performed in the clinical data of 23 SAP patients from January 2008 to January 2011 undergoing CRAI plus blood purification therapy (CRAI group) and 26 SAP patients from January 2003 to September 2010 receiving traditional treatment (traditional group). The alterations of the clinical parameters before and after treatment, and therapeutic efficacies between the two groups were compared. Results: All the observed pre-treatment clinical variables had no obvious differences between the two groups (all P>0.05). On the third and seventh day after treatment, the body temperature, heart rate, APACHE-II score, white blood cell count, and levels of alanine transaminase and creatinine significantly decreased and the oxygenation index and platelet count significantly increased in CRAI group compared with traditional group (P<0.05 or P<0.01). The length of time of abdominal pain and for distension resolution, bowel function recovery and hospital stay in CRAI group were all shorter than those in traditional group (all P<0.01). Furthermore, the incidence of complications, surgical conversion rate and mortality of CRAI group were all significantly lower than those of traditional group (P<0.05 or P<0.01). Conclusion: Combination of CRAI and blood purification can improve the cure rate and reduce the complications of SAP, so it is an effective modality of treatment for SAP.

Abstract:Objective: To compare the clinical efficacies between percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) insertion and nasojejunal tube in enteral nutrition (EN) for severe acute pancreatitis (SAP). Methods: The treatment records of 61 SAP patients were retrospectively analyzed. Fifteen cases underwent PEG/J insertion (PEG/J group) and the other 46 cases received nasojejunal tube feeding (nasojejunal tube group). The operative time, time to first defecation, time for hemogram returning to normal, incidence of catheter-related lung infection, duration of feeding tube retention and subjective comfort levels of the two groups were compared. Results: PEG/J group had a prolonged operative time, but faster recovery of bowel function and shorter time for hemogram to return to normal compared with nasojejunal tube group (all P<0.05). In PEG/J group, the duration of tube retention was longer, but the incidence of catheter-related lung infection was lower and the subjective comfort level was better than those of nasojejunal tube group (all P<0.05). Conclusion: In early EN support for SAP, PEG/J insertion has better efficacy and fewer complications than those of nasojejunal tube feeding, which is beneficial for the late nutritional support and recovery of the SAP patients.

Abstract:Objective: To monitor the alterations of TNF-α, IL-1β and IL-6 levels in patients with severe acute pancreatitis (SAP), so as to determine the influence and significance of enteral nutrition (EN) on excessive activation of leucocytes during the early course of SAP. Methods: Seventy-nine SAP patients were divided into EN group and parenteral nutrition (PN) group, and all the patients received the basic treatment according to guidelines for SAP management. In PN group (25 cases), the PN support was initiated on the third day after onset and continued until oral intake was resumed. In the EN group (54 cases), the EN support was started at different time periods after onset (the first, fourth or sixth day after onset) and continued until oral intake was resumed. The drop extent in TNF-α, IL-1β and IL-6 levels of the two groups were compared. Results: The TNF-α, IL-1β and IL-6 levels in both groups decreased gradually after treatment. However, from the fifth day after treatment, the drop extents of above parameters in each EN group were significantly evident than those of PN group (P<0.05), and the earlier the EN support was initiated, the more evident did the above parameters decrease (P<0.05). Conclusion: Early EN support can effectively reduce the TNF-α, IL-1β and IL-6 levels in SAP patients, and it is faster than PN support in reducing the duration of excessive activation of leucocytes during SAP, which is beneficial to the recovery of the patients.

Abstract:Objective: To evaluate the practicability, safety and effectiveness of pancreatic-duct hanging and end-to-side continuous pancreaticojejunostomy in pancreaticoduodenectomy (PD). Methods: Using a prospective, randomized, controlled design, 165 patients undergoing PD were allocated to use an end-to-end or end-to-side invagination anastomosis (group A), end-to-side mucosa-to-mucosa anastomosis (group B) or pancreatic-duct hanging and end-to-side continuous pancreaticojejunostomy (group C) for pancreaticojejunostomy, respectively. The rate of pancreatic fistula and other complications after PD among the groups were compared. Results: The overall incidence of pancreatic fistula was 13.9% (23/165). The incidence of pancreatic fistula in group A, B and C was 23.1% (12/52), 18.8% (9/48) and 3.1% (2/65) respectively, and it was significantly lower in group C than that in group A and B (both P<0.05). In addition, the operative time, intraoperative blood loss and postoperative plasma tube drainage volume were significantly less than those of group A and B (all P<0.05), while no significant difference was noted with regard to other complications among the three groups (all P>0.05). There were no significant differences between group A and B in all recorded variables (all P>0.05). Conclusion: Pancreatic-duct hanging and end-to-side continuous pancreaticojejunostomy can reduce the incidence of pancreatic fistula after PD. Furthermore, it is safe and applicable, so it deserves to be widely used.

Abstract:Objective: To analyze the risk factors for intra-abdominal or gastrointestinal bleeding after pancreaticoduodenectomy (PD). Methods: The clinical data of 132 patients undergoing PD for periampullary cancer in the first affiliated hospital of Xinjiang Medical University during May 2005 and May 2011 were retrospectively analyzed. Results: Twenty-seven (20.5%) of the 132 patients developed postoperative hemorrhage (intra-abdominal or gastrointestinal bleeding), among whom, intra-abdominal bleeding occurred in 12 cases (9.1%), gastrointestinal bleeding occurred in 6 cases (4.5%), and both intra-abdominal and gastrointestinal bleeding occurred in 9 cases (6.8%). Univariate analysis results indicated that the intraoperative blood loss, volume of intraoperative blood transfusion, intra-abdominal infection, pancreatic fistula, biliary fistula and leakage of the pancreaticointestinal anastomosis were significantly associated with post-PD bleeding (all P<0.05). Multivariate analysis results identified that the intraoperative blood loss greater than or equal to 500 mL (P<0.000, 95%CI=6.900–103.775), pancreatic fistula (P=0.003, 95%CI=2.319–55.717) and intra-abdominal infection (P=0.043, 95%CI=1.046–19.364) were independent risk factors for post-PD bleeding. Conclusion: Intraoperative blood loss greater than or equal to 500 mL, pancreatic fistula and intra-abdominal infection are independent risk factors of post-PD bleeding.

Abstract:

Objective: To investigate the effect of co-transplantation of islet and mesenchymal stem cells (MSCs) to induce immune tolerance on islet graft, and to compare the efficacies of MSCs via different delivery routes. Methods: SD and Lewis rats were used as donor and recipient, respectively. MSCs were isolated from the femur of the SD rats with adherence culture method and then expanded in vitro. Islets were also isolated from the donor pancreas by collagenase-V digestion. Forty recipient Lewis rats with streptozotocin induced diabetes were equally randomized into group A (islets combined with BrdU-labeled MSCs were transplanted via portal vein), group B (islets were transplanted through portal vein and BrdU-labeled MSC were infused via tail vein), group C (islets transplantation through portal vein combined with cyclosporine administration) and group D (islets transplanted via portal vein without any other intervention). Blood glucose levels of the recipient rats were observed after transplantation and the survival times of islet grafts in each group were compared. On the 7th day after transplantation, the samples of liver, thymus gland and spleen were taken from some of the living donors to observe homing sites of MSCs. Results: Both group A and B had the longest maintenance times of normal blood glucose level, followed by group C, and that of group D was the shortest. The survival time of islet graft in group A was (12.1±2.3) d, group B was (8.6±1.4) d, group C was (13.2±1.9) d and group D was (2.2±0.6) d, respectively. MSCs homing observation showed that in group A, the BrdU-positive MSCs were mainly located in the liver, and some of them formed the “microencapsulation” that enclosed islet grafts, while MSCs were mainly observed in the thymus gland and spleen in group B. Conclusion: Co-transplantation of islets and MSCs can promote immune tolerance for islet grafts, and MSCs delivery through portal vein has better efficacy than that observed through peripheral vein.

Abstract:Objective: To investigate the effect of thoracic duct lymph drainage on lung injury induced by severe acute pancreatitis (SAP) and its mechanism. Methods: Seventy-two SD rats were randomized into sham operation group, SAP model group (SAP group) and SAP model plus thoracic duct lymph drainage group (drainage group). SAP model was induced by retrograde injection of 5% sodium taurocholate into biliopancreatic duct, and rats in drainage group underwent continuous thoracic duct lymph drainage. Eight rats in each group were sacrificed at 4, 8 and 14 h after surgery, respectively. The endotoxin (ET) levels in the lymphatic fluid and plasma were measured, the pathological changes of rats’ lung tissues were assessed and NF-κBp65 protein expressions in lung tissues were also detected. Results: Except for sham operation group, rats in both SAP group and drainage group exhibited remarkable lung injury 8 h later, which in drainage group was less evident than that in SAP group. The lymphatic ET levels in each group showed no significant difference at the 4-h time point, but were increased in both SAP group and drainage group with time prolongation, which were significantly higher than those in sham operation group at 8- and 14-h time points (all P<0.05). The lymphatic ET levels in sham operation group showed no difference at the three observation time points (P>0.05). The change patterns of plasma ET levels in each group were similar to those in the lymphatic fluid, and the plasma ET levels were significantly positively correlated with the lymphatic ET levels (4 h: r=0.7857, P=0.0208; 8 h: r=0.7233, P=0.0426; 14 h: r=0.9048, P=0.0002). The NF-κBp65 protein expression levels showed no significant difference among groups at the 4-h time point, but were significantly increased in both SAP group and drainage group compared with sham operation group at 8- and 14-h time points (all P<0.05). The elevation degrees of NF-κBp65 expression in drainage group were significantly lower than those in SAP group at both time points (both P<0.05). Conclusion: The lymphatic ET and NF-κB expression levels in lung tissues increase significantly in rats with lung injury secondary to SAP, and thoracic duct lymph drainage is a positive treatment modality for this condition.

Abstract:Objective: To investigate the effect of microRNA-10b (miR-10b) expression alteration on the biological behavior of human pancreatic cancer ASPC-1 cells. Methods: ASPC-1 cells were transfected with the eukaryotic expression plasmid vector containing pre-miR-10b and antisense miR-10b or empty vector by lipofectamine, respectively, and the transfection efficiency was measured with fluorescence microscopy. Using the non-transfected ASPC-1 cells as blank control, the miR-10b and RhoC protein expression of the transfected cells in each group were detected, and their growth, apoptosis and invasve ability were also examined. Results: The transfection efficiencies of each group were about 50%-70% 48 h after transfection. By comparison with blank control group, cells in pre-miR-10b transfection group showed increased expression of miR-10b and RhoC protein, decreased apoptosis, and enhanced proliferative and invasion ability (all P<0.05), while the results of above indexes in antisense miR-10b transfection group showed the opposite changes to those in pre-miR-10b transfection group (all P<0.05). Bat there were no significant differences in all determined parameters between empty vector transfection group and blank control group (all P>0.05). Conclusion: Up-regulation of miR-10b in ASPC-1 cells can promote their growth and invasive ability with reduced apoptosis, and these effects may probably be associated with its action on regulation of RhoC expression.

Abstract:Objective: To develop an effective method to detect circulating micrometastases in patients with pancreatic cancer. Methods: Peripheral blood mononuclear cells (PBMC) from normal subject were mixed with human pancreatic cancer PANC-1 cells in different proportions. The mixed cells of each proportion were sorted by using EpCAM-antibody-coated immunomagnetic nanobeads for separation and enrichment of the tumor cells. Then, the expression of human telomerase reverse transcriptase (h-TERT) and c-met in the tumor cells were detected by RT-nest-PCR, so as to determine the sensitivity of this method. The expressions of h-TERT and c-met in the PBMC from 25 patients with pancreatic cancer and 15 patients with benign diseases were detected by using the above combined immunomagnetic nanobeads and RT-nest-PCR method. The relations of both genes with the clinicopathologic factors were also analyzed. Results: The sensitivity of the combined immunomagnetic nanobeads and RT-nest-PCR method for h-TERT and c-met was 1 tumor cell/1×107 PBMC and 1 tumor cell/1×106 PBMC, respectively. The expression rates of h-TERT and c-met both were 0 (0/15) in benign patients, and was 100% (25/25) and 80% (20/25) in pancreatic cancer patients, respectively. Moreover, the positive expression rate of c-met was significantly related to the tumor stage (P<0.05). Conclusion: Detection of h-TERT and c-met using combined immunomagnetic nanobeads and RT-nest-PCR is a highly sensitive method for identifying the micrometastases of pancreatic cancer in peripheral circulation.

Abstract:Objective: To summarize the experience in diagnosis and treatment of solid pseudopapillary tumor of the pancreas (SPT). Methods: The clinical data of 42 patients with SPT admitted between June 2000 and May 2011 were retrospectively analyzed. Results: Of the 42 patients, 41 (98%) cases were female and only one case was male, and their ages ranged from 16 to 63 (average of 31.1). In nine patients the tumors were located in the head of the pancreas, three were located in the neck and 29 were located in the body and tail. The maximum tumor diameter varied from 2 to15 cm (average of 6.3 cm). Twenty patients had no obvious signs on admission, 21 patients had only vague upper abdominal pain or discomfort, and only one case presented with severe abdominal pain and high fever due to tumor rupture. Lesions in the pancreas appeared as hypoechoic, isoechoic, or complex masses (having both cystic and solid components) at ultrasound, and presented as roundish cystic/solid masses on CT scan where the solid component showed different degrees of enhancement after contrast-enhanced imaging. All patients underwent surgical resection and the lesions were confirmed as SPT by intra- and postoperative pathology. Of the patients, two cases underwent pylorus-preserving pancreaticoduodenectomy, two cases had duodenum-preserving pancreatic head resection, spleen-preserving pancreatic body and tail resection was performed in 10 cases, pancreatic body and tail resection in 13 cases, local resection in 14 cases, and one case received palliative resection. Forty patients were followed up for 6 months to 11 years (average of 49 months); all of them were alive and with no distant metastases, and one of them who experienced local recurrence 8 years after local resection underwent a second local resection and survived to date for 41 months. Conclusion: High vigilance should be maintained for SPT in young women with the complex cystic/solid pancreatic masses. Due to low-grade malignancy, patients can obtain long-term survival through complete surgical resection and with organ function preservation as far as possible.

Abstract:Objective: To investigate the diagnosis and treatment of the space-occupying lesions of the spleen. Methods: The clinical data of 22 patients, who had space-occupying lesions of the spleen, admitted from January 1992 to December 2009 were retrospectively analyzed. Results: Of the entire group, 18 cases were benign space-occupying lesions that included 4 cases of splenic cyst, 11 cases of splenic hemangioma, and 3 cases of splenic abscess; 4 cases were malignant space-occupying lesions that included 2 cases of malignant lymphoma, and one case each of splenic metastasis from pancreatic cancer and metastases in the liver and splenic following surgery for stomach cancer. Twenty-six patients underwent total splenectomy and 2 patients underwent partial splenectomy. Of the 2 malignant lymphoma and 2 splenic metastasis patients, one case was lost to follow-up, and the other 3 cases died one year, 2 years and 2.5 years after operation, respectively. All the benign patients were cured. Conclusion: The diagnosis of space-occupying lesions in the spleen is mainly based on clinical manifestation and imageological examination. Differentiation of benignancy or malignancy of the lesions depends on contrast-enhanced ultrasonography, CT or selective splenic artery angiography. For these patients, surgical treatment is the major therapeutic alternative, while adjuvant radiotherapy and chemotherapy is required for the malignant cases.

Abstract:Objective: To systematically review the clinical efficacy of using fast-track surgery (FTS) in perioperative management of laparoscopic cholecystectomy. Methods: The literature concerning randomized controlled trials of laparoscopic cholecystectomy using FTS principles in online databases was retrieved. Data collection ended in July 2012. Then the literature was screened, data of the studies were extracted, qualities of the studies were evaluated and Meta analysis was performed. Results: A total of 8 studies with 1 060 patients were included. Compared with conventional group, FTS group had reduced length of hospital stay (MD=–2.36, 95%CI=–3.47— –1.25) (P<0.01), time to first postoperative passage of flatus (SMD=–3.04, 95%CI=–4.92— –1.16) (P<0.01) and incidence of lung infections (OR=–0.20, 95%CI=0.05–0.79) (P=0.02) as well as decreased hospital charges. Conclusion: FTS can enhance the rehabilitation of patient undergoing laparoscopic cholecystectomy. It deserves further investigation and spreading in clinical practice.

Abstract:Objective: To investigate a reliable and effective anastomotic approach after excision of gastric cardia cancer, so as to improve the clinical efficacy. Methods: The clinical data of 110 patients undergoing hand-sewn anastomoses (hand-sewn group) and 180 patients undergoing anastomosis with tubular stapler (mechanical stapler anastomosis group) after gastric cardia tumor resection were retrospectively analyzed, and then the incidences of anastomosis-related complications of the two groups were compared. Results: There were no obvious differences in operative time and incidence of anastomotic bleeding between the two groups (both P>0.05). The incidence of anastomotic leakage, anastomotic stricture, reflux and hoarseness as well as the half-year mortality in mechanical stapler anastomosis group were lower than those of hand-sewn group (all P<0.05). No statistical difference was noted in 3-year survival rate between the two groups (P>0.05). Conclusion: Mechanical stapling anastomsis is more effective than hand suturing in reducing postoperative complications and mortality, and also has the advantages of being simple to perform and reliable results.

Abstract:Objective: To investigate the impacts of different nutritional supports on the nutritional status, immune function and prognosis in patients with the gastrointestinal cancer after surgery. Methods: The enrolled patients were randomly assigned to parenteral nutrition (PN) group (n=270) and enteral nutrition (EN) group (n=270). Both nutritional supports were initiated on the first day after surgery under isoenergetic [125 kJ/(kg·d)] and isonitrogenous [0.25 g/(kg·d)] conditions. The nutritional status, immune function, outcome and prognosis of the two groups were compared. Results: In respect of nutritional parameters, the level of transferrin in PN group decreased but other parameters showed no obvious alterations after operation, while in EN group, the levels of total protein, albumin, pre-albumin and transferrin all increased after operation and were all significantly higher than those of PN group (all P<0.05). In terms of immune function, only the level of NK cells increased and other parameters showed no evident alterations after operation, while in EN group, the levels of CD3, CD4, CD8, NK cells and IL-2 receptor all increased after operation and were all significantly higher than those of PN group (all P<0.05). As for the complications and prognosis, the overall incidence of complications in PN and EN group was 56.3% and 28.9%, respectively (P<0.05), while no significant difference was noted in the mortality rate between the two groups (P>0.05). In addition, the length of time of complications, administration of antibiotics and average hospital stay of EN group were all significantly shorter than those of PN group (all P<0.05). Conclusion: Early postoperative EN support is better than PN support for patients with gastrointestinal cancer. EN support can effectively improve the nutritional status and immune function as well as reduce the incidence of postoperative complications.

Abstract:Objective: To compare the impacts between breast-conserving surgery and modified radical treatment on clinical efficacy and quality of life in patients with early breast cancer. Methods: The clinical data of 95 patients with early breast cancer undergoing breast-conserving therapy (breast-conserving group) between July 2004 and July 2007 were analyzed, and were compared with those of 95 matched patients over the same period undergoing modified radical mastectomy (modified radical group). Results: There were no significant differences between the two group in recurrence, metastasis and survival rate (all P>0.05). The rate of aesthetically excellent breast shape in breast-conserving group and modified radical group was 93.7% and 0, respectively (P<0.05). The quality-of-life score of the 5-year survival patients in breast-conserving group was significantly higher than that in modified radical group (83.66±3.70 vs. 73.07±4.85) (P<0.05). Conclusion: In early breast cancer patients, breast-conserving surgery can achieve the same therapeutic efficacy as modified radical mastectomy, and meanwhile significantly improve their quality of life. Strict observation of the indications, standardized surgical resection and individualized, comprehensive postoperative management are critical to success of breast-conserving treatment.

Abstract:Block of proliferation 1 (BOP1) is a nucleolar protein that affects the protein synthesis by its participation in ribosome biogenesis. Recent investigations suggest that BOP1 overexpression occurs in some tumors, which plays a critical role in epithelial-to-mesenchymal transition (EMT), and cancer occurrence and development as well as invasion and metastasis. The mechanism of BOP1 function in cancer remains unclear. This paper reviews the recent understanding of the biological characteristics of BOP1 and its relation with cancer.

Abstract:Hypoxia inducible factor 1α (HIF-1α) participates in several biological processes of cancer, such as proliferation, apoptosis, invasion and metastasis, through regulating its target genes and self-expression, and its overexpression predicts the poor prognosis of the cancer. Epithelial-mesenchymal transition (EMT) plays an important role in tumor invasion and metastasis, and its mechanism involves complex signaling pathways, E-cadherin, Snail transcription factor, microRNA and so on. This paper reviews the role and significance of HIF-1α and EMT in tumor progression.