Objective: To investigate the expression and action of microRNA-200c (miRNA-200c) in pancreatic cancer stem cells. Methods: Pancreatic cancer stem cells were sorted from human pancreatic cancer PANC-1 cells by FACS using CD24+CD44+ESA+ as marker, and their stem cell properties were assessed by xenograft tumor assay in NOD/SCID mice. The miRNA-200c expression and invasion ability in PANC-1 cells, pancreatic cancer stem cells and pancreatic cancer stem cells transfected with miRNA-200c precursor sequence or negative control sequence were determined by RFQ-PCR method and Transwell invasion assay, respectively. Results: The CD24+CD44+ESA+cells (accounting for 0.8%) sorted from PANC-1 cells presented tumor stem cell properties, and the volume of the xenograft tumor after their subcutaneous transplantation in mice was significantly larger than that after PANC-1 cells transplanted at the same time [(1 725.14±261.29) mm3 vs. (479.65±99.67) mm3, P<0.05]. In pancreatic cancer stem cells compared with PANC-1 cells, the miRNA-200c expression level was significantly decreased (0.15±0.01 vs. 1.00±0.09, P<0.05), and transmembrane cell number was significantly increased (321±7.62 vs. 70±16.47, P<0.05), but the miRNA-200c expression level was significantly increased and transmembrane cell number was significantly decreased in pancreatic cancer stem cells after transfection with miRNA-200c precursor sequence (both P<0.05). Conclusion: MiRNA-200c expression is reduced in pancreatic cancer stem cells, and miRNA-200c has inhibitory effect on growth and invasiveness of pancreatic cancer stem cells.

Objective: To investigate the clinical features, diagnosis and treatment as well as outcomes of infected pancreatic necrosis (IPN) and IPN complicated with intestinal fistula. Methods: The clinical data of 33 IPN patients, including 10 cases complicated with intestinal fistula, admitted from January 2010 to December 2014 were retrospectively analyzed. Results: All patients underwent standardized treatment in accordance with acute pancreatitis diagnosis and treatment guideline, and patients with intestinal fistula had additional fistula repair or fistula resection and anastomosis, and peritoneal drainage according to the specific conditions. The mortality of the entire group of 33 patients was 39.4% (13/33), and the severity score (2012) was closely associated with the mortality (P<0.05). The mortality of those complicated with intestinal fistula was 40.0% (4/10), and intestinal fistula exerted no impact on the overall mortality (P>0.05), but significantly prolonged the hospital stay of the patients (P<0.05). The mortality in patients with intestinal fistula located in uncommon sites (75%, 3/4) was higher than that in patients with intestinal fistula located in common sites (16.7%, 1/6) (P<0.05). Conclusion: IPN has a relatively high mortality, and although intestinal fistula does not obviously increase mortality of IPN patients, it significantly influences the recovery of the patients, and intestinal fistula in an uncommon site may increase the mortality of the patients.

Objective: To investigate the pathogenic factors, and diagnostic and treatment features of chronic pancreatitis (CP). Methods: The general data, clinical manifestations, therapeutic protocols, and relationship between major risk factors and clinical features in 138 CP patients were retrospectively analyzed. Clinical typing and staging of the patients were performed according to CP Diagnosis and Treatment Guideline of the Chinese Medical Association (2012), and changes of the disease state of the patients between pre- and post-treatment were analyzed based on M-ANNHEIM classification system. Results: Of the 138 patients, abdominal pain was the main symptom in 116 cases (84.1%); cases with regular alcohol consumption accounted for 44.2%, with smoking habit accounted for 42.8%, with hyperlipidemia accounted for 39.9%, and with biliary tract disease accounted for 20.2%, respectively; 11 cases were classified as clinical type I, 58 cases were type II, 47 cases were type III and 22 cases were type IV; 69 cases were at clinical stage I, 47 cases at stage II, and 22 cases at stage III. The proportion of cases with pancreatic calcification in patients with regular alcohol consumption was higher than that in non-alcohol consumers, while either the proportion of cases with pancreatic calcification or diabetes in patients with smoking habit were higher than those in patients who did not smoke (all P<0.05). There was no significant difference in therapeutic results between stage I patients undergoing conservative treatment and surgical treatment (P=0.744), while the therapeutic result of surgical treatment was better than that of conservative treatment in stage II patients, and conservative treatment was better than surgical treatment in stage III patients (both P<0.05). Conclusion: Alcohol consumption, smoking, hyperlipidemia and biliary tract disease are still the main risk factors for occurrence of CP, the features are somewhat different in CP caused by different factors, and choice of plan of treatment should be made on the basis of the Diagnosis and Treatment Guideline and the specific conditions of patients.

Objective: To investigate the clinical value and safety of endoscopic therapy for acute biliary pancreatitis (ABP) during pregnancy. Methods: The clinical data of 35 women with ABP treated from 2000 to 2014 were retrospectively analyzed. Of the patients, 13 cases received conservative treatment (conservative group), and the other 22 cases received minimally invasive endoscopic treatment within 48 h after definite diagnosis was made (endoscopic group). Results: In conservative group, 9 pregnant women (69.2%) were cured, 4 pregnant women (30.8%) died, and fetal death occurred in 6 cases (46.2%). In endoscopic group, 19 pregnant women (86.4%) were cured, of whom 12 cases were cured by endoscopic sphincterotomy (EST), 2 cases were cured by endoscopic nasobiliary drainage (ENBD) and 4 cases were cured by laparoscopic treatment after ENBD, and one case whose condition worsened after endoscopic treatment underwent emergent open surgery and termination of pregnancy, and then recovered but the fetus died; 3 pregnant women (13.6%) died, of whom one case underwent open conversion due to failure of endoscopic treatment, and then developed pancreatic fistula that caused both maternal and fetal death, and 2 cases developed multiple organ failure that caused both maternal and fetal death. The maternal and fetal mortality in endoscopic group were significantly lower than those in conservative group (both P<0.05), moreover, the degree of improvement of laboratory parameters in endoscopic group was better than that in conservative group at 3 d after treatment (all P<0.05). Conclusion: Early endoscopic intervention for ABP patients during pregnancy is safe and effective.

Objective: To investigate the clinical efficacy of endoscopic plus laparoscopic treatment for severe acute pancreatitis (SAP) complicated by pancreatic pseudocyst (PPC). Methods: The clinical data of 52 patients with SAP and PPC undergoing surgical treatment from June 2012 to March 2014 were collected. Of the patients, 31 cases underwent endoscopic plus laparoscopic treatment (endoscopic-laparoscopic group), and 21 cases were subjected to open surgery (open surgery group). The intraoperative conditions, postoperative outcome and recovery as well as incidence of complications were compared between the two groups. Results: In endoscopic-laparoscopic group, the operative time, intraoperative blood loss, time to first flatus and length of postoperative hospital stay were significantly decreased compared with open surgery group (all P<0.05). There was on statistical difference in treatment efficacy rate and incidence of postoperative complications between the two groups (both P>0.05). The incidences of postoperative pain, nausea and vomiting in endoscopic-laparoscopic group were significantly lower than those in open surgery group (all P<0.05). Postoperative follow-up was conducted for 6 months, and no PPC recurrence was noted in any of the two groups. Conclusion: Endoscopic plus laparoscopic procedure has remarkable efficacy and better safety in treatment of SAP with PPC, and individualized treatment strategies can be formulated according to the specific condition of patients. So it is recommended to be used in clinical practice.

Objective: To investigate the impact of ESKAPE bloodstream infection on the prognosis and complications in patients with acute necrotizing pancreatitis (ANP). Methods: Eighty-seven ANP patients admitted from January 2003 to July 2014 with blood culture results were retrospectively studied. Of the patients, 49 cases had negative and 38 cases had positive blood culture. The impact of bloodstream infection, especially ESKAPE bloodstream infection on therapeutic outcomes of these ANP patients was analyzed. Results: In the 69 pathogen test results from the 38 ANP patients with positive blood culture, 40.6% were ESKAPE pathogens that included Acinetobacter baumanni (50.0%), Enterococcus faecium (14.3%), Klebsiella pneumonia (10.7%), Enterobacter species (10.7%), Staphylococcus aureus (7.1%) and Pseudomonas aeruginosa (7.1%). Patients with bloodstream infection had significantly increased incidence of shock, respiratory failure, renal failure and digestive tract bleeding and mortality, as well as increased hospital expenses and prolonged length of ICU stay compared with those without bloodstream infection (all P<0.05). Patients with ESKAPE bloodstream infection had higher incidence of shock and hospital expenses than those with non-ESKAPE bloodstream infection (both P<0.05). Conclusion: Bloodstream infection can significantly increase the complications and mortality in ANP patients. ESKAPE are the major pathogens resulting in bloodstream infection in ANP patients, and are also closely associated with occurrence of shock in the patients.