Volume 32,Issue 9,2023 Table of Contents

1 Application of "single-incision plus one port" laparoscopic duodenum-preserving pancreatic head resection for benign pancreatic head tumors

YOU Xinyu , CHENG Donghui , JIANG Jipeng , ZUO Bangyou , HAO Jianjie , LIU Tao , ZHANG Yu

2023, 32(9):1287-1295. DOI: 10.7659/j.issn.1005-6947.2023.09.001

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Background & Aims With a deeper understanding of the anatomy of the ampulla of Vater, the technique of duodenum-preserving pancreatic head resection (DPPHR) has emerged. Alongside advancements in minimally invasive laparoscopic techniques, single-incision laparoscopic surgery (SILS) and laparoscopic DPPHR have been developed. However, due to the inherent complexity of the procedure, combining "single-incision" with "preservation of the duodenal pancreatic head" has remained challenging. Therefore, our team sought to simplify and improve this approach by attempting single-incision laparoscopic DPPHR (SILDPPHR) with the addition of a 12 mm Trocar at the left rib margin, referred to as SILDPPHR+1. This study was primarily conducted to evaluate the feasibility and effectiveness of SILDPPHR+1 with fluorescence-guided navigation.Methods The clinical data of 8 patients who underwent SILDPPHR+1 with fluorescence-guided navigation in the Department of Hepatobiliary and Pancreatic Surgery of Sichuan Provincial People's Hospital between February 2022 and May 2023 were retrospectively analyzed. SILDPPHR+1 involved the integration and refinement of techniques, including traditional 5-port laparoscopic DPPHR, single-incision laparoscopic surgery, and indocyanine green cholangiography; techniques such as suture suspension and cross traction were applied to achieve optimal exposure within limited operating space; emphasizing the protection of the pancreaticoduodenal artery arch, bile duct-pancreatic segment, and the duodenum, along with the use of pancreaticojejunostomy techniques to reduce postoperative complications.Results All 8 patients who underwent fluorescence-guided SILDPPHR+1 completed the surgery successfully, with no intraoperative conversions to 5-port laparoscopic or open procedures. The average surgical duration was (360±68) min, and intraoperative blood loss was (84±26) mL, with no intraoperative transfusions required. Pathological examination revealed 5 cases of intraductal papillary mucinous neoplasm of the pancreas, 1 case of mucinous cystic neoplasm, and 2 cases of chronic pancreatitis. All 8 cases achieved radical resection, with no severe gastrointestinal dysfunction after operation. Oral intake was resumed after an average of 5 d, and the average length of hospital stay was (9±2) d. During a follow-up period of (7.8±4.6) months, none of the 8 patients experienced tumor recurrence or gastrointestinal dysfunction. There were no bile leaks or duodenal ischemic necrosis, but 2 cases developed grade A pancreatic fistula, and 1 case had biliary stricture.Conclusion In appropriately selected cases and within experienced hepatobiliary and pancreatic surgery centers, performing fluorescence-guided navigation SILDPPHR+1 is safe and feasible.

2 Analysis of the efficacy and safety of extended radical resection of pancreatic cancer with small bowel autotransplantation: a report of two cases

LIU Jungui , ZHANG Tao , LIU Xiang , GUO Yu , JIN Kui , LEI Lei , DUAN Weihong

2023, 32(9):1296-1304. DOI: 10.7659/j.issn.1005-6947.2023.09.002

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Background and Aims The treatment strategies for locally advanced pancreatic cancer (LAPC) are continuously evolving, and with advancements in vascular reconstruction and autologous organ transplantation techniques, the radical resection rate for LAPC with vascular invasion has greatly improved. This study was performed to evaluate the feasibility and safety of extended radical resection of pancreatic cancer with small bowel autotransplantation.Methods The clinical data of two LAPC patients with involvement of the mesenteric root who were treated at the Rocket Force Characteristic Medical Center from May 2022 to May 2023 were retrospectively analyzed. Both patients were female, aged 66 and 58 years, and preoperative imaging indicated malignant tumors within the pancreatic uncinate process, with tumor invasion and encasement of the superior mesenteric artery (SMA) and jejunal artery branches. Both patients had a generally stable preoperative condition but had not undergone chemotherapy due to signs of duodenal obstruction. Preoperative assessments of heart, lung, liver, and kidney function showed that both patients were able to tolerate the surgery. Then, the extended radical resection of pancreatic cancer with small intestinal autotransplantation was performed. The key to the surgery was the simultaneous removal of the small intestine along with the tumor specimen, then rapidly remove the specimen, followed by sequential reconstruction of the SMA/mesenteric vein (SMV) with "artery first, then vein" approach.Results Both patients underwent successful surgeries. In case 1, reconstruction was performed using the inverted splenic artery and the SMA, and the SMV was anastomosed distally to the portal vein (PV). The warm ischemia time of the small intestine was 24 min, and postoperative pathology diagnosed it as poorly differentiated adenocarcinoma of the pancreas. In case 2, end-to-end anastomosis was used for SMA reconstruction, with distal anastomosis of SMV and PV. The warm ischemia time of the small intestine was 18 min, and postoperative pathology diagnosed it as pancreatobiliary-type ampullary carcinoma. Both patients had good postoperative recoveries, with no arterial or venous thrombosis. Their postoperative hospital stays were 25 d and 21 d, respectively. As of August 1, 2023, both patients had been followed up in the outpatient clinic for 12 and 2 months, respectively. During the follow-up period, their general conditions remained good, with no evidence of recurrence or metastasis, except for unstable blood sugar control in case 2.Conclusion Based on the retrospective analysis of these two cases, small bowel autotransplantation for LAPC patients with mesenteric root invasion can be safely and successfully performed. This approach offers a treatment option to relief pain and increase the chances of survival for such patients.

3 Analysis clinical characteristics of pancreatic neuroendocrine tumors: a report of 111 cases

LIU Ya , JIA Yan , HUANG Yilin , WANG Jie , WANG Hanyue , SHI Yuxin , CHEN Tingyin , PENG Jie

2023, 32(9):1305-1312. DOI: 10.7659/j.issn.1005-6947.2023.09.003

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Background & Aims Pancreatic neuroendocrine tumors (pNETs) are rare epithelial-origin tumors arising from pancreatic islet endocrine cells with malignant potential. Some tumors secrete excessive hormones, leading to specific endocrine syndromes. This study was performed to analyze the clinical characteristics, basic features of CT and endoscopic ultrasonography (EUS), and the correlation between various clinical features and prognosis of pNETs to provide clinical reference.Methods The clinical data of 111 patients with pNETs treated in Xiangya Hospital, Central South University, from January 1, 2016, to May 1, 2023, were reviewed. All patients were pathologically confirmed through surgical resection or biopsy. The general information, laboratory indexes, and imaging data of patients were collected. The clinical characteristics, pathological grade, imaging features of pNETs, and risk factors related to prognosis were analyzed.Results Among the 111 diagnosed pNETs patients, there were 53 males (47.7%) and 58 females (52.3%), with a mean age of (50.54±13.38) years. There were 61 cases (55.0%) of non-functional pNETs (NF-pNETs) and 50 cases (45.0%) of functional pNETs (F-pNETs). Analysis of clinical characteristics revealed that patients in the advanced stage (Ⅲ/Ⅳ) had higher pathological grades, and tumors mostly non-functional, manifesting predominantly through symptoms related to compression or metastasis, higher positivity for neuron-specific enolase (NSE), and non-surgical treatment, such as chemotherapy and biologics, predominated in cases with metastasis. According to the pathological grades, CT feature analysis revealed that, compared to the low-grade group (G1/G2), the high-grade group (G3/NEC) had irregular tumor shapes, unclear borders, and were more prone to lymph node metastasis and distant metastasis (all P<0.05); EUS feature analysis showed that patients in the high-grade group had a greater tumor longitudinal diameter compared to the low-grade group (P<0.05). The median follow-up time was 37 months, with a follow-up rate of 78.37%. A total of 87 cases were included in the analysis of prognosis-related factors, and the results showed that treatment method (surgery vs. non-surgery: HR=0.232, 95% CI=0.056-0.969, P=0.045), lesion morphology (irregular vs. regular: HR=7.038, 95% CI=2.028-24.427, P=0.002), and NSE (positive vs. negative: HR=3.584, 95% CI=1.029-12.481, P=0.045) were independent risk factors for prognosis of patients.Conclusion Surgery is the preferred treatment for pNETs, with a higher surgical rate for F-pNETs than NF-pNETs. CT and EUS-guided fine-needle aspiration/biopsy (EUS-FNA) are sensitive and accurate methods for diagnosing pNETs. Lesion morphology, treatment method, and NSE have the potential to predict clinical prognosis in patients. Therefore, analyzing the clinical characteristics and imaging features of pNETs is helpful for comprehensive disease assessment, monitoring disease progression, making appropriate diagnosis and treatment plans, and improving prognosis.

4 Bioinformatics analysis and validation of the prognostic significance of ATP-binding cassette transporter A5 in pancreatic cancer

FEI Haoran , SUN Dan , ZHONG Chengcheng , YANG Haishen , SI Xinxin , HU Wei

2023, 32(9):1313-1323. DOI: 10.7659/j.issn.1005-6947.2023.09.004

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Background and Aims ATP-binding cassette transporter A5 (ABCA5), a member of the ABC transporter, plays a crucial role in various cancers. However, the role of ABCA5 in pancreatic cancer remains unclear. Therefore, this study was conducted to explore the expression of ABCA5 in pancreatic cancer and its relationship with prognosis of patients, using both bioinformatics analysis and clinical sample validation. Additionally, the potential mechanisms of ABCA5 in pancreatic cancer were analyzed.Methods The expression of ABCA5 in pancreatic cancer tissues and normal tissues was analyzed using TCGA and GEO databases. Kaplan-Meier survival curves and Cox proportional hazards models were used for univariate and multivariate analyses of the survival of patients. Immunohistochemistry was employed to detect ABCA5 expression in 65 pancreatic cancer and adjacent tissue samples, and its association with prognosis and clinicopathologic features was assessed. TIMER, STRING, and Gene MANIA databases were used to analyze ABCA5 in relation to immune cell infiltration, protein-protein interaction networks (PPI), and gene-gene interaction networks. Gene set enrichment analysis (GSEA) and correlation analysis were performed to explore the potential signaling pathways and mechanisms involving ABCA5 in pancreatic cancer. The relationship between ABCA5 and drug sensitivity was analyzed using the Genomics of Drug Sensitivity in Cancer (GDSC).Results In both TCGA and GEO datasets, ABCA5 expression was significantly lower in pancreatic cancer tissues compared to normal tissues (both P<0.05); patients with low ABCA5 expression had significantly shorter overall survival in both TCGA and GSE62452 datasets (both P<0.05); ABCA5 expression was identified as an independent prognostic factor for pancreatic cancer patients (HR=0.458, P=0.001; HR=0.439, P=0.017). Clinical analysis of 65 cases revealed that ABCA5 was downregulated in cancer tissues compared to adjacent tissues, and patients with low ABCA5 expression had worse prognoses (both P<0.05). Univariate and multivariate Cox regression analyses indicated that ABCA5 expression was an independent prognostic factor for pancreatic cancer patients (HR=0.327, P=0.032). TIMER database results showed a close association between ABCA5 expression and immune infiltration. The PPI network revealed 14 interacting proteins associated with ABCA5, while the gene-gene interaction network identified 20 interacting genes. Gene enrichment and correlation analyses suggested that ABCA5 may be related to the cell cycle and ferroptosis in pancreatic cancer. Patients with high ABCA5 expression showed significantly lower IC₅₀ values for five therapeutic drugs than those with low ABCA5 expression (all P<0.05).Conclusion The expression of ABCA5 is downregulated in pancreatic cancer tissue and is associated with poor prognosis in patients. ABCA5 expression is an independent prognostic factor for pancreatic cancer, and its potential mechanism in pancreatic cancer may involve the cell cycle, immune regulation, and ferroptosis.

5 Multiple intraperitoneal metastases of pancreatic hepatoid adenocarcinoma: a case report and literature review

LI Chunmei , LI Chunman , TANG Jihong , HE Min , BAI Yufan , ZHU Jiaqi

2023, 32(9):1324-1332. DOI: 10.7659/j.issn.1005-6947.2023.09.005

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Background and Aims Pancreatic hepatoid adenocarcinoma (PHC) is a rare and aggressive adenocarcinoma with hepatocellular carcinoma (HCC)-like characteristics, primarily found in the tail of the pancreas. It has a low incidence rate, high malignancy, strong invasiveness, early propensity for lymphatic and distant metastasis, rapid disease progression, and poor prognosis. Clinical and radiological features of PHC lack specificity, making preoperative diagnosis challenging. However, most patients exhibit elevated alpha-fetoprotein (AFP) levels, which serves as a diagnostic clue. Nevertheless, the definitive diagnosis of the disease requires pathological examination. This article retrospectively analyzes and summarizes the clinical characteristics and treatment process of one patient with PHC and multiple intra-abdominal organ metastases, as well as reviews relevant literature from both domestic and international sources to enhance clinicians' understanding of PHC and continually improve treatment strategies for the disease.Methods The clinical data and treatment process of one patient with PHC and multiple intra-abdominal organ metastases treated in the Department of Hepatobiliary and Pancreatic Surgery at the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed. The pathogenesis, clinical characteristics, diagnostic methods, and disease treatment options were analyzed and summarized in combination with a review of relevant domestic and international literature.Results The patient was a 63-year-old male admitted to the hospital due to abdominal distension, abdominal pain, fatigue, and poor appetite for over three months. Examination revealed space-occupying lesions in multiple organs, including the liver, pancreas, spleen, and stomach, with the nature of the lesions yet to be determined. The patient underwent palliative tumor resection surgery. Postoperative pathological results supported the diagnosis of PHC, with a solid type and a histological grade of 3. Three months after surgery, intrahepatic metastases were detected, and the patient underwent hepatic arterial infusion chemotherapy with oxaliplatin (130 mg), fluorouracil (200 mg), and embolization therapy. Subsequently, the lesions metastasized to the lungs, and the patient died 10 months after surgery due to multiple organ failure.Conclusion PHC is a rare, poorly understood adenocarcinoma with HCC-like differentiation, lacking typical clinical and radiological features. It exhibits high malignancy early lymphatic and distant metastasis and is often diagnosed in advanced stages, and the opportunity for radical surgical resection has already been lost. The pathogenesis of PHC remains unclear, but it presents with characteristic HCC-like differentiation and often shows high levels of AFP and HCC immunohistochemical markers, making pathological examination the gold standard for diagnosis. Currently, there is no consensus on diagnosing and treating PHC at home and abroad. Aggressive surgical treatment is recommended for patients eligible for surgical resection to improve prognosis. However, adjuvant therapy should be considered for those who cannot undergo radical resection. Radiotherapy is generally considered ineffective, and chemotherapy is an independent prognostic factor, though the optimal chemotherapy regimen remains debated. Therefore, if conditions permit, an appropriate chemotherapy regimen can be selected after biopsy diagnosis to improve patients' objective remission rate. For those with an unclear diagnosis, treatment can follow protocols used for gastrointestinal system diseases.

6 Effect of long non-coding RNA PCAT19 on proliferation and invasion in pancreatic cancer cells and its action mechanism

ZHAO Yinfeng , LIANG Yun , WEI Tiantian , JIA Yucheng

2023, 32(9):1333-1340. DOI: 10.7659/j.issn.1005-6947.2023.09.006

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Background and Aims Long non-coding RNA PCAT19 (lncRNA PCAT19, hereafter referred to as PCAT19) is upregulated in various tumors and closely associated with malignant progression and poor prognosis. However, no studies have reported the expression, function, and mechanisms of PCAT19 in pancreatic cancer. The authors predicted that PCAT19 could interact with miR-195-5p in a complementary manner through the starBase database. Therefore, this study was conducted to investigate the expression and function of PCAT19 in pancreatic cancer cells, as well as its regulatory relationship with target genes and corresponding miRNA.Methods The expressions of PCAT19 and miR-195-5p in human pancreatic ductal epithelial cells (HPNE) and pancreatic cancer cell lines (PANC-1, SW1990, HS766T, CFPAC-1) were detected by qRT-PCR method. Dual-luciferase reporter gene analysis was conducted to assess the targeted binding interaction between PCAT19 and miR-195-5p. PANC-1 cells were transfected with PCAT19 silencing sequence si-PCAT19 (si-PCAT19 group), negative control sequence (si-NC group), and miR-195-5p inhibitor plus si-PCAT19 (co-transfection group). Then, cell proliferation ability was determined using MTT assay, cell invasion ability was assessed using Transwell assay, and the expressions of proteins related to the Wnt/β-Catenin signaling pathway were determined by Western blot analysis.Results In all studied pancreatic cancer cell lines, the expression levels of PCAT19 were significantly higher than that in HPNE cells. In contrast, the expression levels of miR-195-5p were significantly lower than that in HPNE cells (all P<0.05). Dual-luciferase experiments showed that miR-195-5p was a target miRNA of PCAT19. In the si-PCAT19 group compared with the si-NC group, the expression of miR-195-5p was significantly increased, cell proliferation and invasion abilities were significantly decreased, and the expression levels of β-catenin, c-Myc, and cyclin D1 were significantly downregulated (all P<0.05). However, in the co-transfection group, there were no statistically significant differences in these indexes compared with the si-NC group (all P>0.05).Conclusion PCAT19 is upregulated in pancreatic cancer cells and can promote the proliferation and invasion of pancreatic cancer cells. The mechanism may be related to regulating miR-195-5p and affecting the Wnt/β-Catenin signaling pathway.

7 Impact of the circZMYM2/miR-29a/PUMA axis on acinar cell apoptosis in acute pancreatitis and its action mechanism

GAO Ming , WANG Qi , SUN Yuansong , LI He

2023, 32(9):1341-1348. DOI: 10.7659/j.issn.1005-6947.2023.09.007

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Background and Aims Apoptosis of acinar cells plays a crucial role in the inflammatory response and progression of acute pancreatitis (AP). A better understanding of the apoptotic mechanisms and related pathways in acinar cells can provide new insights for AP-specific therapies. This study was conducted to investigate the expressions of the zinc finger protein gene ZMYM2 transcribed circular RNA (circZMYM2), microRNA-29a (miR-29a), and p53 upregulated modulator of apoptosis (PUMA) in AP and their potential relationships.Methods Rat pancreatic acinar cells AR42J were induced to form an in vitro model of AP using cerulein (AP group) or were transfected with pcDNA3.1-si-ZMYM2 to knock down circZMYM2 expression before cerulein induction (si-circZMYM2 group), using untreated AR42J cells as a control group. After 3 h, the amylase level was determined by ELISA assay, the cell viability was assessed by CCK-8 assay, the apoptosis was measured by flow cytometry and TUNEL assay, and the PUMA protein expression was examined by Western blot analysis, and the circZMYM2 and miR-29a expression levels were detected by qRT-PCR method.Results Compared to the control group, the AP group and si-circZMYM2 group showed significantly increased amylase levels, decreased cell viability, increased apoptosis rates or apoptotic cell numbers, and elevated PUMA protein expression (all P<0.05). However, the changes in the above indicators were significantly less pronounced in the si-circZMYM2 group than those in the AP group (all P<0.05). The expression level of circZMYM2 was significantly increased in the AP group and significantly decreased in the si-circZMYM2 group, while the expression level of miR-29a was significantly downregulated in the AP group and significantly upregulated in the si-circZMYM2 group compared to the control group (all P<0.05).Conclusion The expression of circZMYM2 in acinar cells during AP is upregulated, and it may probably inhibit miR-29a expression through endogenous competition, thereby upregulate PUMA expression level and then promote acinar cell apoptosis and AP progression.

8 Protective effect of paeoniflorin against renal injury induced by acute necrotizing pancreatitis and its mechanism

WANG Peng , SHAO Junwei , ZUO Teng , GUO Wenyi , ZHANG Lilong , QIU Zhendong , WANG Weixing

2023, 32(9):1349-1357. DOI: 10.7659/j.issn.1005-6947.2023.09.008

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Background and Aims Paeoniflorin is an important traditional Chinese medicine with broad-spectrum anti-inflammatory properties. However, its role in protecting kidney function in acute necrotizing pancreatitis (ANP)-related renal injury remains unclear. Therefore, this study was conducted to investigate the effects of paeoniflorin on ANP-related renal injury and its action mechanism.Methods SD rats were randomly divided into a sham surgery group, an ANP model group (ANP group), and an ANP model plus paeoniflorin treatment group (paeoniflorin group). ANP was induced by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct, and paeoniflorin was injected via the femoral vein after modeling. Initially, different doses of paeoniflorin (50, 100, 150 mg/kg) were tested to determine the optimal dosage based on their effects on serum amylase (AMY), lipase (LIPA), and liver function indicators. Subsequently, the optimal dose of paeoniflorin was used for intervention, and at different time points after modeling (3, 6, 12 h), the groups were evaluated for pancreatic and renal tissue histopathological changes, serum inflammatory markers, AMY, LIPA, urea nitrogen (BUN), and creatinine (Cr) levels. In renal tissues 12 h after modeling of all groups, immunohistochemistry was employed to examine the expression of NF-κB and caspase-3, TUNEL assay was used to detect cell apoptosis, and Western blot was performed to analyze the expression of p38 and phosphorylated p38 (p-p38).Results The dose-response analysis revealed that 100 mg/kg was the optimal dosage of paeoniflorin. Subsequent experiments showed that compared to the sham surgery group, both the ANP group and the paeoniflorin group exhibited varying degrees of ANP and renal injury histopathological changes (increased histopathological scores), elevated inflammatory markers (TNF-α, IL-1β, IL-6), increased serum enzyme indicators (AMY, LIPA) and renal function indicators (BUN, Cr) after modeling, which worsened over time. However, the paeoniflorin group showed significantly lower levels of all these variables at each time point than the ANP group (all P<0.05). In renal tissues 12 h after modeling, the expression of NF-κB and caspase-3, the number of apoptotic cells, and the p-p38/p38 ratio were significantly increased in both the ANP group and the paeoniflorin group; however, the extents of increases in the paeoniflorin group was significantly lower than those in the ANP group (all P<0.05).Conclusion Paeoniflorin exerts significant protective effects against ANP-related renal injury. Its mechanism of action involves inhibiting the progression of ANP on the one hand, and on the other hand, it may reduce ANP-related renal damage by suppressing the cascade reaction caused by NF-κB-related inflammatory factors through the reduction of p38 pathway activity.

9 Role of TMEM117 in promoting gastric cancer progression via regulating TGF-β signaling pathway and its action mechanism

LI Jing , ZHAO Zidan , ZHANG Hui

2023, 32(9):1358-1369. DOI: 10.7659/j.issn.1005-6947.2023.09.009

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Background and Aims Transmembrane proteins (TMEMs) are a class of proteins that span the entire lipid bilayer. TMEM117 is an important member of the TMEM family, and previous research has shown that TMEM117 plays a significant role in regulating blood sugar, preventing myocardial hypertrophy, and participating in endoplasmic reticulum stress. However, the role of TMEM117 in gastric cancer (GC) remains unclear. Therefore, this study was conducted to explore the expression and biological functions as well as the action mechanisms of TMEM117 in GC.Methods Bioinformatics analysis was used to assess the expressions of TMEM117 in various cancer types. qRT-PCR and Western blot were employed to measure the expression levels of TMEM117 mRNA and protein in human normal gastric epithelial cells and different GC cell lines. qRT-PCR was also used to detect TMEM117 mRNA expression in GC tissue and corresponding adjacent tissue. TMEM117 was either knocked down or overexpressed in different GC cell lines, and its effects on GC cell function were assessed using CCK-8, EdU, and Transwell assays. Western blot analysis was conducted to examine the levels of relevant pathway proteins, and the impact of TMEM117 on GC cells was analyzed by adding specific inhibitor. Finally, the effects of TMEM117 knockdown on the growth of GC cells in nude mice were observed.Results Database analysis showed that TMEM117 was upregulated in various cancer tissues, and its expression in GC tissue was significantly higher than that in normal tissue (P<0.05). High expression of TMEM117 in GC was associated with poor prognosis (P<0.05). qRT-PCR and Western blot results revealed that TMEM117 mRNA and protein expressions in GC cells were significantly higher than those in normal gastric epithelial cells, and TMEM117 mRNA expression in GC tissue was significantly higher than that in adjacent tissue (all P<0.05). Functional experiments demonstrated that knocking down TMEM117 in GC cells significantly reduced proliferation, invasion, and migration, while overexpressing TMEM117 had the opposite effects (all P<0.05). Knocking down TMEM117 in GC cells resulted in a significant downregulation of TGF-β expression, while overexpressing TMEM117 in GC cells led to a significant upregulation of TGF-β expression; treatment with the TGF-β inhibitor LY2157299 partially reversed the promoting effect of TMEM117 overexpression on the malignant phenotype of GC cells (all P<0.05). In vivo tumor formation experiment in nude mice showed that knocking down TMEM117 significantly inhibited the growth of GC cells in the mice.Conclusion TMEM117 is highly expressed in GC and is closely associated with poor prognosis of patients. Its mechanism of promoting GC progression may be related to the activation of the TGF-β signaling pathway, which promotes the proliferation, invasion, and migration of GC cells. TMEM117 has the potential to be an effective target for GC treatment.

10 An analysis of the clinical characteristics of 333 cases of hemosuccus pancreaticus reported in the literature from 1977 to 2021

WANG Jian , WANG Chengguo , HUI Liliang , DUAN Dongfeng , LU Jianguo

2023, 32(9):1370-1378. DOI: 10.7659/j.issn.1005-6947.2023.09.010

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Background and Aims Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding, and there are currently no recognized diagnostic and treatment standards. This study summarized the clinical characteristics of HP patients reported in the literature over the past four decades to enhance our understanding of HP, improve early recognition and diagnosis, and provide a theoretical basis for standardizing clinical diagnostic and treatment strategies.Methods The relevant literature published from January 1977 to December 2021 concerning HP was collected. The etiology, clinical manifestations, laboratory tests, imaging examinations, diagnostic and treatment methods, and prognosis of HP patients were analyzed.Results A total of 151 articles were included, comprising 333 patients, including 267 males and 66 females, with a male-to-female ratio of approximately 4∶1. The age ranged from 3 to 94 years, with an average age of 45.9 years. The most common cause was pancreatitis (82.3%), with chronic pancreatitis accounting for 89.1%, followed by peripancreatic artery aneurysm (6.0%) and pancreatic tumors (5.4%). The most common clinical manifestations were melena (74.2%) and abdominal pain (53.8%). Imaging diagnosis primarily relied on upper gastrointestinal endoscopy, contrast-enhanced abdominal CT, and celiac artery angiography. Among the 282 patients who underwent upper gastrointestinal endoscopy, 140 (49.6%) received a definitive diagnosis. Abdominal CT scans were performed in 204 cases, revealing pseudoaneurysms in 120 cases (58.8%), pseudocysts in 46 cases (22.5%), pancreatic tumors in 15 cases (7.4%), peripancreatic artery aneurysms in 13 cases (6.4%), and pancreatic duct stones in 4 cases (2.0%). Among the 193 patients who underwent celiac artery angiography, 112 (58.0%) had positive results. The most common source of bleeding was the splenic artery (41.2%), followed by the gastroduodenal artery (16.7%), bleeding from the cyst wall (9.9%), and the pancreaticoduodenal artery (9.6%). Thirty-six patients opted for conservative treatment, 180 attempted interventional treatment, 147 (81.7%) achieving success, and 140 underwent surgical treatment. Nine patients chose other treatment modalities. Follow-up results for 218 patients showed that 197 cases (91.4%) had no recurrent bleeding, 13 cases (6.0%) suffered re-bleeding, and 5 cases (2.3%) died.Conclusion The diagnosis of HP is difficult and should be based on a comprehensive assessment, including medical history and clinical presentation. Repeated imaging examinations may be necessary to improve diagnostic accuracy. Treatment should primarily target the underlying cause with a multidisciplinary approach, and the treatment choice should be based on the clinical course of the disease.

11 Efficacy of early pancreatic duct stent placement in treatment of acute necrotizing pancreatitis: a report of 57 cases

CHEN Liangping , ZHAO Chengsi , PENG Bo , DONG Tongtong , SHI Jinping , HAO Qianqian , YAO Weijie , WANG Zuozheng

2023, 32(9):1379-1386. DOI: 10.7659/j.issn.1005-6947.2023.09.011

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Background and Aims Acute necrotizing pancreatitis (ANP) is a complex and variable condition with diverse pathological progressions, and the mortality rate can reach 20% to 30% when secondary infections occur. Currently, the treatment for ANP mainly involves early symptomatic management, such as fasting, fluid infusion, pain relief, acid suppression, and enzyme inhibition, followed by a step-up approach involving surgical interventions when complications develop in the later stages. Late-stage local complications of ANP are associated with a high incidence complications and poor prognosis. Studies have suggested that pancreatic duct hypertension and obstruction play crucial roles in the pathogenesis of acute pancreatitis (AP), with a probability of pancreatic fluid leakage exceeding 90%. Therefore, this study investigated the efficacy and safety of early pancreatic duct stent placement in treating ANP.Methods Clinical data of ANP patients who underwent pancreatic duct stent placement within 48 h of admission at Ningxia Medical University General Hospital from June 1, 2019, to December 30, 2021, were retrospectively collected.Results According to the inclusion and exclusion criteria, 57 patients were included, including 34 with moderately severe disease and 23 with severe disease. The median time from admission to surgery for all patients was 8 (3-21) h, and all patients successfully underwent pancreatic duct stent placement. Pancreatic protein plugs were observed in 18 patients during surgery, including 8 cases (23.53%) with moderately severe disease and 10 cases (43.48%) with severe disease. Patients had varying degrees of relief from symptoms such as abdominal pain and bloating after surgery. On 48 h after admission, the white blood cell count, amylase, lipase, blood glucose levels, and APACHE Ⅱ scores were significantly reduced compared to admission values (all P<0.05). The median time to the first oral intake and length of hospital stay were 72 (48-144) h and 9 (6-16.5) d, respectively. The analysis further revealed that patients with moderately severe disease had significantly better outcomes in terms of ICU admission, time to first oral intake, hospital stay, hospital costs, and CT severity index compared to patients with severe disease (all P<0.05). Most patients had significant peripancreatic fluid collections at admission, and after pancreatic duct stent placement, these collections showed varying degrees of absorption. No severe surgery-related adverse events occurred. Late-stage complications included infected necrosis in 8 cases and walled-off necrosis in 7 cases, of whom 5 cases were cured through pancreatic duct stent drainage, while the remaining 10 cases underwent percutaneous drainage without the need for open surgical debridement or other surgical interventions.Conclusion Early pancreatic duct stent placement in the treatment of ANP can rapidly alleviate symptoms, reduce the incidence of local complications, and decrease the need for subsequent surgical interventions. It is an effective clinical treatment strategy.

12 Advances in non-surgical diagnosis and treatment of pancreatic neuroendocrine tumors

ZHANG Zitong , ZHAN Feng

2023, 32(9):1387-1395. DOI: 10.7659/j.issn.1005-6947.2023.09.012

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Pancreatic neuroendocrine tumors (pNETs) are a relatively rare and highly heterogeneous type of neuroendocrine tumors, accounting for approximately 9.9% of malignant pancreatic tumors. However, due to their subtle early symptoms, most patients are diagnosed when distant metastases have already occurred. Therefore, early detection and intervention are particularly important. Currently, surgical resection remains the only curative option for pNETs. Although traditional treatment modalities such as radiation and chemotherapy can effectively kill tumor cells and improve patient survival, their treatment outcomes have always been unsatisfactory. In recent years, the emergence of new treatment modalities such as targeted therapy, immunotherapy, epigenetic drugs, and other approaches has benefited many patients who are not eligible for surgery and are insensitive to traditional treatment methods. Here, the authors discuss recent advances in the diagnosis and non-surgical treatment of pNETs.

13 Research progress of pancreatic cancer stem cell markers

ZHAO Xu , YAN Siqi , ZHAO Jianguo

2023, 32(9):1396-1401. DOI: 10.7659/j.issn.1005-6947.2023.09.013

[Abstract](720) [HTML](465) [PDF 676.72 K](1016)

Abstract:
Pancreatic cancer is a highly invasive and malignant tumor with a significant propensity for distant metastasis, recurrence, and a high fatality rate. Recent research has revealed that cancer stem cells (CSCs) in the tumor tissue play a critical role in the initiation, development, metastasis, recurrence, and resistance to treatment of the cancer. The markers of CSCs hold potential value for clinical diagnosis and prognosis analysis of tumors and may serve as potential therapeutic targets. The dismal prognosis of pancreatic cancer may be attributed to the presence of pancreatic CSCs. Therefore, the study and identification of pancreatic CSCs will contribute to a better understanding the mechanisms underlying pancreatic cancer and the development of new treatment approaches.

14 Application of contrast-enhanced ultrasound in the diagnosis of pancreatic cystic/solid lesions: current status and progress

YUAN Kerong , DENG Xuesong

2023, 32(9):1402-1409. DOI: 10.7659/j.issn.1005-6947.2023.09.014

[Abstract](506) [HTML](537) [PDF 726.07 K](1105)

Abstract:
Contrast-enhanced ultrasound (CEUS) is a relatively simple, repeatable, real-time dynamic, and safe ultrasound examination technique that provides a highly sensitive reflection of the microcirculatory perfusion in lesions. It has become one of the fastest-growing technologies in the field of ultrasound medicine. Here, the authors provide an overview of the recent applications and research progress of CEUS in pancreatic cystic/solid lesions, so as to gain a more comprehensive understanding of the diagnostic and therapeutic advantages of CEUS in the qualitative analysis of pancreatic cystic/solid lesions as well as the challenges it faces, and thereby enhance its clinical utility.

15 Advances in non-invasive assessment methods for peritoneal adhesions

OUYANG Ziqi , LI Guanwei

2023, 32(9):1410-1414. DOI: 10.7659/j.issn.1005-6947.2023.09.015

[Abstract](658) [HTML](316) [PDF 631.63 K](915)

Abstract:
Peritoneal adhesions refer to abnormal fibrous connections that form during the repair process of abdominal organs and tissues due to various causes such as surgery, trauma, intra-abdominal infections, and peritoneal dialysis. Abdominal surgery is the most common cause of peritoneal adhesions, and the majority of patients who undergo abdominal surgery will experience varying degrees of peritoneal adhesions after surgery. Peritoneal adhesions can lead to long-term abdominal pain, induce intestinal obstruction, and in some cases, acute intestinal necrosis due to constriction by adhesions. In females, peritoneal adhesions increase the risk of infertility. Furthermore, peritoneal adhesions can make subsequent surgery difficult, with a higher risk of associated injuries. Non-invasive methods for assessing the extent of peritoneal adhesions, screening high-risk populations for adhesions, and evaluating the clinical effectiveness of drugs and barrier materials are of significant clinical importance. Ultrasonography, cine magnetic resonance imaging, and artificial pneumoperitoneum CT can provide precise assessments of peritoneal adhesions. In addition, parameters such as body mass index, inflammatory markers, and lysyl oxidase-like protein 2 also have some value in evaluating adhesions. In this review, the authors summarize the current non-invasive assessment methods for peritoneal adhesions, aiming to provide clinical insights and guidance.

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Volume 32,Issue 9,2023 Table of Contents

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