NRS 2002 Nutritional Risk Screening and GLIM Step 2 for diagnosis of malnutrition (without FFMI currently) / 中华临床营养杂志

The three steps of nutritional care in Europe, the United States and China were basically same as [Nutritional screening-assessment-intervention]. This review article discussed the second step of GLIM for diagnosis of malnutrition, when the diagnosis of malnutrition being needed. No normal range in healthy volunteer and no cut-off point based on clinical studies for FFMI in China now.

Treatment of pancreatic diseases and prevention of infection during outbreak of 2019 coronavirus disease / 中华外科杂志

Objective@#To explorethe proper protective measures for pancreaticdiseases treatment during theoutbreak of 2019 coronavirus disease(COVID-19).@*Method@#Clinical data of four cases of patients that suffered COVID-19from February 2nd, 2020 to February 9th, 2020 in pancreatic surgery were reviewed.After the first patientscuffednosocomial infection of COVID-19, the general protective measures in our department wereupdated.Only one patient was admitted to each room alone, with no more than one caregiver.The body temperature of care givers was measuredtwice a day.Primary protections were applied to all staff.The floor was sterilized using disinfectant with an effective chlorine concentration of 1000 mg/L.The protective measures for interventional procedures were as follow.Primary protection was applied to the operators ofcentral venipuncture catheter, percutaneous abdominal/pleural drainage, percutaneous retroperitoneal drainage, percutaneous transhepatic cholangial drainage and other surgical procedures with local anesthesiaand epidural anesthesia.Secondary protection was applied to the operators of endoscopic retrograde cholangiopancreatography and surgical procedures with general anesthesia.@*Results@#During Feb 2nd, 2020 to Feb 9th, 2020, four patients in our department were diagnosed with COVID-19, of which one was died of COVID-19, two were cured, and one is still in hospital for COVID-19.After the update ofprotective measures in our department, no more nosocomial infection of COVID-19occurred.Two central venipuncture catheter, three percutaneous abdominal/pleural drainage, one percutaneous retroperitoneal drainage, one percuteneous transhepatic cholecyst drainage and one open surgery with general anesthesia were performed with no infection of operators.@*Conclusions@#The caregivers of patients are potential infection source of COVID-19.Enhanced protective measures including the management measures of caregivers can decrease the risk of nosocomial infection of COVID-19.

Clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy for infected pancreatic necrosis / 中华消化外科杂志

Objective@#To investigate the clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy (MARPN) for infected pancreatic necrosis (IPN).@*Methods@#The retrospective cohort study was conducted. The clinical data of 61 patients with IPN who were admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 2014 and December 2017 were collected. There were 39 males and 22 females, aged 36-67 years, with a median age of 49 years. Of 61 patients, 40 undergoing open surgery were allocated into open group, and 21 undergoing MARPN were allocated into MARPN group. All the patients underwent surgical treatments after standard non-surgical treatments according to the Guidelines for the diagnosis and treatment of severe acute pancreatitis (2014 edition). Observation indicators: (1) intraoperative and postoperative situations; (2) follow-up. Follow-up using telephone interview or outpatient examination was performed to detect weight loss, pathoglycemia, steatorrhea, intestinal obstruction, and pancreatic portal hypertension for one year after surgery up to December 2017. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was done using the chi-square test.@*Results@#(1) Intraoperative and postoperative situations: operation time, time to out-of-bed activity, time to initial food intake, cases with reoperation, cases with postoperative multiple organ dysfunction syndrome (MODS), incidence rate of postoperative complications, mortality, time to drainage-tube removal, duration of hospital stay, and hospital expenses were (77±20)minutes, (13.0±3.6)days, (9.0±2.7)days, 8, 9, 45.0%(18/40), 7.5%(3/40), (37.0±6.3)days, (49±8)days, (84 321±8 872)yuan in the open group, and (59±20)minutes, (2.7±0.9)days, (1.9±0.4)days, 6, 2, 19.0%(4/21), 0, (21.0±2.7)days, (39±6)days, (58 594±3 576)yuan in the MARPN group, respectively, showing no significant difference in the cases with reoperation (χ2=0.69, P>0.05) but significant differences in the other indices between the two groups (t=4.24, 9.61, 15.34, χ2=23.76, 4.02, 36.03, t=11.07, 5.93, 8.43, P<0.05). There were 18 patients with postoperative complications in the open group, including 2 with digestive hemorrhage, 3 with abdominal hemorrhage, 9 with pancreatic leakage, and 4 with intestinal leakage. There were 4 patients with postoperative complications in the MARPN group, including 3 with pancreatic leakage, and 1 with intestinal leakage. Patients with complications were treated by endoscopy, interventional therapy, placement of jejunal nutrition tube, and ileum stoma. Three patients in the open group died, and all the patients in the MARPN group were cured. (2) Follow-up: 47 of 61 patients were followed up for one year, including 31 in the open group and 16 in the MARPN group. During the follow-up, weight loss, pathoglycemia, steatorrhea, intestinal obstruction, and pancreatic portal hypertension were detected in 4, 11, 5, 4, 5 patients of the open group and in 2, 6, 2, 0, 3 patients of the MARPN group, showing no statistically significant difference between the two groups (χ2=0.18, 0.02, 0.01, 0.03, 0.90, P>0.05).@*Conclusion@#MARPN for IPN is safe and reliable, with certain efficacy, which can effectively reduce incidence of postoperative complication, motality and shorten hospital stay.

Changes of surgical interventions on necrotizing pancreatitis / 中华外科杂志

Objective@#To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data.@*Methods@#One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ2 test was used for the statistical test.@*Results@#Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175/1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018, which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant, 4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period, debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346), and 6.03%(23/365) and 6.91%(27/346), respectively.@*Conclusions@#Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don′t decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.

Clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy for infected pancreatic necrosis / 中华消化外科杂志

Objective To investigate the clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy (MARPN) for infected pancreatic necrosis (IPN).Methods The retrospective cohort study was conducted.The clinical data of 61 patients with IPN who were admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 2014 and December 2017 were collected.There were 39 males and 22 females,aged 36-67 years,with a median age of 49 years.Of 61 patients,40 undergoing open surgery were allocated into open group,and 21 undergoing MARPN were allocated into MARPN group.All the patients underwent surgical treatments after standard non-surgical treatments according to the Guidelines for the diagnosis and treatment of severe acute pancreatitis (2014 edition).Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up.Follow-up using telephone interview or outpatient examination was performed to detect weight loss,pathoglycemia,steatorrhea,intestinal obstruction,and pancreatic portal hypertension for one year after surgery up to December 2017.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Count data were represented as absolute numbers or percentages,and comparison between groups was done using the chi-square test.Results (1) Intraoperative and postoperative situations:operation time,time to out-of-bed activity,time to initial food intake,cases with reoperation,cases with postoperative multiple organ dysfunction syndrome (MODS),incidence rate of postoperative complications,mortality,time to drainage-tube removal,duration of hospital stay,and hospital expenses were (77±20)minutes,(13.0±3.6) days,(9.0±2.7)days,8,9,45.0％ (18/40),7.5％(3/40),(37.0±6.3)days,(49±8)days,(84 321±8 872)yuan in the open group,and (59± 20) minutes,(2.7±0.9) days,(1.9 ± 0.4) days,6,2,19.0％ (4/21),0,(21.0± 2.7) days,(39 ± 6) days,(58 594±3 576) yuan in the MARPN group,respectively,showing no significant difference in the cases with reoperation (x2=0.69,P＞0.05) but significant differences in the other indices between the two groups (t =4.24,9.61,15.34,x2=23.76,4.02,36.03,t=11.07,5.93,8.43,P＜0.05).There were 18 patients with postoperative complications in the open group,including 2 with digestive hemorrhage,3 with abdominal hemorrhage,9 with pancreatic leakage,and 4 with intestinal leakage.There were 4 patients with postoperative complications in the MARPN group,including 3 with pancreatic leakage,and 1 with intestinal leakage.Patients with complications were treated by endoscopy,interventional therapy,placement of jejunal nutrition tube,and ileum stoma.Three patients in the open group died,and all the patients in the MARPN group were cured.(2) Follow-up:47 of 61 patients were followed up for one year,including 31 in the open group and 16 in the MARPN group.During the follow-up,weight loss,pathoglycemia,steatorrhea,intestinal obstruction,and pancreatic portal hypertension were detected in 4,11,5,4,5 patients of the open group and in 2,6,2,0,3 patients of the MARPN group,showing no statistically significant difference between the two groups (x2=0.18,0.02,0.01,0.03,0.90,P＞0.05).Conclusion MARPN for IPN is safe and reliable,with certain efficacy,which can effectively reduce incidence of postoperative complication,motality and shorten hospital stay.

Developmental history of the extent of lymph node dissection in pancreatic cancer surgery / 临床肝胆病杂志

Pancreatic cancer is one of the digestive malignant tumors with the worst prognosis and has an overall 5 -year survival rate as low as 5%.Even though radical resection is performed,the 5 -year survival rate is only about 20%.Recurrence and metastasis are the most important influencing factors for the postoperative survival of patients with pancreatic cancer.Lymph node metastasis is an important feature of pancreatic cancer,and the extent of lymph node dissection has always been a hot topic in radical surgery for pancreatic cancer.This arti-cle summarizes the history and current status of the extent of lymph node dissection in pancreatic cancer and points out that standardized lymph node dissection is a key factor for improving patients′prognosis after pancreatic cancer surgery.

Diagnosis and treatment of ampullary tumors / 临床肝胆病杂志

Ampullary tumors mainly manifest as obstructive jaundice and ampullary mass in clinical practice and are difficult to be identified in early stage due to a complex structure of the anatomical site,a deep location,and hidden symptoms.Sometimes a qualitative diagnosis cannot be made.Based on the experience in the treatment of ampullary tumors for many years in our center,this article summarizes the features of ampullary tumors from the aspects of clinical manifestations,diagnosis,treatment,and prognosis,especially the issues regarding imaging evaluation of ampullary tumors,selection of surgical procedure,and prognosis.An early diagnosis is the key to the treatment of ampullary tumors,and early identification and treatment of lesions have great impacts on patients' prognosis.Accurate preoperative imaging evaluation,a professional diagnosis and treatment team,accurate preoperative and intraoperative pathological analysis,and implementation of reasonable therapeutic strategy are the key to patients' recovery.

Subcutaneously transplanted human pancreatic cancer tissue fragments in a mouse model / 中华普通外科杂志

Objective To establish a mouse model by transplanting subcutaneously human pancreatic cancer tissue fragments.Methods Surgically resected pancreatic cancer tissue fragments from patients were transplanted into NOD/SCID mice subcutaneously,and then the growth of the tumor and transplanting it into the next generation were observed.The growth rate,HE staining and immunohistochemistry staining of Ki67 and VEGF were compared.Results We have obtained 13 cases ofpancreatic cancer tissues and 6 cases of biopsy specimens.In 5 cases transplantation was successful,in onemouse model passing to fourth generation,in 4 models to second generation.With the increase of generaions,tumor growth accelerated.HE staining showed later passage cells behavior in an identical manner as the primary cells.Immunohistochemistry staining showed that expressions of Ki67 and VEGF are increasing.Conclusions Through transplanting human pancreatic cancer tissue fragments directly,we have constructed mouse model of pancreatic cancer successfully.With the passage of subculture,the malignant degree and invasiveness may increase.

Progress in diagnosis and treatment of autoimmune pancreatitis / 临床肝胆病杂志

Autoimmune pancreatitis (AIP)is a special type of chronic pancreatitis that originates from an autoimmune -mediated mecha-nism.AIP has unique radiological,serological,and histopathological features,often accompanied by peripancreatic lesions.AIP may be easily confused with pancreatic cancer and cholangiocarcinoma.It is necessary to diagnose AIP while integrating a variety of clinical indica-tors.Steroid therapy should be performed for patients diagnosed with AIP,and surgical treatment can be selected if necessary.

Surgical treatment of necrotizing pancreatitis: 10-year experience at a single center / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the indication, timing and methods of surgery for acute necrotizing pancreatitis.</p><p><b>METHODS</b>There were 5 538 patients with acute pancreatitis (AP) were treated in the Union Hospital, Tongji Medical College from January 2005 to December 2014. Of all AP cases, 2 415 patients with acute necrotizing pancreatitis proved by computed tomography, and 732 patients underwent surgical treatment. Among 732 patients with surgical treatment, 439 (60.0%) were males and two hundreds and ninety-three (40.0%) were females. The median age was 45 years, ranging 20-76 years. Two hundreds and eighty-nine cases were treated with minimally invasive debridement and drainage and 684 cases were treated with open debridement.</p><p><b>RESULTS</b>The cure rate of minimally invasive operation was 16.6% (48/289). The rest of the 241 patients were treated furtherly with open necrosectomy. Among 684 patients with open surgery, 523 patients (76.5%) were infected, and the median time from the onset of symptom to first open operation was 46 d (range 19-205 d). There were 115 patients need to surgery again because of necrotic tissue residual and the reoperation rate was 16.81% (115/684), 684 patients were performed open surgery on average 1.26 times per person. The main postoperative complications were intra-abdominal hemorrhage (37 cases), upper digestive tract fistula (34 cases), colonic fistula (12 cases), gastrointestinal obstruction (29 cases) and pancreatic fistula (83 cases). The overall incidence of complications were 28.5% (195/684). Forty-nine cases died after surgery and the mortality rate was 6.7% (49/732).</p><p><b>CONCLUSION</b>Rational surgical indications and timing of surgical intervention are the key to improve the efficacy of necrotizing pancreatitis, open debridement is still an effective method for necrotizing pancreatitis.</p>

Effect of hydroxyethyl starch on early stage of abdominal pressure and inflammatory cytokines in severe acute pancreatitis patients with intra-abdominal hypertension / 中华胰腺病杂志

Objective To investigate the effect of hydroxyethyl starch (HES) 130/0.4 on intraabdominal hypertension (IAH) and inflammatory cytokines in early stage of severe acute pancreatitis (SAP).Methods Clinical data of 55 case of SAP with IAH from Nov 2007 to Oct 2013 in Pancreas Surgery Department of Wuhan Union Hospital were analyzed retrospectively.All patients received conventional treatment without operation.According to the method of fluid resuscitation,patients were divided into treatment group (n =24) and control group (n =31).In treatment group,patients received ringer solution plus 6％ HES 130/0.4 for fluid resuscitation,and patients in control group received only ringer solution for fluid resuscitation.The IAP level,APACHE Ⅱ score and serum inflammatory cytokine from day 1 to 8 were measured.Results The baseline data between the two groups were comparable.The IAP level was significantly lower in treatment group than that in control group from day 5 to day 8 [(10.2 ±2.9),(8.8 ±2.9),(7.9 ± 2.5),(6.9±2.6)mmHg vs (11.9±2.7),(10.5±2.7),(9.5±2.4),(8.6±2.5)mmHg,1 mmHg=0.133 kPa,respectively],and the difference between the two groups was statistically significant (P ＜0.05).There was no significant difference in APACHE Ⅱ score between the two groups,but the decline of APACHE Ⅱ score from baseline (△APACHE Ⅱ score) was more significant in treatment group (P ＜0.05).The serum IL-1 and IL-8 level in treatment group at day 8 was lower than that in control group [(15.1 ± 13.7) μg/L vs (23.6 ± 13.5) μg/L,(11.2 ± 12.8) μg/L vs (23.8 ± 27.9) μg/L,respectively],and the difference between the two groups was statistically significant (P ＜ 0.05).And the serum TNF-α level in treatment group at day 4 and day 8 was lower than that in control group [(31.9 ± 12.1) μg/L vs (43.4 ± 22.4) μg/L,(24.2 ± 12.8) μg/L vs (35.1 ± 15.3) μg/L],and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Early fluid resuscitation with HES 130/0.4 and ringer solution relieves IAH,reduces APACHE Ⅱ score and down-regulates IL-1,IL-8 and TNF-α level.

In-vitro study of glycogen synthase kinase-3β on regulation of migration, invasion and epithelial-mesenchymal transition in pancreatic cancer cells / 中华普通外科杂志

Objective To explore the role of GSK-3β in migration,invasion,metastasis and epithelial-mesenchymal transition of pancreatic cancer in vitro.Methods Lentiviral interference was used to inhibit the expression of GSK-3β in pancreatic cancer cells.Western blotting was used to detect expression of GSK-3β phosphorylation molecules and epithelial-mesenchymal transition and invasion related molecule.Scratch test and transwell test were adopted to detect the effect of GSK-3β inhibition on cell migration and invasion in pancreatic cancer cells.Luciferase reporter gene test was used to detect the effect of GSK-3β inhibition on NF-κB binding activity.Results Inhibition of GSK-3β expression significantly restrain migration,invasion and epithelial-mesenchymal transformation.Migration inhibitory rate was 59.1％ ±6.4％ in ASPC-1 group and 55.9％ ± 7.3％ in PANC-1 group.GSK-3β inhibition affected the activity of NF-κB,the binding activity decreased to 24.8％ ± 3.1％ and 31.5％ ±5.4％,respectively (all P ＜ 0.05).Conclusions GSK-3β participates in the regulation of migration,invasion,and epithelialmesenchymal transition of pancreatic cancer.GSK-3β inhibition could surpress proliferation,invasion and epithelial-mesenchymal transformation,and NF-κB might be the key molecule in the regulation of pancreatic malignant behavior.

Effect of CpG ODN on pancreatic cancer cell line PANC1 sensitivity to gemcitabine / 中华胰腺病杂志

Objective To investigate the effects of toll-like receptor 9 (TLR9) agonist CpG ODN2216 on the sensitivity of pancreatic cancer cell line PANC1's to gemcitabine.Methods The immunofluorescence staining method and Western blot method were used to examine the expression of TLR9 protein in PANC1 cells.The changes of sensitivity to gemcitabine after CpG ODN2216 treatment were examined by MTT assay.Results The TLR9 protein was highly expressed in PANC1 cells and the median inhibition concentration of gemcitabine against PANC1 cells was reduced from (1.23 ± 0.14) mg/L to (0.28 ± 0.13) mg/L after CpG ODN2216 treatment,and the difference between the two groups was statistically significant (P ＜0.01).After 0.01,0.10,1.00,10.00 mg/L gemcitabine treatment with CpG 0DN2216,the inhibition rates of PANC1 were (34.4 ±1.3)％,(43.5 ± 2.7)％,(76.3 ± 2.5)％,(95.3 ± 2.2)％ ; and without CpG ODN2216,the inhibition rates of PANC1 were (14.5 ± 0.9) ％,(23.5 ± 1.1) ％,(44.8 ± 1.4) ％,(63.6 ± 1.8) ％,and the difference between the two groups was statistically significant (P ＜ 0.01).Conclusions The sensitivity of PANC1 cells to gemcitabine can be enhanced by CpG ODN2216.

Efficacy of modified duodenum-preserving pancreatic head resection for chronic pancreatitis / 中华消化外科杂志

Objective To investigate the efficacy of a modified duodenum-preserving pancreatic head resection (DPPHR) for the treatment of chronic pancreatitis.Methods The clinical data of 109 patients with chronic pancreatitis who received modified DPPHR at the Union Hospital of Huazhong University of Science and Technology from January 2004 to June 2013 were retrospectively analyzed.Of the 109 patients,66 were with mass in the head of the pancreas,29 were with calcification of the head of the pancreas,14 were with atrophy of the head of the pancreas and stones in the main pancreatic duct.The level of glucose of 56 patients were normal,34 patients had glucose tolerance abnormalities and 19 were complicated with diabetes mellitus.Modified DPPHR was carried out after confirming the diagnosis of chronic pancreatitis and excluding the malignancies by frozen pathological examination.The head of the pancreas was completely resected.The posterior pancreaticoduodenal aortic arch running parallel to the duodenum was preserved to guarantee the blood supply to the remaining duodenum.A thin sheet of the pancreatic tissue behind the intrapancreatic common bile duct and between the common bile duct and the duodenum was preserved to guarantee the blood supply to the common bile duct.The gastrointestinal tract was reconstructed with an anastomosis of the distal pancreas and the jejunum and an end-to-en anastomosis of the proximal jejunum and the distal jejunum.Patients were followed up via out-patient examination to learn the frequency of abdominal pain,analgesics usage and the endocrine function.The pain scale,life quality and endocrine function were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30),Gastrointestinal Quality of Life Index (GLQI) questionnaire,and oral glucose tolerance test (OGTT),respectively.Patients were followed up till January 2014.The measurement data and the count data were analyzed using the t test and the chi-square test,respectively.Results No patients died during the operation.The operation time,volume of blood loss and blood transfusion were (3.5 ± 0.7) hours,(360 ± 125) mL and (260 ±220) mL,respectively.After the operation,5 patients were complicated with pancreatic leakage,5 with bile leakage,2 with duodenal fistula and 1 with peritoneal bleeding,and all the patients were cured after conservative treatment.Four patients were complicated with abdominal abscess,1 patient of whom was treated by conservative treatment,and the remaining 3 patients were cured by drainage guided by B sonography.The duration of hospital stay was 13.8 days (range,10.0-32.0 days).The median time of follow-up was 18.0 months (range,3.0-24.0 months).A total of 102 patients were followed up for more than 9 months.At postoperative month 9,the ratio of patients with abdominal pain was decreased from 78.90％ (86/109) to 18.63％ (19/102),and the ratio of patients administered analgesics was decreased from 76.47％ (78/102) to 12.75％ (13/102),with significant difference between the indexes before and after operation (x2=76.57,74.31,P ＜ 0.05).The score of the EORTC QLQ-C30 was decreased from 58 ±36 before operation to 15 ±4 after operation,with significant difference (t =11.39,P ＜ 0.05).The score of GLQI was increased from 69 ± 8 before operation to 87 ± 15 after operation,with significant difference (t =20.05,P ＜ 0.05).The patient with diabetes mellitus was cured,and no newly onset of diabetes was found.Two patients received reoperation because of recurrence of stones in the distal pancreatic duct and pancreatogenic portal hypertension.Conclusion Modified DPPHR is effective for the treatment of chronic pancreatitis with low incidence of postoperative complications.

Management of inoperable advanced pancreatic head carcinoma without gastric outlet obstruction: an analysis of 441 patients / 中华普通外科杂志

Objective To explore the optimal management strategies for unresectable advanced pancreatic head carcinoma without preoperative gastric outlet obstruction(GOO).Methods Clinical data of 441 cases of advanced pancreatic head carcinoma without GOO undergoing surgery from Jan 2001 to Dec 2010 were analyzed retrospectively.Results Among the 441 cases of advanced pancreatic head carcinoma without GOO,101 patients received simple Roux-en-Y cholecystojejunostomy (group A),133 patients received simple Roux-en-Y choledochojejunostomy (group B),83 patients received Roux-en-Y cholecystojejunostomy combined gastrojejunostomy(group C) and the other 124 patients received Roux-en-Y choledochojejunostomy combined gastrojejunostomy (group D).The postoperative recurrent obstructive jaundice rates were 7.9％ and 6.0％ in group A and C,respectively; the postoperative de novo GOO rates were 8.9％ and 8.3％ in group A and B,respectively; there were no differences in median survivals among the four groups (F =1.933,P =0.123).Conclusions Choledochojejunostomy is effective for the reduction of recurrent obstructive jaundice for advanced pancreatic head carcinoma patients without GOO,combined prophylactic gastrojejunostomy during surgical biliary drainage could decrease the rate of postoperative GO0.Cholecystojejunostomy could be only applied for patients with poor health or when choledochojejunostomy is a taboo.

Expression and significance of TLR9 and HIF-1α in pancreatic cancer / 中华胰腺病杂志

Objective To investigate the expression and clinical significance of toll-like receptor 9 (TLR9) and hypoxia inducible factor 1 α (HIF-1 α) in pancreatic cancer.Methods The real-time RT-PCR technique,western blot method and immunohistochemical method were used to examine the expressions of TLR9 and HIF-1α in 30 samples of pancreatic cancer,para-cancerous tissues,and 10 samples of normal pancreatic tissues.The relationship between TLR9 and HIF-1 α was determined,and the correlations between their expressions and clinicopathological parameters were measured,and the impact on survival was detected.Results The levels of TLR9 mRNA and HIF-1 α mRNA expression in human pancreatic cancer tissues was 2.32(1.41～3.22) and 2.26 (1.62～ 2.89) folds as many as that in normal tissues.The levels of TLR9 mRNA and HIF-1α mRNA expression in para-cancerous tissues were 1.23 (1.18 ～ 1.28) and 1.36 (1.17 ～1.55) folds as many as that in normal tissues.The expressions in human pancreatic cancer tissues were significantly higher than those in para-cancerous tissues (t =2.642,P =0.023 ; t =4.076,P =0.001).The positive rates of TLR9 and HIF 1α protein were 73.3％ (22/30) and 70.0％ (21/30),and the corresponding values were 33.3％ (10/30) and 36.7％ (11/30) in para-cancerous tissues,while the corresponding values were 20％ (2/10) and 10％ (1/10) in normal tissues,which showed a decreasing trend (x2 =13.99,P =0.001 ;x2 =13.15,P =0.001).The expressions of TLR9 mRNA in human pancreatic cancer tissues was positively associated with HIF 1 α mRNA (r =0.537,P =0.003).The expressions of TLR9 protein was also positively associated with HIF 1α protein (r =0.511,P =0.001).The expressions of TLR9 and HIF 1α were positively correlated with the degree of tumor differentiation,TNM staging and lymph node metastasis,but were negatively correlated with the survival.Conclusions TLR9 and HIF-1α are over-expressed in pancreatic cancer and they are associated with malignant biological behavior and poor prognosis.

Effcet of silencing HIF-1α by siRNA on expression of toll-like receptor 4 in pancreatic cancer cells under hypoxic conditions / 中华普通外科杂志

Objective To investigate the expression of HIF-1 α and toll-like receptor 4 (TLR4) in human pancreatic cancer cell line panc-l under hypoxia.To observe the effect of HIF-1α in the regulation of TLR4 expression in pancreatic cancer cells under hypoxic conditions.Methods Cells were placed in airtight chamber or treated with CoCl2 to mimic tumor hypoxic micro environment.mRNA and protein levels of HIF-lα and TLR4 were detected by reverse transcription-polymerase chain reaction(RT-PCR) and flow cytometric analysis.By RNA interference( RNAi ) originated from small interference RNA (siRNA) to use siRNA was transfected into panc-1 cells.Western blot was used to detect gene scilencing effect on HIF-1α.RT-PCR and flow cytometric analysis was used to observe the change of TLR4 gene expression after HIF-1α gene silence.Results Under hypoxia,both mRNA and protein levels of TLR4 were up-regulated.The siRNA targeting HIF-1α gene down-regulated HIF-1α gene in panc-l cells efficiently,and TLR4 gene was down-regulated as well.Conclusions Hypoxia can increase protein level of TLR4 in pancreatic cancer cells.TLR4 signaling pathway together with HIF-1α may promote development of the pancreatic cancer.

Construction of TLR4 shRNA plasmid and screening of human pancreatic cancer PANC1 cell line with stable transfection / 中华胰腺病杂志

Objective To construct the eukaryotic plasmid expression vector mediated short hairpin RNA(shRNA) interference targeting TLR4 gene,and transfect it into pancreatic adenocarcinoma cell line PANC1,then screen stably transfected clonal cell line.Methods Three shRNA interference expression plasmid vectors targeting the TLR4 gene were constructed,named TLR4-1,TLR4-2,TLR4-3.The shRNA plasmid with highest inhibitory efficiency was selected and transfected into PANC1 cells with liposome.The silencing efficiency and transfection efficiency of TLR4-shRNA was assayed with real-time quantitative PCR and flow cytometry analysis.Monoclonal cell with stable transfection of TLR4-shRNA were selected by geneticin 418 (C418) and limiting dilution analysis.Results Transient transfection efficiency of PANC1 was (46.72 ±5.06) ％.TLR4 mRNA expressions were 0.025 ± 0.004,0.027 ± 0.003,0.019 ± 0.006in cells transfected with TLR4-1,TLR4-2,TLR4-3,respectively,which were significantly lower than that in untransfected group (0.061 ±0.018) and negative control group (0.057 ±0.015,P ＜0.05).The transfection efficiency of TLR4-3 vector in stably transfected clones [(82.79 ±8.16)％] was significantly higher than that of transient transfection (P =0.001 ).The expression of TLR4 mRNA was decreased to 0.010 ± 0.002,which was significantly lower than that of transient transfection ( P =0.001 ).The expression of TLR4 protein was (0.54±0.32) ％,which was significantly lower than that of untransfected cells [( 87.42 ± 5.00 ) ％] and that of negative control [(82.9±5.00)％,P =0.000].Conclusions Stable transfection PANC1 cell lines with TLR4 gene silencing are successfully identified.

Expression and clinical significance of Pin1 in pancreatic carcinoma / 中华内分泌外科杂志

Objective To investigate the expression of Pin1 in human pancreatic carcinoma as well as adjacent tissues and to discuss the role of Pinl in oncogenesis of pancreatic carcinoma. Methods Specimen of pancreatic carcinoma tissues and adjacent tissues were collected from 20 cases. Pin1 mRNA and protein expression in pancreatic neoplasm and corresponding adjacent nontumorous tissues were detected by real-time quantitative reverse transcription-polymerase chain reaction (RQ-RT-PCR) and western blot. Results Pin1 was overexpressed at mRNA and protein level in pancreatic carcinoma tissues compared with that in their nontumorous counterparts ( 2.78 ± 1.02 vs 4.36 ± 1.27;5. 48 ± 1.69 vs 9.97 ± 1.86, P ＜ 0.05 ). Pin1 expression was not correlated to clinical stage and pathological grading of the carcinoma. Conclusion Pin1 overexpression may play a key role in pancreatic carcinoma.

Expression of PDX1 in human umblical cord mesenchymal stem cells mediated by adenovirus vector / 中华内分泌外科杂志

ObjectiveTo construct recombinant adenovirus vector containing human pancreatic and duodenal homeobox factor 1 (PDX1) and detect its expression in human umblical cord mesenchymal stem cells (HUCMSCs). MethodsPDX1 obtained by BgⅢ/XhoI enzyme digestion from pUC57-PDX1 was ligated into the recombinant shuttle vector pShuttle-GFP-CMV to obtain the recombinant shuttle plasmid pShuttle-GFP-CMVPDX1. pShuttle-GFP-CMV- PDX1 was shifted to pAdxsi vector to obtain pAdxsi-GFP-PDX1 virus plasmid. The recombinant plasmid was packaged and amplified in 293 cells. The expression of PDX1 gene and protein in HUCMSCs was detected by fluorescence microscopy, RT-PCB, immunofluorescence, immunohistochemistry, and Western Blot. ResultsPDX1 gene was inserted correctly into shuttle plasmid and the recombinant adenovirus vector was successfully constructed according to the results of sequence and enzyme digestion identification. The adenovirus was effectively transfected into HUCMSCs. RT-PCR verified that PDX1 mRNA was positively expressed in HUCMSCs. Expression of PDX1 protein in the nuclear of HUCMSCs was found by immunofluorescence assay, immunohistochemistry and Western Blot. ConclusionThe adenovirus vector containing PDX1 gene is successfully constructed and effectively expressed in HUCMSCs.