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Pancreatic ductal adenocarcinoma (PDA) organoids are 3D cultured from patient-derived stem cells or progenitor cells in vitro. PDA organoids have a variety of cell types, can realize structural self-organization through cell self-renewal, and are similar to the cells in the body of the original organ function in vivo biological bank. PDA organoids can be derived from surgical or biopsy tissue. The ability to build organoids from biopsy will facilitate the sampling of a larger population of PDA patients. Repeated sampling of patients can track the entire progression of the disease longitudinally. Compared with the traditional 2D cell culture and patient-derived xenotransplantation models, the three-dimensional culture of PDA organoids has the characteristics of short time and high success rate, and can be cryopreserved and maintain the stability of genetic traits. Organoids that can simulate diseases can be used as an alternative drug testing system. Using it for drug testing can not only better reflect the patient's response to drugs, but also can reduce the number of animal experiments. Moreover, when using organoids for testing, there is no need to understand the underlying molecular mechanism a priori, and chemical sensitivity testing can be performed directly, thereby shortening the testing time. In this paper, the advantages and disadvantages of different PDA organoids 3D culture methods and the verification methods for the stability and invasiveness of PDA organoids were reviewed. The mechanism of PDA organoids used for tumor chemotherapy drug sensitivity screening was discussed, and the application prospects and challenges of tumor biology in patient individualized treatment and precision medical treatment were discussed.
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Objective:To evaluate the early predictive value of serum procalcitonin (PCT) , C-reactive protein (CRP) , and white blood cell count (WBC) levels for pancreatic fistula after pancreaticoduodenectomy (PD) .Methods:Data of 93 patients undergoing PD in Department of Pancreatic Surgery at the First Affiliated Hospital of Xinjiang Medical University from Jan. 2017 to Nov. 2019 were retrospectively analyzed. The general information of patients before surgery and postoperative pancreatic fistula were recorded. The levels of serum PCT, CRP, and WBC before surgery and 1st, 3rd, and 5th days after operation were recorded. Patients were divided into pancreatic fistula group (63 cases) and non-pancreatic fistula group (30 cases) . The preoperative data were compared between the two groups. Box plot and the receiver operating characteristic curve (ROC) were drawn. The area under the ROC curve (AUC) was calculated. The sensitivity and specificity of PCT, CRP, and WBC levels in predicting pancreatic fistula alone and jointly were calculated.Results:There were no statistically significant differences in the age, gender, presence or absence of diabetes, total bilirubin, preoperative albumin, surgical time, or intraoperative bleeding in the general information of the pancreatic fistula group and the non-pancreatic fistula group. The difference in index (BMI) was statistically significant. The value of PCT, CRP, and WBC before operation and the value of PCT on the first day after operation were not statistically significant between the two groups ( P=0.424, 0.819, 0.484, and 0.072, respectively) . The PCT values on the 3rd and 5th days after surgery, the values of CRP and WBC on the 1st, 3rd, and 5th days after surgery were all statistically significant (all P values were<0.05) . The area under the ROC curve was jointly predicted by the three at the 3rd and 5th days after operation (AUC=0.792, 0.812) , and the sensitivity (62.9%, 71.4%) and specificity (83.3%, 80%) were better than the three alone. Conclusion:PCT, CRP, and WBC values on the 1st, 3rd, and 5th days after surgery alone have certain limitations in predicting pancreatic fistula, and the combined prediction of the three is more valuable.
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Objective To carry out a meta-analysis,in order to evaluate the effectiveness and safety of the duodenum-preserving pancreatic head resection (DPPHR) and pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy(PPPD) for surgical treatment of chronic pancreatitis.Methods Medline,EMBASE,Cochrane library and other medical databases were searched for the clinical trials (randomized controlled trials) of comparing DPPHR Versus PD/PPPD.A total of 5 clinical trials (8 references) met the inclusion criteria.The data were analyzed using the RevMan 5.3 software.Results The two methods don't have statistical differ ence in terms of operation time (P=0.007),postoperative morbidity (P=0.35) and mortality (P=0.18),pain relief(P=0.36),new onset of diabetes(P=0.11),exocrine insufficiency(P=0.18),short-term(P=0.14) and long-term(P=0.16) quality of life score,the length of hospital stay (P=0.69),and pancreatic fistula (P=0.78).Weight gain (P＜0.000 01) and occupational rehabilitation (P=0.03)were significantly improved in the DPPHR group.However,PD/PPPD group was associated with fewer readmission due to pancreatic diseases.Conclusions DPPHR offers more advantages with regard to the quality of life.However,it needs more high-quality clinical trials to verify the results.
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Objective The risk of current pancreaticojejunostomy is carefully considered from the perspective of the morphology of remnant pancreas,and we aimed to discuss the clinical outcomes of selecting different pancreaticojejunostomy techniques based on pancreatic morphology.Methods This was a prospective cohort study.The histopathology of remnant pancreatic tissues was categorized into four types based on preoperative radiological images and intraoperative palpation:Type Ⅰ:pancreas with hard texture in palpation,pancreatic atrophy,dilated pancreatic duct larger than 5 mm and remnant pancreatic surface ＜3 cm;Type Ⅱ:pancreas with hard texture in palpation,pancreatic atrophy and mild dilatation of pancreatic duct with the diameter of 3-5 mm and remnant pancreatic surface ＜3 cm;Type Ⅲ:pancreas with slightly hard texture,no atrophy,and normal or slightly dilated pancreatic duct with the diameter of 3-5 mm and remnant pancreatic surface ≥3 cm;Type Ⅳ:pancreas with soft texture,normal morphology and pancreatic duct.Results From January 2008 to August 2017,116 consecutive patients underwent pancreaticoduodenectomy in our center.Among them,10 patients with type Ⅰ underwent classic pancreatic ductal mucosa to mucosa anastomosis.19 patients with type Ⅱ underwent classic end to end invaginated pancreaticojejunostomy.45 patients with type Ⅲ underwent classic end to end invaginated pancreaticojejunostomy with overlapping U sutures;42 patients with type Ⅵ underwent total invaginated pancreaticojejunostomy.The post-operative pancreatic fistula occurred in 6 patients (5.2％) with one patient died.Postoperative bleeding occurred in 10 patients (8.6％),and gastroparesis occurred in 22 patients (19.0％).Overall complication rate was 33.6％.Conclusions Classification of pancreatic morphology based on preoperative radiological images and intraoperative palpation and the selection of corresponding pancreaticojejunostomy technique is theoretically rational and has the advantage of potentially reducing the risk of remnant pancreatic tissue.
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Objective To investigate the clinical and pathological features of colonic polyp canceration and related risk factors of colon polyps,and explore clinicopathologic features and major risk factors of the canceration of polyps of colon polyps.Methods Totally 80 patients with colon polyps including 6 cases of cancerations and 20 patients with colon cancers were selected from Xuzhou Tumor Hospital Admissions.Those patients were divided into 74 cases of non cancer group and 26 cases of cancer group.The clinical data,the detection index and the statistical analysis were performed.Results The clinical features of patients included 51 cases of multiple polyps,30 cases of fatty liver,13 cases of fecal occult blood positive,and 30 patients with colonoscopy.There were 218 polyps,191 data intact,and 6 cases showed cancer (3.14％).Inflammatory polyps mainly occurred in rectum,cecum,and significant risk other than the colon.Tubular adenoma occurred mainly in the transverse colon.Sigmoid colon cancer colon polyps of the highest risk showed OR =2.30 (P ＜ 0.05).The cancer risk from high to low was from tubular villous adenoma to villous adenoma hair (P ＜0.01),and no difference in tubular adenoma cancer risk (P ＞0.05).There was no difference between the indexes of the canceration group and the non cancerous group (P ＞ 0.05).The single factor analysis showed pathological type,and the lesion were the main risk factors of malignant colonic polyps (P ＜ 0.05).Multi-factor regression analysis showed WBC,pathological type,and the lesion were the main risk factors of malignant colonic polyps (P ＜ 0.05).Conclusions The colonic polyps in male have higher incidence with fatty liver,hypertension and other pathological features,and are mainly tubular adenomas,inflammatory and hyperplastic polyps,with different lesions,pathological types occur and different cancer risk.
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Objective To investigate the value of Helicobacter pylori (HP),blood carcinoembryonic antigen (CEA),carbohydrate antigens 72-4 (CA72-4) and CA24-2 in the screening of gastric cancer.Methods The contents of HP,blood CEA,CA72-4 and CA24-2 in 50 healthy controls,45 patients with benign gastric lesions mnd 70 patients with gastric cancer were detected.According to the number of positive cases,the positive rate of single detection and the positive rate of combined detection were calculated.Sensitivity,specificity,and accuracy of serum tumor markers were calculated according to HP single and combined detection.Results The positive rate of each individual detection and 4 joint detection in gastric cancer group was significantly different from that in the benign lesion group and the normal control group (P ＜0.01).The positive rate of 4 joint detection in gastric cancer group was 89.25％,and the difference was statistically significant (P ＜0.01).There was no significant difference in the positive rate of the single test and the 4 joint detection in benign stomach group and normal control group (P ＞ 0.05).The sensitivity,specificity and accuracy of HP,blood CEA,CA72-4,CA24-2 joint detection were significantly higher than single detection (P ＜ 0.05).Conclusions Joint detection was significandy better than single detection,and can significantly improve the detection rate of gastric cancer.
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BACKGROUND:Central pancreatectomy is a surgical treatment for tumors at the neck or the middle part of the pancreas, which can reserve more normal pancreas, not cut adjacent organs, and reduce the incidence of postoperative internal and external pancreatic secretion deficiency with respect to the expanded proximal and distal pancreatectomy. OBJECTIVE: To systematicaly evaluate the clinical efficacy of the central pancreatectomy and distal pancreatectomy. METHODS: A computer-based search of Chinese and English databases was performed, and then 15 controled clinical trials were included and systematicaly evaluated using RevMa5.2 software. RESULTS AND CONCLUSION: Totaly 1 079 cases were included in this study, which consisted of 436 central pancreatectomy cases and 643 distal pancreatectomy cases. Meta-analysis showed that compared with the distal pancreatectomy group, the incidences of postoperative pancreatic fistula and complications were significantly higher, the risk of postoperative endocrine and exocrine insufficiency were significantly lower, while the surgical time (SMD: 59.23, 95%CI: 22.41-96.05, P < 0.01) and hospital stays (SMD: 7.01, 95%CI: 1.94-12.09,P< 0.01) were longer in the central pancreatectomy group. These findings indicate that although the central pancreatectomy has a high postoperative complication incidence, it can be accepted clinicaly, which may be a reasonable operation method to preserve pancreatic exocrine and endocrine function.
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Objective To investigate the histological changes of the right ventricular remodeling in Xinjiang Mar-mota baibacina which are adapted to high-altitude hypoxia .Methods Hematoxylin and eosin and Masson staining was used to examine the pathological changes and degree of fibrosis , and immunohistochemical technique was used to detect connexin 43 ( CX43) expression in the right ventricular myocardium .Results In the right ventricular myocardium , cardio-myocyte hypertrophy and increased amount of collagen fibers were observed .The right ventricular hypertrophy index and weight index of Marmota baibacina were significantly higher , and expression of CX43 was significantly reduced than that of normal rats ( P<0.05 for both ) .Conclusions High-altitude hypoxia induces right ventricular remodeling in Xinjiang Marmota baibacina.It can be used as an ideal animal model for studies on the mechanisms of hypoxia adaptation on high -altitude plateau .
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Objective To investigate the correlation of single nucleotide polymorphism of rs3731055 and rs2607775 of xeroderma pigmentosum group C (XPC) and smoking with genetic susceptibility to pancreatic cancer.Methods The clinical data of 214 patients with pancreatic cancer who were admitted to the First and Third Affiliated Hospitals of Xinjiang Medical University from January 2009 to June 2011 and 214 healthly individuals were retrospectively analyzed.The samples of venous blood of 214 patients with pancreatic cancer (case group) and 214 healthy individuals (control group) were analyzed by the Multiplex SNaPshot method.The count data were analyzed using the chi-square test.The association between the single nucleotide polymorphism of rs3731055 and rs2607775 with genetic susceptibility to pancreatic cancer was analyzed using the Logistic regression method.Results Four hundred and twenty-three samples of gene were successfully typed,including 210 in the case group and 213 in the control group.The frequency of G allele of XPC rs3731055 was 75.95％ (319/420) in the case group and 77.00％ (328/426) in the control group,with no significant difference between the 2 groups (x2 =0.12,P ＞ 0.05).The frequencies of genotypes GG,GA and AA were 58.57％ (123/210),34.76％ (73/210) and 6.67％ (14/210) in the case group,and 60.09％ (128/213),33.80％ (72/213) and 6.10％ (13/213) in the control group,with no significant difference between the 2 groups (x2=0.12,P ＞ 0.05).The frequency of C allele of XPC rs2607775 was 87.86％ (369/420) in the case group and 93.43％ (398/426) in the control group,with significant difference between the 2 groups (x2=7.75,P ＜ 0.05).The frequencies of genotypes CC,CG and GG were 77.62％ (163/210),20.48％ (43/210) and 1.90％ (4/210) in the case group,and 86.85％ (185/213),13.15％ (28/213) and 0(0/213) in the control group,with significant difference between the 2 groups (x2=8.54,P ＜ 0.05).Patients with rs2607775 GC genotype were associated with a significantly increased risk of pancreatic cancer compared with patients with rs2607775 CC genotype (adjusted OR =1.81,95％ CI:1.06-3.10,P ＜ 0.05).Patients with rs2607775 GC + GG genotype were associated with a significantly increased risk of pancreatic cancer compared with patients with rs2607775 CC (adjusted OR =1.98,95％ CI:1.16-3.36,P ＜ 0.05).The ratio of patients in the case group who smoked cigarettes ≥ 17 pack years was 25.24％ (53/210),which was significantly higher than 13.15 ％ (28/213) of the control group (x2 =11.37,P ＜ 0.05).The results of univariate analysis showed that patients who smoked cigarettes ≥ 17 pack years had higher risk of getting pancreatic cancer (adjusted OR =2.82,95％ CI:1.27-6.29,P ＜ 0.05).Patients who smoked cigarettes ≥ 17 pack years and with rs2607775 CC also had higher risk of getting pancreatic cancer (adjusted OR =2.87,95％ CI:1.18-6.99,P ＜0.05).No significant gene-environment interaction was observed between rs2607775 GC + GG and smoking ≥ 17 pack years (adjusted OR =3.65,95％ CI:0.67-20.03,P ＞ 0.05).Conclusions The polymorphisms of XPC rs2607775 may play a role in the onset of pancreatic cancer.Patients who smoke cigarettes ≥ 17 pack years are more easily to have pancreatic cancer.There is no interaction between smoking and XPC rs2607775 in influencing the progression of pancreatic cancer.
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Objective To systematically review the clinical efficacy of transanastomotic pancreatic ductal stents placement after pancreaticoduodenectomy.Methods According to the Cochrane reviewers handbook (version 5.0 ),literatures were retrived from PubMed,Embase,Cochrane,VIP database,China Biology Medicine disc and CNKI database,and then the quality of the literatures was analyzed.Meta analysis was carried out using the RevMan software ( version 5.0.18 ).A random effects model was adopted,and the results of the meta analysis were presented with odds ratio (OR) and 95％ confidence interval (95％ CI).Results Four randomized controlled trials including 557 patients were retrieved.External stents were used in 160 patients and internal stents in 115 patients.The results of meta analysis showed no significant difference in the rate of fistula,overall postoperative morbidity and mortality between patients who did or did not receive pancreatic stents placement (OR =0.66,0.70,0.63,P ＞ 0.05 ).There were significant differences in the rate of pancreatic fistula and overall postoperative morbidity between patients who received external pancreatic stents placement and those did not receive pancreatic stents placement ( OR =0.48,0.55,P ＜ 0.05 ).There was no significant difference in the mortality rate between patients who received external pancreatic stents placement and those did not receive pancreatic stents placement (OR =0.71,P ＞ 0.05 ).There were no significant difference in the incidence of pancreatic fistula,overall postoperative morbility and mortality between patients who received internal pancreatic stents placement and those did not receive pancreatic stents placement ( x2 =0,0.75,2.11,P ＞ 0.05 ).Conclusions External pancreatic stents placement after pancreaticoduodenectomy can reduce the incidence of postoperative complications.The effects of internal pancreatic stents placement need to be proved by further highquality prospective randomized trials.
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Objective In order to recognize the high risk of acute abdomen caused by mesenteric vascular lesions and to improve the treatment.Method 8 cases have been followed and analyzed in clinic features,curative methods and effects.Results 6 patients were operated on and the diagnosis was confirmed pathologically.Most of patients suffered the acute abdominal,pain and signs were in the disorder.5 patients misdiagnosed, 1 diagnosed preoperatively, 2 cases with mesenteric vascular insufficiency were diagnosed by CT, celiac arteriography and cured with drugs,7 cured, 1 died.Conclusions Mesenteric vascular diseases are uncommon,accurate diagnosis should not rely on symptoms and signs which were nonspecific.Ultrasonography,CT were the sensitive examinations and benefitted to diagnosis.Early operation for the resection of bowel gangrene involving their mesentery,early application of anticoagulant therapy is essential to reduce the mortality and recurrence.
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Objective To study the risk factors of early complications and methods of treatment after pancreaticoduodenectomy(PD).Methods There were 79 patients who undercoent PD at our hospital between January 1998 and December 2007.All of the patients were divided into complication group and non-complication group according to the outcomes.Their clinical features,preoperative tests,and surgical factors were retrospectively analyzed.Results The postoperative complication rate was 58.2%,and the hospital mortality was13.9%.Logistic regression showed that the level of total bilirubin and liver function classification were the independent risk factors(P0.05).Conclusions The early complications after PD are closely related to the preoperative level of serum bilirubin and liver function.Proper periopertive management can effectively decrease the occurrence of pancreatic leakage and other postoperative compliccations.
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Objective To study the results of splenectomy for patients with idiopathic thrombocytopenic purpura(ITP), which refractory to medical therapy or with repeat recurrence of symptoms. Methods 58 ITP (patients) who failed to respond to conservative management were treated with splenectomy and the clinical (outcome) was observed. Postoperatively, 52 cases were followed up for 6 months to 12 years, and in 48 of these cases the followup was more than 1 year. Results Platelet count recovered to normal(≥100?10~9/L ) two weeks after operation in 47 cases(81.03%). The total effective rate was 79.31% when (followed-up) for 2 months, 78.85% when followed-up for 6 months and 11 cases had recurrence. (Conclusions) Splenectomy is a safe and effective therapy for patients with ITP who failed to respond to (conservative) management or have relapse of ITP. Patients who showed temporary response to preoperative (steroid) therapy and those who had an early or a high amplitude of increase of platelet count after operation have better prognosis.
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Objective To study the effect and significance of transforming growth factor-?_1(TGF-?_1), and TGF-?_1mRNA in the pathogenesis of chronic pancreatitis. Methods The expression and distribution of TGF-?_1, and TGF-?_1mRNA in the pancreatic tissue in different stage of the pathogenesis of chronic pancreatitis were studied with immunohistochemical SP staining, in situ hybridization,and reverse transcription-polymerase chain reaction on the canine model of chronic pancreatitis . Results The Expression of TGF-?_1 and TGF-?_1mRNA were found in fibrotic tissues, fibroblasts, macrophages and endothelial cells of blood vessels.The expression of TGF-?_1 and TGF-?_1mRNA were high and lasting in the pathogenesis of chronic pancreatitis. Conclusions High expression of TGF-?_1 is closely related to the fibroblast proliferating activity, extracellular matrix overdeposition and proceeding fibrosis of pancreas.
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Objective To investigate the effect of hypertonic saline in the management of murine experimental severe acute pancreatitis (SAP) Methods SAP was induced in Wistar rats by intraperitoneal injection of 20% L Arginine Rats were divided into four groups ( n =12 in each group ); Healthy controls received intraperitoneal injection of distilled water of 5 ml/kg body weight initially Rats in the four groups were infused at 24 h and 48 h respectively at a dosage of 2 ml/kg body weight of distilled water in both healthy contrals, and SAP controls, of normal saline in group 3 and of hypertonic saline (7 5% sodium chloride) in group 4 Blood samples were collected at 48 h and 72 h after last injection for the measurement of plasma TNF ?、IL 6、 IL 10 All rats were sacrificed for histopathology of pancreatic and lung tissues at 72 h Results Animals that received hypertonic saline showed less pancreatic and lung damage than those resuscitated with normal saline Plasma levels of TNF ?、 IL 6 decreased significantly and plasma levels of IL 10 increased more significiently at 72 h after induction of SAP Conclusion Hypertonic saline resuscitation result in a significant attenuation of the systemic inflammatory response to severe acute pancreatitis
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Objective To study the therapeutic effects and prognosis of advanced pancreatic carcinoma treated with iodine-125 seeds implantation.Methods The records of 98 patients with unresectable advanced pancreatic carcinoma admitted from Mar.2004 to Oct.2008 were analyzed.There were 53 cases treated by supportive treatment,24 cases by palliative operation and 21cases by palliative operation combined with iodine-125 seed implantation.Results Pain partial and complete relief rate in palliative operation combined with iodine-125 seeds implantation radiotherapy group(84.21% and 15.79%,respectively) was better than other two treatment groups(P
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Objective To study the effect of early enteral nutrition(EN) and total parenteral nutrition(TPN) in patients with severe acute pancreatitis by a mata analysis.Methods Randomized controlled trials of TPN and early EN in patients with severe acute pancreatitis were searched in Medline,Pubmed and Embase from Jan 1970 to June 2009,and Cochrane Library(Issue 2,2009).Seven studies were enrolled into the analysis.The detail about the trial design,characters of the subjects and results of the studies were reviewed by two independent authors and analysed by using Revman 5.0.18 software.Results Compared with TPN,early EN was associated with a significantly lower incidence of pancreatic infections(OR =0.38,95% CI :0.18～0.82,P =0.01),organ failure(OR =0.43,95% CI :0.23～0.79,P =0.007),fewer surgical interventions(OR =0.34,95% CI :0.18～0.63,P =0.0006) and mortaily(OR =0.41,95% CI :0.19～0.88,P =0.02).However,there was no significant difference in total infections [ OR =0.43,95% CI(0.17,1.10),P =0.08]between patients with TPN and early EN.Conclusions Early EN could be the preferred nutrition feeding method for patients with severe acute pancreatitis.
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Objective To investigate the role of the spleen in the pathogenesis of acute pancreatitis(AP). Methods The studied rats were divided randomly into four groups:Sham operation group, splenectomy group, AP group and AP with splenectomy group.The rats were sacrificed at 3h,6h and 12h after operation, and spleen and pancreas were removed for examination. Light microscopy was used to examine pancreatic tissues for pathologic change and to assess pathology score. Immunohistochemical method was used to observe the activity of splenic NF-?B(p65) in the rats with AP.Results The pancreas pathology score in the AP with splenectomy group was significantly lower than that in AP group at 6h(7.83?0.753vs 9.67?1.211) and 12 h (9.67?0.816 vs13?0.894) after operation (P