The application of low-dose test method combined with variable helical pitch technology in CT angiography of lower extremity arteries / 实用放射学杂志

Objective To evaluate the application efficacy of low-dose test method combined with variable helical pitch(VHP)technology in computed tomography angiography(CTA)of lower extremity arteries.Methods Eighty patients with CTA imaging of bilateral lower extremity arteries were selected and divided into group A and group B on average.VHP technology was used in group A,and conventional fixed pitch scanning was used in group B.The objective and subjective image quality of the two groups were compared,and the radiation dose and contrast agent dosage of the two groups were recorded and compared.Results The subjective image quality evaluation of group A was significantly better than that of group B,and the difference was statistically significant(Kappa test,P<0.05).In the objective image quality evaluation,the CT value and signal-to-noise ratio(SNR)value of the common iliac artery,popliteal artery and anterior tibial artery in group A were higher than those in group B at the same level,and the differences were statistically significant(P<0.05);The effective dose(ED)value in group A was(6.74±1.20)mSv,and that in group B was(7.93±1.78)mSv(P<0.05).The dosage of contrast agent in group A was significantly lower than that in group B[(73.97±12.15)mL in group A,(82.50±2.61)mL in group B](P<0.05).Conclusion Low-dose test method combined with VHP technology not only can reduce the radiation dose and contrast agent dosage,but also can effectively improve the success rate and image quality of lower extremity arteries examination,which is worthy of clinical application.

Prognostic analysis and clinicopathological features of 20 patients with appendiceal neuroendocrine neoplasms / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate clinicopathological features and prognostic factors of appendiceal neuroendocrine neoplasms(a-NEN).</p><p><b>METHODS</b>Clinical data of 20 patients diagnosed with a-NEN at Zhongshan Hospital of Fudan University between January 2000 and December 2016 were retrospectively analyzed. Pathological diagnosis was based on the WHO classification criteria of digestive system tumors (2010 edition). Based on the mitotic count and Ki-67 index, a-NENs were divided into grade 1 neuroendocrine tumor (NET G1), grade 2(G2) NET G2) and grade 3 (neuroendocrine carcinoma, NEC). Some special types of a-NEN (e.g. goblet cell carcinoid) and mixed adenoneuroendocrine neoplasms were classified as mixed adenoneuroendocrine carcinoma (MANEC). Follow-up was conducted by telephone or return visits. Univariate analysis was carried out using the Kaplan-Meier method, and the log-rank test was used to draw survival curves.</p><p><b>RESULTS</b>Of 20 patients, 14 were male and 6 were female with median age of 54 years. Seventeen cases presented acute right lower quadrant abdominal pain, 1 chronic right lower quadrant abdominal pain, 1 persistent abdominal discomfort with outburst whole abdominal pain and 1 was found during body check without symptoms. Twenty cases comprised 8 G1 patients, 4 G2 patients, 3 G3 patients, and 5 MANEC patients. When diagnosed, there was 1 patient with liver metastasis, 1 patient with abdominal and pelvic metastases, and 2 patients with postoperative pathological findings of lymph node metastasis. Six patients underwent appendectomy, 12 underwent right hemicolectomy, 1 underwent right hemicolectomy plus small intestine resection, and 1 underwent partial hepatectomy plus right hemicolectomy. The follow-up time was 7-187 months(average, 36 months). The total 1- and 3-year survival rates were 94.7% and 60.2%, respectively. Univariate analysis showed that age >50 years (χ=7.036, P=0.008), pathology grade as MANEC (χ=5.297, P=0.021), and metastasis (χ=6.558, P=0.010) indicated lower 5-year survival rate.</p><p><b>CONCLUSIONS</b>Most a-NEN patients have no typical symptoms, and the main complaint at consultation is acute right lower quadrant abdominal pain. Prognosis is poor for patients with age >50 years, MANEC pathology grade and metastasis.</p>

Diagnosis and treatment of pancreatic acinar cell carcinoma / 中华胰腺病杂志

Objective To investigate the clinical characteristics and surgical outcomes of pancreatic acinar cell carcinoma (PACC).Methods The clinical and follow up data of PACC patients treated with surgery in Zhongshan Hospital of Fudan University between 1999 and 2012 were analyzed retrospectively.Results A total of 16 PACC were identified including 13 male and 3 female patients.The age of the patients ranged from 38 to 71 with an average of 57 years old.Six patients presented as abdominal pain,while low back pain in 3 patients,abdominal distention in 2 patients,emaciation in 2 patients,jaundice in 2 patients and melena in 1 patient.Elevated CA19-9 level was observed in 8 patients and 2 patients had elevated serum CEA.The tumors were located in the uncinate process in 1 patient,head in 9,body and tail in 6.The superior mesenteric vein was invaded in 2 cases and 1 patient had hepatic artery invasion.The tumor invaded both the celiac trunk and splenic artery in 1 patient.One patient had just undergone intra-operative needle aspiration biopsy due to unresectable tumor.All the other 15 patients underwent surgical excision with R0 resection.Among the 10 patients received pancreaticoduodenectomy,2 had superior mesenteric vein resection and replacement and 1 had hepatic artery resection.Five patients underwent distal pancreatectomy without spleen preservation.The mean size of these tumors was 5.7 cm × 4.6 cm,12 cases had a surrounding envelope,while lymphatic metastasis was observed in 8 cases.The follow up data of 15 patients were collected and the median postoperative survival was 21 months,and the survival rate of 1,3,5 year was 71.4％,28.6％,7.1％.Conclusions Pre-operative diagnosis of PACC is extremely difficult due to lack of specific clinical features and lab tests.Surgery is the first line treatment for PACC,and the prognosis of PACC is better than that of pancreatic ductal adenocarcinoma.

The relationship between serum procalcitonin and postoperative infectious complications following gastric surgery / 中华普通外科杂志

Objective To analyse the factors that have effects on patients' procalcitonin (PCT)level after gastic surgery and to evaluate PCT as a parameter for detection of infectious complications.Methods A total of 153 patients undergoing gastric surgery were included in the study between Jul 2011 and Jan 2013.Temperature and routine blood samples for determining PCT level,neutrophil ratio,white blood cell count were obtained on postoperative days (POD) 1,3,7.Predictive values for each of the markers were examined.Results Postoperative complication,preoperative infection and surgery type affected the PCT level of patients on POD 1.Meanwhile,the independent factor that had influence on PCT level on POD 3 and 7 was postoperative complication.After excluding those patients with preoperative infection,patients with infectious complication exhibited significantly higher PCT levels (t =2.92,P ＜0.01,t =5.34,P ＜0.01,t =4.03,P ＜0.05) on POD 1,3,7 respectively),neutrophil ratio (on POD 3 and 7) and WBC count (on POD 3) than did those without complication.According to receiver operating characteristic analysis,PCT showed the highest AUC on POD 1,7 (AUC =0.89 and 0.87 respectively).In the patients without complication,the mean PCT value was (0.47 ± 0.97),(0.36 ± 0.50),(0.23 ± 0.24) ng/ml on POD 1,3,7 respectively.The PCT level declined 55％ from POD 1 to POD 3 and from POD 3 to POD 7.Conclusions The serum PCT level of patients without any complication showed a decreasing trend while PCT level of those with infectious complications increased significantly.Continuous monitoring PCT level could serve as a diagnostic tool for the early identification of infectious complication after gastric surgery.

Efficacy comparison between pylorus-preserving pancreaticoduodenectomy and standard pancreaticoduodenectomy for periampullary carcinoma / 中华消化外科杂志

Objective To compare the short-term efficacy of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard pancreaticoduodenectomy (SPD) for the treatment of periampullary carcinoma.Methods The clinical data of 85 patients with periampullary carcinoma who were admitted to the Zhongshan Hospital of Fudan University from October 2010 to October 2012 were retrospectively analyzed.Forty-four patients who underwent PPPD were divided into the PPPD group and 41 patients who underwent SPD were divided into the SPD group.The pancreatic fistula(Grade B and above), biliary fistula, blood loss, intra-abdominal infection, delayed gastric emptying (DGE) and prognosis were analyzed.Patients were followed up by telephone interview and outpatient examination once every 3 months within postoperative 1 year and once every 6 months within postoperative 2-3 years till October 2014.Count data were analyzed using the chi-square test, measurement data with normal distribution were presented as M(Qn) and comparison was analyzed using the Mann-Whitney U test.The survival curve was drawn by the Kaplan-Meier method, and survival rate was analyzed using the Log rank test.Results The operation time was 195 minutes (180 minutes, 240 minutes) in the PPPD group and 210 minutes (180 minutes,300 minutes) in the SPD group, with a significant difference (Z =-2.090, P ＜ 0.05).The volume of intraoperative blood loss, intraoperative blood transfusion and duration of postoperative hospital stay were 200 mL(113 mL,288 mL), 0 mL(0 mL, 0 mL) and 17 days(12 days, 24 days) in the PPPD group, and 200 mL(150 mL, 325 mL),0 mL(0 mL, 400 mL) and 16 days(12 days, 30 days) in the SPD group respectively, with no significant differences between the 2 groups (Z =-1.185,-1.780,-0.533, P ＞0.05).There was no perioperative death and incidence of overall complication was 42.4％ (36/85) with pancreatic fistula, intra-abdominal infection and DGE as the top 3 common postoperative complications.The incidence of DGE was 20.5％ (9/44) in the PPPD group,which was significantly different from 4.9％ (2/41) in the SPD group (x2=4.571, P ＜ 0.05).The incidence of pancreatic fistula, biliary fistula, intra-abdominal infection, postoperative bleeding and 2 or more complications were 20.5 ％ (9/44), 2.3 ％ (1/44), 15.9％ (7/44), 4.5 ％ (2/44), 25.0％ (11/44) in the PPPD group, and 14.6％ (6/41), 4.9％ (2/41), 19.5％ (8/41), 7.3％ (3/41), 14.6％ (6/41) in the SPD group, respectively, showing no significant difference between the 2 groups (x2=0.495, 0.423, 0.295, 0.190, 1.425, P ＞ 0.05).Eighty-five patients were followed up for 6-47 months with a median time of 31 months, and postoperative overall 1-and 3-year survival rates were 95.3％ and 75.5％, respectively.The 1-and 3-year survival rates were 97.7％ and 78.9％ in the PPPD group, and 92.7％ and 71.7％ in the SPD group, respectively, with no significant difference in 3-year survival rate (x2=0.690, P ＞0.05).The 3-year overall survival rate was 80.5％ in patients without lymph node involvement (LNI) compared with 54.9％ in patients with LNI, showing a significant difference (x2=4.290, P ＜ 0.05).Conclusions Both PPPD and SPD have good short-term efficacy for periampullary carcinoma.There is no significant difference between PPPD and SPD concerning short-term survival rate of periampullary carcinoma.PPPD has shorter operation time, but has a higher postoperative DGE incidence.LNI is a significant prognostic factor for short-term survival of periampullary carcinoma.PPPD is not recommended while the lymph nodes are involved.

Clinical characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma treated with radical surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastric neuroendocrine carcinomas (g-NECs) are rare tumors that have aggressive biological behaviors and poor prognosis, but the prognostic factors of postoperative patients with g-NEC are still unclear. Our aim was to study and explore the clinical characteristics and prognostic factors of patients with g-NEC treated with radical surgery.</p><p><b>METHODS</b>The clinical data of 43 g-NEC patients who underwent surgery from January 2002 to January 2011 at the Zhongshan Hospital of Fudan University were analyzed. Follow-up was conducted by telephone, mail, or returning visit survey.</p><p><b>RESULTS</b>The sizes of the 43 neuroendocrine carcinomas (G3) were 1.5 cm × 1.5 cm × 0.5 cm to 7 cm × 8 cm × 1.5 cm. Eight NECs were localized, and 35 had lymph node involvement, of which 1 also had hepatic metastasis. At the end of the follow-up, the follow-up rate was 97.7% (42/43), and the median follow-up time was 22.2 months. The median overall survival of g-NEC patients was 36.5 months, and the 1-, 3-, and 5-year overall survival rates were 86.0%, 51.6%, and 36.7%, respectively. Sex (P < 0.05) and lymph node involvement (P < 0.05) were prognostic factors of postoperative g-NEC patients, among which sex was an independent prognostic factor (P < 0.05), as a survival advantage of female patients over male was observed.</p><p><b>CONCLUSIONS</b>Most of the g-NECs were diagnosed at an advanced stage. The prognosis of g-NECs was related with sex and lymph node involvement, of which sex was an independent prognostic factor, with female patients having a survival advantage.</p>

Early complications of pancreaticojejunostomy or pancreaticogastrostomy after pylorus preserving pancreaticoduodenectomy / 中华普通外科杂志

Objective To evaluate the early postoperative complications of pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG) following pylorus preserving pancreaticoduodenectomy (PPPD).Methods Clinical data of 97 patients undergoing PPPD,in Zhongshan Hospital,Fudan University from June 2011 to October 2012,were retrospectively analyed.Digestive tract continuity was established respectively by PG(n-45) or PJ(n =52) after PPPD.Results The demographic characteristics of both group were not significantly different.In the two groups,there were not statistically significant difference in those postoperative complications such as biliary fistula,introabdominal infection,bleeding,and the rc-admission rate.The rate of pancreatic fistula in PJ group was significantly higher than that in the PG group (28.85％ vs.6.67％,P =0.033).However,in PG group the incidence of delayed gastric emptying was significantly higher than that in the PJ group (22.22％ vs.5.77％,P =0.018),and the average length of stay was significantly longer than that in PJ group (19.28 ± 11.04 vs.15.09 ± 6.21 ; P =0.034).In PJ group,one patient died of pancreatic fistula and ensuing surgical site infection and intra-abdominal hemorrhage,there was no mortality in PG group.Conclusions After PPPD,PG and PJ are both safe ways of digestive tract reconstruction.But compared to PJ,PG can decreas the rate of pancreatic fistula but may increase the risk of postoperative delayed gastric emptying,and prolong postoperative hospital stay.

Diagnosis and treatment of anaplastic carcinoma of the pancreas / 中华消化外科杂志

Objective To investigate the diagnosis and treatment of anaplastic carcinoma of the pancreas.Methods The clinical data of 10 patients with anaplastic carcinoma of the pancreas who were admitted to the Zhongshan Hospital from January 1999 to June 2010 were retrospectively analyzed.Computed tomography was carried out preoperatively and surgical plan was designed according to the site of tumors.Chemoradiotherapy was applied postoperatively.Patients were followed up till March 2012 by phone call and out-patient examination.The clinical and imaging features,pathological characteristics,treatment and follow-up data were analyzed.The clinical and pathological features were analyzed by descriptive statistics.The continuous data were described as (x) ± s,and categorical data were presented by frequency and precentage.Results The tumors located at the head of the pancreas were observed in 5 patients,tumor located at the neck of the pancreas in 1 patient,and tumors located at the body and tail of the pancreas in 4 patients.Two patients underwent pancreaticoduodenectomy (PD),2 underwent PD + extended lymph node dissection,1 underwent PD + portal vein reconstruction,1 underwent pancreatectomy,4 underwent resection of body and tail of pancreas and splenectomy.The size of the tumors ranged from 2.0 cm × 2.0 cm × 2.0 cm to 14.0 cm × 12.0 cm × 9.0 cm.Duodenal and biliary invasion was observed in 4 patients,superior mesenteric vein-portal vein invasion in 1 patient,splenic artery invasion in 1 patient.Neural invasion was observed in 8 patients,including 4 patients with lymph node metastasis.The results of immunohistochemical staining showed that 10 patients were with positive expression of cytokeratin 7,and 1 patient was with positive expression of vimentin.Nine patients were followed up,2 patients did not receive postoperative chemoradiotherapy,6 received chemotherapy with Gemicitabine and 1 received interventional treatment.The survival time of the 9 patients ranged from 8 to 20 months,and the median survival time was 12 months.Eight patients died of tumor recurrence and metastasis.Conclusions Pancreatic anaplastic carcinoma is a distinct rare variant of pancreatic ductal adenocarcinoma.Pancreatic anaplastic carcinoma has high malignancy,definite diagnosis depends on pathological examination,and the surgical plan should be made according to the result of imaging examination.Conventional radiotherapy and chemotherapy are ineffective for the treatment of this disease.

Hypergammaglobulinemia: a sentinel detecting autoimmune pancreatitis / 中华普通外科杂志

Objective To determine the clinical value of hypergammaglobulinemia as a sentinel for autoimmune pancreatitis and avoid unnecessary pancreas resection.Methods All 14 patients with autoimmune pancreatitis or related pancreatic diseases underwent routine examinations,including liver function,CA199 and imaging.Measurement of serum IgG or IgG4 was performed for patients with clinically suspected or pathologically proved autoimmune pancreatitis.Clinical features were retrospectively compared between the AIP and non-AIP patients using x2 statistics with Yates correction or Fisher exact test.Results Ten cases were finally confirmed as autoimmune pancreatitis.All patients with autoimmune pancreatitis had elevated levels of serum γ-globulins,while only one case without autoimmune pancreatitis had elevated levels of serum γ-globulins.It was proved by subsequent antibody tests that serum IgG/IgG4 and γ-globulins were simultaneously increased.Conclusions Hypergammaglobulinemia can be used as a preoperative sentinel indicator for differentiating autoimmune pancreatitis from pancreatic malignancies and avoiding unnecessary pancreas operation.

The immunogenicity of the new MUC1 DNA vaccine for pancreatic cancer / 中华肝胆外科杂志

Objective The development of cancer vaccines deserves experimentation,specifically the immunogenicity of the new MUC1 DNA vaccine for pancreatic cancer.Methods Three strategies were combined to optimize the new MUC1 DNA vaccine.The female C57BL/6 mice were immunized,through tibial muscle injection,with 100 μg of plasmid DNA of the recombinant plasmids (pIRES2-EGFP-3VNTR group,pIRES2-EGFP-3VNTR-C1-144 group,pIRES2-EGFP 3VNTR-mIL-18 group,pIRES2-EGFP-3VNTR-C1-144-mIL-18 group,n=5) for a total volume of 100 μl.Mice inoculated with the empty vector pIRES2-EGFP (EV group,n=5) and normal saline (NS group,n=5) were used as vector and blank controls,respectively.All the mice were immunized again every two weeks.Two weeks after the third immunization,all the mice were euthanized and spleen cells were separated for CTL cytotoxic assay.Results The specific cytolysis percentages of the four groups (pIRES2-EG-FP-3VNTR,pIRES2-EGFP-3 VNTR-C1-144,pIRES2-EGFP-3VNTR-mIL-18,pIRES2-EGFP 3VNTR-C1-144-mIL-18) expressing VNTR were higher than the EV and NS group with the effector/target cells ratio (E/T) from 80:1 to 20:1 (P＜0.05).Therefore,it showed a difference among the four groups.After the primary immunization,the OD450 of the serum antibody level specific to MUC1 began to increase in the four groups which contained the gene of VNTR3 (P＜0.05).This suggests that the recombinant plasmids could induce a specific antibody response to MUC1,and showed no remarkable difference among the four groups.IFN-γ serum cytokine among the four groups were higher than that of the EV and NS groups (P＜0.05).There was a significant difference of OD450 between the groups containing mIL-18 pIRES2-EGFP-3VNTR-mIL-18,pIRES2-EGFP-3VNTR-C1-144-mIL-18) and those not (pIRES2-EGFP-3VNTR,pIRES2-EGFP-3VNTR-C1-144,)(P＜0.05).Conclusions In conclusion,all of the four recombinant plasmids could induce MUC1 specific CTL and antibodies responses,and C1-144 and IL-18 could enhance the immunogenicity of plasmids.

A study on the imaging characteristics of autoimmune pancreatitis / 中华普通外科杂志

ObjectiveTo investigate the CT and MRI imaging characteristics of autoimmune pancreatitis and its clinical value.MethodsFourteen patients(13males, 1female, mean age 58.3 years) with autoimmune pancreatitis proved histopathologically or clinically were enrolled in the study.Clinical data was studied retrospectively.Among those patients,CT was performed on 12 cases and MR imaging was performed on 8 patients,6 patients underwent both CT and MR imaging.ResultsAll 14 patients had enlargement of the pancreas,which could be divided into three types including diffuse type ( n =7 ),focal type ( n =5 ) and mixed type ( n =2 ).On plain CT the pancreas was of isodensity ( n =5 ) or mild hypodensity ( n =7).In one case there was several small hypodensity cystic lesions within and around the pancreas that was rarely seen in other autoimmune pancreatitis cases.Pancreatic lesions as shown by MRI were all mildly hypointense on T1WI and mildly hyperintense on T2WI,all displayed lesions were detected as high-signal intensity areas on DWI. By medium contrast,autoimmune pancreatitis lesions demonstrated “ snow-like” heterogeneously decreased enhancement on artery phase of dynamic contrast enhanced imaging and then showed gradually delayed enhancement on portal venous phase and later phases.“Capsule-like” rim was present around the autoimmune pancreatitis lesions in 9 cases.Main pancreatic duct was irregular in shape in 4 cases and slightly dilated in 5 patients.Strictures of lower common bile duct and upper bile duct dilatation as well as thickening and enhancement of the bile duct wall were found in 9 cases.Peripheral vascular involvement was seen in 4 cases. Abdominal lymphadenopathy at hepatic portal was observed in 1 patient.Two cases showed tiny decreased enhancement lesions in the kidneys.Steroid therapy was given in 10 cases,all pancreatitis lesions ameliorated as showed by follow-up imaging examinations.ConclusionsAIP specific CT and MRI imaging findings are common in most patients which help establish the diagnosis and differential diagnosis of AIP.

Effect of fibroblast activation protein expression silencing of mouse fibroblast cells on the proliferation of muse pancreatic cancer cells / 中华胰腺病杂志

ObjectiveSmall interfering RNA (siRNA) was used to silence the fibroblast activation protein4 (FAP) expression of mouse pancreatic cancer related fibroblast cells (mPCa-FCs-1212),and to observe the effects of mPCa-FCs-1212 silencing FAP gene on mouse pancreatic cancer cells (mPCa-1212) proliferation and apoptosis.MethodsThe small interfering RNA targeting FAP gene was designed; the recombinant siRNA plasmid siFAP and control plasmid siMOCK was constructed,which were transfected into mPCa-FCs-1212,respectively.The FAP mRNA and protein expression in transfected cells were examined by real-time PCR and Western blotting.The mPCa-1212 and transfected mPCa-FCs-1212 were co-cultured with a 1:1 ratio in vitro.The growth inhibitory rates and apoptosis rates of mPCa-1212 were detected by MTT assay and Annexin V-FTTC/PI staining and FCM assay.ResultsThe mRNA and protein expressions of FAP in siFAP transfected mPCa-FCs-1212 were significantly down-regulated when compared with that in siMOCK transfected mPCa-FCs-1212[0.584 ±0.029vs.1.052±0.281,P=0.0213; (27.18±3.23)％ vs.(61.58±4.72)％,P=0.0317].The mPCa-1212 was co-cultured with the mPCa-FCs-1212 transfected with siFAP or siMOCK for 3 d,and the inhibitory rates of mPCa-1212 were (23.02 ±3.32)％ and (1.11 ±0.23)％,and the apoptosis rates were (42.31 ±5.34)％ and (7.38 ± 2.09)％,the difference between the two groups was statistically significant (P =0.000).ConclusionsmPCa-FCs-1212 silencing FAP gene can inhibit the proliferation of mPCa-1212 in vitro and induce cell apoptosis,and may be a potential new approach to gene therapy.

Difference between intraductal papillary mucinous neoplasms and pancreatic ductal adenocarcinoma / 中华肝胆外科杂志

Objective To identify difference between intraductal papillary mucinous neoplasms (IPMN) and pancreatic common ductal adenocarcinoma. Methods Between March 2003 and June 2006, 29 patients with pathological diagnosis of IPMN and 46 patients with pancreatic adenocarcinoma in Zhongshan Hospital were retrospectively reviewed. Clinical, biochemical, and histopathologic factors were retrospectively analyzed. Prognosis between two groups were compared by log-rank test.Results The proportion with no symptom visit in IPMN was obviously higher than in pancreatic cancer. Twenty-one of 29 specimens were malignant in IPMN. Stage of the malignant IPMN was significantly earlier than that of the pancreatic adenocarcinoma (P=0.017). Intrapancreatic neural invasion was more common in pancreatic adenocarcinoma than in malignant IPMN (P=0.005). The survival curve of the malignant IPMN was significantly better than that of the pancreatic adenocarcinoma (P=0.014). Conclusion IPMN with less aggressive bionomics can be diagnosed and treated in an earlier stage. So its prognosis is better than that of pancreatic ductal adenocarcinoma. Prognosis of malignant IPMN which is more invasive than stage Ⅱ B is simular to that of common pancreatic cancer. However, this conclusion should be further investigated.

Surgical treatment of intraductal papillary mucinous neoplasms of the pancreas / 中华普通外科杂志

Objective To investigate the outcome of intraductual papillary mucious neoplasms (IPMN) of the pancreas after surgical resection. Method Clinical data of 76 patients with intraductal papillary neoplasms of the pancreas undergoing surgical resection at Zhongshan Hospital, Fudan University between January 1999 and December 2008 were retrospectively analyzed. Results Among the 76 patients,49 were male, 37 were female. 32 had noninvasive IPMNs, including adenomas( n = 16), borderline tumors (n =6 ), carcinomas in situ (n = 10 ). 44 had invasive IPMNs. Lesions were present in the head in 63 cases, in the body or tail in 10, in the whole pancreas in 3. There were significant difference in age,jaundice, weight loss, asymptomatic cases and CA199 value between noninvasive and invasive IPMNs.Three patients underwent total pancreatectomy, 59 patients underwent pancreaticoduodenectomy, 4 patients underwent pancreaticoduodenectomy with portal vein resection and reconstruction, six patients underwent distal pancreatectomy, two patients each underwent central pancreatectomy or enucleation. The overall postoperative morbidity rate were 28.9%, there was no operative mortality. Positive pancreatic margin was identified in seven patients of noninvasive neoplasms, among thoee one developed recurrence after 67 months. The five-year survival rate for patients with noninvasive and invasive neolpasms was 100% and 35% ,respectively. Size and lymph node metastasis were significant prognostic factors after surgical resection of the invasive IPMNs. Conclusions Surgical resection provides a favorable outcome for patients with noninvasive IPMNs. In contrast, invasive IPMNs was associated with a poor survival. Early resection is essential for improving survival. Long-term follow-up is necessary for all patients with IPMNs after resection.

Acinar cell carcinoma of the pancreas: an analysis of 10 cases / 中华胰腺病杂志

Objective To investigate the histological features,biological features,clinical treatment and prognosis of pancreatic acinar cell carcinoma.Methods A retrospective review of 10 patients with pancreatic acinar cell carcinoma treated in our hospital from 1999 to 2008 was conducted and the clinical features,imaging changes,pathologic feature,treatment course and follow-up data were collected.Results There were 9 men and 1 woman with a mean age of (62±8) years old.Tumors were located in the uncinate process in 1 patient,head of pancreas in 7,body and tail in 2.The median size of these tumors was 4.5 cm×4.7 cm;common bile duct and intrahepatic bile duct,pancreatic duct dilation was detected in 7 cases,and superior mesenteric vein was invaded in 2 cases.Of the 10 patients,8 received pancreaticoduodenectomy,among these 8 patients,3 had extended lymph node dissection,2 had portal vein resection and replacement;2received resection of pancreatic body and tail as well as splenectomy.Histologically,the size of these tumors were 4.0 cm×3.3 cm×3.4 cm.Macrescopically,duodenum was invaded in 5 patients,superior mesenteric vein was invaded in 2 patients and neural invasion was present in 7 cases.Lymph node metastasis was noted in 6 cases.Follow-up data was available in 9 patients and 1 patient was lost in follow-up.The survival ranged from 3 to 51 months with a median survival 18 months,and 9 patients died of tumor recurrence and metastasis after operation.Conclusions Pancreatic acinar cell carcinoma should be recognized as a distinct tumor entity and it may not be sensitive to radiotherapy or chemotherapy.The biological features of pancreatic acinar cell carcinoma should be investigated further.

Construction of protein profiling models for diagnosis of pancreatic carcinoma / 中华消化杂志

Objective To establish diagnostic models for pancreatic carcinoma(PC)and to find out the biomarkers related to PC.Methods Serum samples obtained from subjects including PC patients,pancreatic benign disease patients and normal controls were examined with strong anionic exchange chromatography(SAX2)chips for protein profiling using surface enhanced laser desorption/ionization-time of flight-mass spectrometry(SELDI-TOF-MS).The decision tree models and logistic regression models for evaluating the value of serum biomarkers were assessed.SELDI immunoassay and ELISA were used to identify the biomarker and its level in serum respectively.Results Twentysix mass peaks were different between PC patients and normal controls(P＜0.0 1)and 16 mass peaks were different between patients with PC and with pancreatic benign disease(P＜0.05).The decision tree model had a sensitivity of 83.3%and a specificity of 100.0%in differentiation of PC,which was better than that of CA19-9 by ROC curve.There were significant differences in 6 mass peaks among different stages of PC(P＜0.01).Logistic regression model showed a sensitivity of 81.6%and a specificity of 80.6%in diagnosis of early PC.The M/Z 28068 protein was identified as C14orf166 with a sensitivity of more than 82%and a specificity of more than 88%in diagnosis of PC.Conclusions The diagnostic models based on SELDI-TOF-MS were superior to CA19-9 in diagnosis of PC.The identified biomarker C14orf166 is expected to play a role in the diagnosis of PC.

Neuroendocrine tumors of pancreas: treatment and survival analysis / 中华胰腺病杂志

Objective To analyze the surgical treatment strategy and prognostic factors of pancreatic neuroendocrine tumor. Methods The clinical data of 30 patients who underwent pancreatic surgery in our department from April, 1999 to May, 2007 were retrospectively reviewed. According to the new WHO classification system, factors possibly influence the long term survival, such as tumor size, operation types, pathological types, were analyzed. Results There were 18 males and 12 females, with a mean age of 54 years old (28 ～ 78 years old). Five patients were lost in follow up. Among 25 patients who were completely followed, 20 cases were benign and other 5 were malignant, the median survival time of benign and malignant group was 74.8 months and 33.8 months, respectively (X2 = 8.90, P = 0.003). Overall 1, 2, 3, 4, 5-year survival rates were 100%, 100%, 82. 0%, 82. 0%, 65. 6%, respectively. Conclusions Pancreatic neuroendocrine tumor was a rare type of tumor of the pancreas with a good prognosis if surgically resected. The new classification method was effective in predicting the prognosis.

Solid pseudopapillary neoplasm of the pancreas / 中华普通外科杂志

Objective To investigate the clinical features,diagnosis and prognosis of solid pseudopapillary tumor of the pancreas(SPTP). Method The clinical data of SPTP cases that underwent surgical resection with a definitive histological diagnosis in Zhong Shan Hospital from 1999 to 2007 were retrospectively analyzed.Result There were 42 SPTP cases undergoing surgery in this period,including 37 females and 5 males:mean age was 37.6 years.Tumors located in the pancreatic head in 18 cases and in the body or tail in 24 cases.The most common symptom was abdominal discomfort(n=20),palpable mass (n=8).Preoperative diagnostic accuracy of MRI and CT were 93%and 31.8%,respectively.Ten cases underwent pancreaticoduodenectomy,20 cases received distal pancreatectomy,3 cases did spleen-preserving distal pancreatectomy.Tumors were simply enucleated in 8 cases.Average diameter of the tumors was 6.1 cm,34 lesions were solid,6 were solid-cystic,2 were cystic.The overall perioperative morbidity was 38.1%,10 cases developed postoperative pancreatic fistula.The mean follow-up time was 38.6 months.Except three cases that were lost to follow-up,all the other cases were alive.Four cases(2 cases had had tumor enucleation,2 had had distal pancreatectomy)developed hepatic metastases on 70、110、41、3 months after first surgery,respectively.A transarterial chemoembolization was employed in three cases,while right hemihepatectomy was performed in one case. Conclusion SPTP is an indolent tumor with low-grade biological aggressiveness.Patients had a favorable outcome after surgical treatment,but enucleation should be avoided.Patients with liver metastasis may benefit from chemoembolization and liver resection.

CT findings of pancreatic mucinous neopalsms / 中华放射学杂志

Objective To analyze the CT appearances with pathologic correlation and improve the recognition of pancreatic mucinous cystadenoma/cystadenocarcinoma.Methods CT findings in 20 patients with pathologically proven pancreatic mucinous cystic tumor were retrospectively and jointly reviewed by two observers blinded to the pathological results.All patients underwent precontrast and postcontrast helical CT.The number,size,location,and margins of the lesions were observed,along with wall thickness,septation,calcification witllin the lesions.and presence of mural nodules and their enhancement.The findings of malignant and benign tumors were compared.Results Twelve cases of mucinous cystadenoma.3 borderline cystadenomas and 5 cystadenocacinomas were included in this study.Sixteen tumors(16/20)were located at pancreatic body or tail.The findings of thick walsl,calcifications and mural nodules appeared in 4,2 and2 cases respectively in benign mucinous cystic tumors,while appeared in 7,5,and 5 cases respectively in malignant mucinous cystic tumom.Presence of tIlick walls.calcifications and mural nodules in the lesions were significantly associated with malignancy(P＜0.05).Conclusion CT manifestations of pancreatic mucinous neoplasm are variable,but has some specific radiographic features.A combination of CT findings is helpful ifl differentiation of malignant and benign pancreatic mucinous adenomas.

Anti-tumor effect through human endostatin gene transfer in mice bearing B16 melanoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the effects of direct intratumor injection of the packaged cells with retroviral vector carrying human endostatin (hEN) on the growth inhibition of B16 melanoma in C57/BL6 mice.</p><p><b>METHODS</b>Retroviral vector, pLNC-hEN, was constructed with modified and identified hEN gene. The cell line, PA317, was used to establish ecotropic virus producing cells by transfecting and packing with pLNC-hEN. Then the cells were injected directly into the tumor in C57/BL6 mice bearing B16 melanoma, established by intra-cutaneous injection of B16 cell suspension. The tumor size was measured at different intervals to observe the antitumor effect. Micro-vessel density (MVD) in the tumor tissue was evaluated by immunohistological examination to count the apoptotic cells by TUMEL staining.</p><p><b>RESULTS</b>Tumor with diameter of 2 - 3 mm was observed in all mice after 7 - 9 days. The average tumor volume on D3, D5, D7 and D9 after gene transfection was 4.67 +/- 1.1, 22.25 +/- 13.06, 84.17 +/- 43.5 and 155.08 +/- 81.1 mm(3) in the gene therapy group but 136.17 +/- 30.61, 390.17 +/- 220.47, 1 021.67 +/- 537.4 and 2 920.2 +/- 220.01 mm(3) in the control group, the difference of which was statistically significant. The average MVD in the gene therapy and control groups were 8 +/- 2.28 and 28.17 +/- 5.31 while the average apoptotic cell number in the two groups were 23.33 +/- 3.83 and 2.33 +/- 1.21, both of which were statistically significant.</p><p><b>CONCLUSION</b>The direct injection of packaged cells carrying hEN gene is able to inhibit the growth of micro-blood vessels and promote tumor cell apoptosis, which ultimately inhibits the growth of B16 melanoma.</p>