It was reported that three cases of neuropsychiatric complications after liver transplantation were enrolled from Department of Hepatobiliary Surgery, Weifang People's Hospital from March 2001 to August 2004. Two cases of delirium kind of mental disorder, and one patient had epilepsy and limb movement disorder. All subjects were mainly given immunosuppressant drug therapy, a timely correction of fluid and electrolyte imbalance and symptomatic treatment. Postoperative prognosis of patients as well as the diagnosis and treatment of patients were retrospectively observed. Case one, male aged 54 years of hepatitis B liver cirrhosis and large, with a history of hypertension for 15 years and diabetes for 10 years. On September 25th, 2001 the patient received piggyback liver transplantation. During and after transplantation the patient received a strong impact on the treatment with the Dragon 1 000 mg. After 28 days,the patient died of hyperbilirubinemia, hyperkalemia, liver and kidney failure clinically. Case two, male aged 47 years of hepatitis B, cirrhosis and huge hepatocellular carcinoma, chronic calculous cholecystitis, with a history of hypertension for 5 years and diabetes for 2 years. On December 26th, 2001 the patient was treated with piggyback liver transplantation. At day 44 the patient had obvious cough with yellow-green phlegm, sputum culture was Aspergillus spp (50%) and diflucan for the treatment. Till day 53, drowsiness and depressed spirit appeared; at day 54, the patient was disoriented, and at day 55 hemiparesis occurred at right side, gradually coma, by brain CT scan it confirmed to be intracerebral hemorrhage, and died. Case three, male aged 59 years of hepatitis B, cirrhosis of liver atrophy with right hepatic small hepatocellular carcinoma. On August 20th, 2004 the patient was given classic modified line-situ liver transplant surgery without venovenous bypass. Four days after sudden aphasia, gradually motor dysfunction, swallowing dysfunction,restlessness and epilepsy appeared. After Phenytoin Sodium, chloral hydrate enema and luminal sodium treatment, focal epilepsy and irritable symptoms were effectively controlled, but aphasia and left hemiparesis still occurred. After five months, the patient died of cerebral hemorrhage. Incidence rate of neuropsychiatric complications are high after liver transplantation. Besides, brain hemorrhage is a serious complication and has a high mortality rate. It is important and positive of reducing bleeding, maintaining hemodynamics and environmental stability to avoid the large blood transfusion and infusion for the prevention of serious complications.

It was reported that three cases of neuropsychiatric complications after liver transplantation were enrolled from Department of Hepatobiliary Surgery,Weifang People's Hospital from March 2001 to August 2004. Two cases of delirium kind of mental disorder,and one patient had epilepsy and limb movement disorder. All subjects were mainly given immunosuppressant drug therapy,a timely correction of fluid and electrolyte imbalance and symptomatic treatment. Postoperative prognosis of patients as well as the diagnosis and treatment of patients were retrospectively observed. Case one,male aged 54 years of hepatitis B liver cirrhosis and large,with a history of hypertension for 15 years and diabetes for 10 years. On September 25th,2001 the patient received piggyback liver transplantation. During and after transplantation the patient received a strong impact on the treatment with the Dragon 1 000 mg. After 28 days,the patient died of hyperbilirubinemia,hyperkalemia,liver and kidney failure clinically. Case two,male aged 47 years of hepatitis B,cirrhosis and huge hepatocellular carcinoma,chronic calculous cholecystitis,with a history of hypertension for 5 years and diabetes for 2 years. On December 26th,2001 the patient was treated with piggyback liver transplantation. At day 44 the patient had obvious cough with yellow-green phlegm,sputum culture was Aspergillus spp (50%) and diflucan for the treatment. Till day 53,drowsiness and depressed spirit appeared; at day 54,the patient was disoriented,and at day 55 hemiparesis occurred at right side,gradually coma,by brain CT scan it confirmed to be intracerebral hemorrhage,and died. Case three,male aged 59 years of hepatitis B,cirrhosis of liver atrophy with right hepatic small hepatocellular carcinoma. On August 20th,2004 the patient was given classic modified line-situ liver transplant surgery without venovenous bypass. Four days after sudden aphasia,gradually motor dysfunction,swallowing dysfunction,restlessness and epilepsy appeared. After Phenytoin Sodium,chloral hydrate enema and luminal sodium treatment,focal epilepsy and irritable symptoms were effectively controlled,but aphasia and left hemiparesis still occurred. After five months,the patient died of cerebral hemorrhage. Incidence rate of neuropsychiatric complications are high after liver transplantation. Besides,brain hemorrhage is a serious complication and has a high mortality rate. It is important and positive of reducing bleeding,maintaining hemodynamics and environmental stability to avoid the large blood transfusion and infusion for the prevention of serious complications.

Objective To analyze, treatment of ipsilateral Pilon and calcaneal fractures (IPCF). Methods Injury causes included fallings in seven patients, traffic injury in two and impact injury in one, with ISS score of 5-22 points. There were seven patients with open injuries and 3 with close ones. Nine pa-tients had Ⅱ-Ⅲ degree of Pilon fractures according to the AO/OTA classification and six comminuted com-pression calcaneal fractures according to the Essex-Loprest classification. The Pilon fractures were fixed by cannulated nail, screw or Kirschner wire through open reduction in six patients including four fixed with ex-ternal fixators (the calcaneal fractures were fixed with percutaneous eannulated nail or Kirschner wire by poking reduction). The calcaneal fractures were fixed with only Kirschner wire through poking reduction in two patients and double fractures treated conservatively in two. Results The reduction of Pilon and cal-caneal fractures treated by operation were markedly improved in six patients, while there occurred angular deformity and joint surface introeession in the patients treated conservatively. The wound healing of soft tis-sue was sound in seven patients but unsatisfactory in the other three. The ankle-hind foot score was 82-94 points in four patients who were followed up. Conclusions IPCF is caused by the high energy force and characterized by severe injures of the soft tissues and the bone tissues at the distal tibia and calcaneua, for which limited internal fixation plus external fixation are suitable treatment choice.

AIM: To investigate the role of epigenetic modification in Pdx-1 gene transcription and expression, and to compare the differences between epigenetic modifications of Pdx-1 gene promoter in various cell types of mice. METHODS: The promoter DNA methylation and histone modification status of Pdx-1 and MLH1 genes in NIT-1 cells, NIH3T3 cells and mouse embryonic stem cells were measured by chromatin immunoprecipitation-real time PCR method. The expression levels of these genes in the three cell lines were measured by real time RT-PCR. The relation between epigenetic modifications and gene expression was analyzed. RESULTS: (1) Compared to mES cells, there was lower DNA methylation and higher H3K4m3 modification levels in the promoter of Pdx-1 gene in NIT-1 cells (P<0.05). DNA methylation, H3 acetylation, H3K4m3 and H3K9m3 modification levels in the promoter of Pdx-1 gene in NIH3T3 cells were distinctly increased (P<0.05). (2) Pdx-1 gene transcription expressed only in NIT-1 cells. The Spearman's rho between Pdx-1 gene expression and DNA methylation (r=-0.802,P<0.01) was observed. The Pearson correlation between Pdx-1 gene expression and H3K4m3 modification (r=0.997,P<0.01) was also found. The Spearman's rho between Pdx-1 gene expression and H3K9m3 modification (r=-0.879,P<0.01) was observed. (3) No correlation between housekeeper MLH1 gene expression and epigenetic modification was found. CONCLUSION: DNA methylation, H3K4m3 and H3K9m3 modification coordinated participate to regulate and control the expression of Pdx-1 gene. It is of great significance to the differentiation of β cells from ES cells.

Objective To investigate the effects of sodium butyrate(NaBT) on proliferation of human pancreatic cancer cell line ASPC-1 and explore the possible mechanism. Methods The methylthiazolyl tetrazolium assay (MTT) method was used to detect cell proliferation and draw a curve. The cell apoptosis and cell cycle were determined with flow cytometry. Western blot was used to study the effect NaBT on the pancreatic cancer cells and explore its mechansim. Real-time PCR was employed to assess the expression levels of p53, p21, bcl-2 and cell cycle regulation gene p21. Results After incubation with different concentrations of NaBT for 24 to 72 h, ASPC-1 cell proliferation was inhibited dramatically. NaBT induced an increase of G0/G1 phase cells and a significant decrease in the ratio of S phase cells. The expression of p21 and bax was up-regulated at protein and mRNA level. The expression of bcl-2 was down-regulated at protein and mRNA level. There was no significant difference in the expression of p53 at protein and mRNA level. Conclusion TSA-induced growth inhibition is associated with a block in the G0/G1 phase and apoptosis, which may occur through down-regulating the expression of apoptosis gene bcl-2 and up-regulating the expression of cell cycle regulation gene p21and pro-apoptotic gene bax.

Objective To investigate the relationship between EphA7 protein and carcinogenesis and development of pancreatic cancer by detecting the expression of EphA7 protein in pancreatic cancer tissues. Methods The expression of EphA7 in 10 cases of normal pancreatic tissue, 51 cases of pancreatic cancer and its adjacent tissues were detected with immunohistechemieal methods and the relationship between EphA7 and pathologic features of pancreatic cancer were analyzed. Results The rate of expression of EphA7 protein in normal pancreatic tissue was 10% (1/10), 47.1% (24/51) in adjacent pancreatic cancer tissues, 94.1% (48/51) in pancreatic cancer tissues. There were significant difference among the three groups (P <0.05). There was no significant correlation between the expression of EphA7 protein and the age, sex, tumor location, tumor size in patients with pancreatic cancer (P > 0.05). However there was significant correlation between the expression of EphA7 protein and the degree of differentiation, clinical staging, lymph node metastasis, or distant metastasis (P < 0.05). Conclusions The abnormally high expression of EphA7 may be relevant with the occurrence and development of the pancreatic cancer.

This study examined whether 1-methyl-tryptophan [1-MT, an indoleamine 2, 3-dioxygenase (IDO) inhibitor] could reduce CD4(+)CD25(+) regulatory T cells (Tregs) proliferation and improve the anti-tumor efficacy of dendritic cells (DCs) pulsed with tumor cell lysate in the mice bearing pancreatic adenocarcinoma. The models of pancreatic adenocarcinoma were established in C57BL/6 mice by subcutaneous injection of Pan02 cells. Eight mice which were subcutaneously injected with PBS served as control. The expression of IDO was determined in tumor draining lymph nodes (TDLNs) and spleens of the murine pancreatic adenocarcinoma models. The prevalence of Tregs was measured in the TDLNs and spleens before and after 1-MT administration. The dendritic cells were pulsed with tumor cell lysate for preparing DC vaccine. The DC vaccine, as a single agent or in combination with 1-MT, was administered to pancreatic adenocarcinoma mice. The anti-tumor efficacy was determined after different treatments by regular observation of tumor size. The results showed that the levels of IDO mRNA and protein in tumor-bearing mice were significantly higher than those in the normal control mice. The percentage of Tregs in the spleen and TDLNs was also higer in tumor-bearing mice than in normal control mice (P<0.05). Foxp3 expression was significantly lower in the TDLNs and spleens of tumor-bearing mice administrated with 1-MT than that in normal control mice. Furthemore, in the mice that were administered 1-MT plus DC vaccine, the tumor was increased more slowly than in mice treated with DC vaccine or 1-MT alone, or PBS on day 36 (P<0.01). Our results indicated that 1-MT may enhance anti-tumor efficacy of dendritic cells pulsed with tumor cell lysate by downregulating the percentage of Tregs.

Objective To explore the clinical selection of surgical methods for pure stenosis at the end of the common bile duct.Methods The clinical data of 43 cases of pure stenosis at the end of the common bile duct treated in this hospital from October 2003 to June 2009 were retrospectively analyzed.Of the 43 cases, 12 underwent endoscopic sphincterotomy(EST), 9 sphincteroplasty of Oddi, 5 pancreaticoduodenectomy,8 Roux-en-y choledochojejunostomy and 5 choledocoduodenostomy,4 underwent drainage of the T tube after exploration of the biliary passage.Results Among 37 patients did not undergo the radical pancreaticoduodenectomy,6 had space-occupying lesions 5-19 months postoperatively.Five of them received pancreaticoduodenectomy again.Conclusion Pure stenosis at the end of the common bile duct should be carefully managed.

In order to investigate the correlation between protein expression of PTEN and the proliferation, infiltration, metastasis and prognosis in pancreatic cancer, immunohistochemical SP method was used to examine the protein expression of PTEN, PCNA, MVD, MMP-2, MMP-9 and TUNEL method to detect the levels of apoptosis of pancreatic cells in 41 pancreatic head cancers from regional pancreatectomy (RP) and 10 normal pancreatic tissues. The results showed that among 41 cases of pancreatic cancers, the positive staining of PTNE (39.02%) was significantly weaker than that in normal pancreatic tissues (P < 0.05). The levels of PCNA labeling index (LI), apoptotic index (AI), microvessel density (MVD), MMP-2 LI and MMP-9 LI were decreased gradually with the increase of the expression intensity of PTEN, and there was a significant difference in the above parameters among the patients having different expression levels of PTEN (P < 0.01 or P < 0.05). There was a negative correlation between the expression of PTEN and PCNA LI, MVD, MMP-2 LI, MMP-9 LI, and a positive correlation between AI and the expression of PTEN. The expression intensity of PTEN was correlated with the postoperative survival of the patients with pancreatic cancer (chi2 = 22.3400, P < 0.0001, RR = 2.030). It was suggested that the expression levels of PTEN protein were closely related with proliferation, infiltration and metastasis in human pancreatic cancer, and the expression of PTEN protein was one of the prognostic factors for pancreatic cancer following RP.

ObjectiveTo investigate the effects of insulin on the proliferation and invasion of human pancreatic cancer cells PANC1,and on its HIF-1α,VEGF expression.MethodsPANC1 was pretreated with insulin of different concentrations (0.1,1,10,100 nmol/L).The proliferation of PANC1 was tested by MTTmethod,and transwell assay was used to test the invasion ability of PANC1.HIF-1α,VEGF and PCNA protein expression was assessed by Western blots,and HIF-1α,VEGF mRNA was detected by real-time PCR.Results Insulin could increase the proliferation of PANC1 in a dose-dependent manner (p ＜0.05 ),and increase the expression of HIF-1α,VEGF protein.After 100 nmol/L insulin treatment for4 d,the PCNA protein expression in the insulin group was significantly higher than that in the control group (1.196 ±0.014 vs 1.157 ±0.013,P ＜ 0.05).The cancer cells passed through the chamber in insulin group were much more than that in the control group ( 141.0 ± 2.1 vs 89.0 ± 1.4,P ＜0.05 ).The expression of HIF-1α protein was significantly increased (1.139 ±0.020 vs 0.598 ±0.013,P ＜0.05),while there was no significant change of HIF-1αmRNA expression.Both the expression of VEGF protein and mRNA were significantly increased (1.011 ± 0.023 vs 0.627 ± 0.013 0.970 ± 0.016 vs 0.350 ± 0.01 3,P ＜ 0.05 ).Conclusions High insulin microenvironment could enhance the proliferation and invasion of PANC1 cells by up-regulating the expression of HIF-1α and VEGF.