Objective To explore the key points of diagnosis,treatment and the reasonable surgical methods in 39 cases of pancreas trauma.Methods A retrospective review and analysis the cause and classification of injury,surgical methods of 39 cases of pancreatic trauma in the Department of General Surgery of Affiliated Provinical Hospital of Anhui Medical University during Jan.1990 to Dec.2011.Results In the 39 patients who underwent surgery,38 patients were cured,1 dead duing to craniocerebral injuries,3 patients with complications of pancreatic leakage cured after adequate drainage.Two patients with pancreatic pseudocyst pancreatic pseudocystcyst cured after pancreatic pseudocyst jejunum anastomosis.One patients with traumatic pancreatitis cured after conservative treatment.Conclusions Blunt injury is the most common cause of pancreas trauma.Imaging examination has high value in the early diagnosis of pancreas trauma.The reasonable surgical methods and careful examination during operation can improve the cure rate and reduce the mortality and incidence of complications of pancreatic trauma.If the patient's condition allowed,endoscopy not only contributes to the diagnosis of pancreatic trauma,but is an effective method for treatment of it.

Neural invasion is an important invasion pathway of pancreatic cancer.New research shows that neural invasion of pancreatic cancer related genes in the sequential role effect,through the cell signal transduction,regulation of specific growth factors,adhesion molecules,matrix metallopmteinase and other related systems,then changed in the generation,resulting in the cancer cells invasion of the nerve tissue eventually.We reviewed the progress of neural invasion of pancreatic cancer in this paper.

Purpose To study clinical pathological characteristics,margin status and its influencing factors in different type of facial basal cell carcinoma (BCC).Methods The histopathological features,margin status of the first frozen section and influencing factors was retrospectively analyzed,with review of the relevant literature.The primary outcome variable was the rate of initially positive frozen section margins.Multivariable Logistic regression was used to study histologic subtype,surgical margins,tumor size,location and other factors influence on the rate of initially positive frozen section margins.Results The pathological subtype is the major risk factor,the infiltrative (OR =4.463,95％ CI =1.919-10.380,P ＜0.05) and morpheaform (OR=5.018,95％CI=2.025-16.623,P＜0.05) had higher risk on positive surgical margin compared with the nodular.The rate of initially positive frozen section margins of nodular and superficial BCC at different margins were observed but the difference were not significant (P ＞ 0.05).Conclusion The pathological subtype is the major risk factor.Surgical excision with a 3 mm margin can achieve ideal results for nodular and superficial BCC in facial area.

ObjectiveA comparative proteomic method was used to analyse serum proteins between pancreatic cancer patients and control group,and to find a new protential specific marker.MethodsComparative analysis on the pancreatic peripheral blood protein profiling from 40 pancreatic cancer patients,10 chronic pancreatitis patients,10 benign tumor patients and 40 cancer-free controls was carried out by 2D differential gel electrophoresis,and differentially expressed proteins were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry.ResultsTwo differentially expressed proteins:transthyretin and apolipoprotein E were identified.Those proteins were highly expressed in pancreatic carcinoma group compared with normal control group,chronic pancreatitis group and benign tumor group.Conclusion2D differential gel electrophoresis and matrix-assisted laser desorption/ionization time of flight mass spectrometry technology in screening specific serum biomarkers of pancreatic cancer has a well repeatability and stability.The identified protein transthyretin in this study may be as specific serum biomarkers of pancreatic carcinoma.

Objective A comparative proteomic method was utilized to analyze serum proteins among pancreatic cancer patients,pancreatic benign tumor group,chronic pancreatitis group and normal control group to discover a new potential specific early diagnostic marker.Methods Comparative analysis on the pancreatic peripheral blood protein profiling from 40 pancreatic cancer patients,10 benign tumor patients,10 chronic pancreatitis patients and 40 cancer-free controls from May 2009 to April 2011 was carried out by 2D differential gel electrophoresis (2D-DIGE) and differentially expressed proteins were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS).Results Three differentially expressed proteins,Hemopexin (Hpx),Ficolin 3 (FCN3) and Serum amyloid P-component (SAP) was identified.Those proteins were higher expression in pancreatic cancer group compared with benign tumor group,chronic pancreatitis group and normal control group.Each point in pancreatic cancer expression were 1.57,1.99,1.63 times than normal control expression,respectively (P ＜0.05).Conclusions In this study,the identified proteins,Hpx,FCN3 and SAP may be as potential specific early diagnostic markers of pancreatic carcinoma.2D-DIGE and MALDI-TOF-MS technology in screening specific serum tumor markers of pancreatic cancer has a well repeatability and stability.

Objective To discuss the diagnosis and treatment of systemic lupus erythematosus(SLE)patients associated with pancreatic pleural effusion and pancreatic:panniculitis.Methods Retrospectively analyzed the clinical data,therapy and experiences.Results A 40-year-old female SLE patient associated with pancreatitis,huge pancreatic pseudocysts,pancreatic pleural effusion,pancreatic panniculitis.Abdominal computed tomography(CT)showed an edematous swelling of the pancreas and several pseudocysts,the biggest one measuring 230 mm×95 am.Markedly elevated amylase (11 327 U/L)was contained in the massive pleural effusion.Erythema nodosum tissue pathology revealed the pancreatic panniculitis.The pscudocyst did not completely resolve with high-dose steroid.Growth hormone release inhibiting hormone (GIH),ulinastatin,nasojejunal feeding,and it was later complicated by infection and rupture.After a surgical percutaneous drainage for the complicated pseudocyst,the clinical symptoms and signs were markedly improved.Conclusion This case shows the importance of performing eady drainage rather than conservative treatment for pancreatic pseudocyst in patients with lupus-associated pancreatitis.

Pancreatic cancer is a commonly malignant gastrointestinal tumor with an significantly increasing incidence.Those patients without nonspecific symptoms at early stage had mostly lost the opportunity of surgical therapy when pancreatic cancer was detected at advanced stage,and its prognosis is poor.Therefore,it is rather important to improve the early diagnosis of pancreatic cancer.In recent years,proteomics is developing rapidly.Proteomics technologies have been widely used in clinical research.Using proteomics technology screening pancreatic cancer tumor markers becomes the research focus,thus we try to find a kind of or a group of pancreatic tumor markers,so as to improve the diagnosis of pancreatic cancer.

Objective To determine the expression of brain-derived neurotrophic factor (BDNF) in pancreatic ductal adenocarcinoma and its clinical significance.Methods SP immunohistochemical staining method was used to detect the expression of BDNF in 46 cases of pancreatic ductal adenocarcinoma,38 cases of benign pancreatic diseases and 20 cases of normal pancreatic tissue.Real time PCR and Western blot was used to detect the protein and mRNA expression levels.The relationship between BDNF expression and clinicopathological parameters of pancreatic cancer was determined.Results The positive expression rate of BDNF was 52.2％ (24/46) in pancreatic ductal adenocarcinoma pancreatic ductal adenocarcinoma,7.8％ (3/38) in benign pancreatic diseases,and none of the normal pancreatic tissue was BDNF positive.The BDNF protein expression levels in pancreatic ductal adenocarcinoma,benign pancreatic diseases and normal pancreatic tissue were 0.38± 0.01,0.56± 0.01,0.97± 0.01,respectively,and the BDNF mRNA expression levels were 0.85 ± 0.14,1.67 ± 0.21,3.45 ± 0.67,respectively,and the expression levels in pancreatic ductal adenocarcinoma and benign pancreatic diseases were significantly higher than that in normal pancreatic tissue,while the expression level in pancreatic ductal adenocarcinoma was significantly higher than that in benign pancreatic diseases (P ＜0.05).Positive BDNF expression was correlated with nerve infiltration and lymph node metastasis of pancreatic ductal adenocarcinoma,but it was not related to age,sex,tumor size,location and differentiated degree (P ＞ 0.05).Conclusions BDNF is involved in the development and growth of pancreatic cancer,and it may be related with patient's prognosis.

Objective To summarize the experience of diagnosis and treatment for pancreatic neuroendocrine neoplasms (pNENs).Methods Forty-seven patients with pNENs who were treated at Anhui Province Hospital during January 2002 to December 2013 were retrospectively analyzed.They were followed by telephone or clinic interview,and the deadline date was January 31st,2014.Survival was analyzed with the Kaplan-Meier method,and the prognostic factors for survival were identified.Results Among the47 patients,there were 13 males and 34 females,aged from 16 to 74 years old,with a median age of 45 years,There were 17 cases of non-functioning pNENs,30 cases of functioning pNENs.The detection rate of B ultrasound,CT,MRI was 71.8％ (28/39),92.7％ (38/41),75.6％ (6/8).Forty-six patients underwent radical surgery,and 1 patient underwent palliative surgery.The pathologic type included 41 cases of pancreatic neuroendocrine neoplasms,6 cases of neuroendocrine cancer.There were 22,19,6 cases of grade G1,G2,G3 lesions,respectively.There were 32,11,4 cases of TNM staging Ⅰ,Ⅱ,Ⅲ,respectively.Vascular structure was invaded in 15 cases,and nerve was invaded in 18 cases.Lymph node was examined in 15 cases,and 5 were found to have metastatic lesion.After surgery,pancreatic fistula occurred in 9 patients,ascites in 4 patients,wound infection in 4.The follow-up period ranged from 2 to 144 months.The overall 1,3,5-year survival rates were 94.9％,88.4％,and 84.4％.The 5-year survival rates of patients with grade G1,G2,G3 were 100％,73.3％,60％;and the 5-year survival rates of patients with TNM staging Ⅰ,Ⅱ,Ⅲ were 100％,70.0％,33.3％.It was showed that TNM staging system,WHO classification,lymph node metastasis,vascular and neural invasion were associated with the prognosis.Conclusions CT is the imaging test of choice for pNENs,while surgery is the first choice for treatment.Surgical resection of pNENs results in long-term survival.TNM staging,WHO classification,lymphatic metastasis,vascular and neural invasion are closely related to the prognosis of pNENs.

Objective To investigate the clinicopathological features of patients with serous cystadenomas of the pancreas (SCAP).Methods The clinical and pathological features of 21 cases of SCAP were retrospectively analyzed.Results The mean age of the 21 cases was 61 years old,male:female ratio was 1∶ 1.33,18 (85.7％) patients presented with abdominal pain,bloating,abdominal mass,weight loss,and 3 (14.3％) patients were found during check-up.The tumors were located in pancreatic head in 9 patients,in pancreatic body and tail in 12 patients.The clinical manifestations were pancreatic cystic lesions.All patients underwent surgery.Histologically,the cyst wall was complete and lined with flat or cuboidal epithelium,cytoplasm was translucent,nucleus were round or oval with similar size,no significant nuclear atypia and mitotic activity was found.The pathologic diagnosis was micro-cyst type in 15 cases,single-cyst type in 6 cases.Immunohistochemistry method showed EMA,CK7,CK19 positive and PAS staining positive.The positive expression rate of Ki 67 was between 1％ and 3％.After follow-up of 19 cases ranging from 3 months to 7 years,no recurrence and metastasis was detected.Conclusions SCAP is seen predominantly in elderly female patients with significant symptoms.A majority of tumors are located in the pancreatic body and tail.SCAP presents with characteristics of pancreatic ductal epithelial,and the prognosis is excellent.