Objective To explore the prognosis impact of lymph nodes metastasis in pancreatic cancer.Methods The clinical data of 61 patients with pancreatic cancer who underwent pancreaticoduodenectomy from January 2004 to September 2011 were analyzed retrospectively.Patients were categorized into different groups by lymph nodes metastasis status,count of positive lymph nodes,location of positive lymph nodes,lymph nodes ratio (LNR) and other factors.Kaplan-Meier,log-rank and COX proportional hazard models were used to evaluate the prognostic effect.Results Median survival for the overall 61 patients was 13 months (95％ CI 9.158-16.842),with 6 months,1 year,3 years,5 years survival rates of 84.6％,47.7％,14.3％ and 9.1％ respectively.Univariate analysis showed:the median survival of patients with and without lymph nodes metastasis had statistical significant outcome (P ＜ 0.01).Patients within the first station lymph nodes metastasis had a better outcome than those lymph nodes metastasis beyond the first station (P ＜0.05).Patients with LNR ≤0.2 had better prognosis than those LNR ＞ 0.2 (P ＜ 0.01).The number of lymph nodes examined had no effect on overall survival in either nodes-positive patients or nodes-negative patients (P ＞ 0.05).The count of positive lymph nodes did not affect the prognosis in the pN1 patients (P＞ 0.05).Multivariate analysis showed:location of positive lymph nodes and LNR were independent predictors of the prognosis in the pN1 patients.Conclusions Lymph nodes metastasis status has significant effect on the prognosis of the pancreatic cancer.Location of positive lymph nodes and LNR are independent predictors of the prognosis in the pN1 patients.The number of lymph nodes examined and the number of positive lymph nodes have no effect on the prognosis of the pancreatic cancer.

Objective To investigate the effect of hydroxyethyl starch (HES 130/0. 4) on the expression of aquaporin 1 (AQP-1) and liver injury in rats with severe acute pancreatitis(SAP).Methods Forty-eight male SD rats were randomly divided into three groups: Sham, SAP, and HES;each group was divided into 6 hour and 24 hour timepoints, with 8 in each subgroup. An SAP model was induced by injecting 5% sodium taurodeoxycholate into the biliary pancreatic duct. AMY, ALT,AST and water content in the liver were measured and TNF-a was examined by ELISA, and the expression of liver AQP-1mRNA was determined by RT-PCR, and the expression of liver AQP-Ⅰ protein was evaluated by immunohistochemical methods. Results Compared with the Sham group, the level of AMY, ALT, AST, TNF-a, water content, AQP-1mRNA and AQP-1 protein increased significantly in the SAP group (P＜0.05). Compared with the SAP group, the level of AMY, ALT, AST,TNF-a, water content, AQP-1mRNA and AQP-1 protein decreased significantly in the HES group (P＜0.05). At 6 hours, the expressions of liver AQP-1mRNA were (0. 402 ± 0. 023), (0. 811 ±0. 032) and (0. 595 ± 0. 015) in the Sham, SAP, and HES groups, respectively; at 24 hours, they were(0. 412 ± 0. 017), ( 0. 823 ± 0. 029) and (0. 607 ± 0. 021 ), with significant differences between each group (P＜0. 05). At 6 hours, the expressions of liver AQP-1 proteins were (2.07±0.25),(6.90±0.38)and (4.48±0.29) in the Sham, SAP and HES groups, respectively;at 24 hours, they were (2. 32±0. 31 ), (7. 04 ± 0. 32) and (4. 56 ± 0. 35), with significant differences between each group (P＜0. 05). Compared with the SAP group, the pathology of the pancreas and liver ameliorated significantly in the HES group. Conclusions Hydroxyethyl starch 130/0.4 may ameliorate liver injury of severe acute pancreatitis and alleviate the capillary leak. AQP-1 may play a role in the capillary leak caused by the liver injury of severe acute pancreatitis.

Objective To investigate the effects of recombinant human interleukin-10 (IL-10) on serum tumor necrosis factor α (TNF-α) and histopathological changes of pancreas in rats with severe acute pancreatitis (SAP),and provide theorical basis for SAP clinical treatment.Methods 90 Sprague-Dawley (SD) rats were randomly divided into three groups:normal control group (group N,n =30),SAP group (group S,n =30) and IL-10 interference group (group Ⅰ,n =30).5％ sodium taurocholate was retrogradely injected into the pancreatic duct in S group and Ⅰ group to induce SAP model.Rats in N group whose pancreas was just flipped and stricken gently without injection.Group Ⅰ was treated with 10 000 units of intraperitioneal recombinant human IL-10 at 1,3 and 5 h.Group N and group S received three intraperitoneal injections of 0.9％ normal saline at the same time points.Rats were killed at 6,12 and 24 h.The level of TNF-α in serum was determined by enzyme-linked immunosorbent assay (ELISA),and the level of amylase was assayed by biochemical methods.The pancreas histological changes were observed by H-E staining.Results Compared with group N [serum amylase (1 025.3 ±326.9),(999.9 ±212.3),(962.3 ± 128.9) IU/L;TNF-α (55.6 ± 2.1),(56.1 ± 2.2),(58.7 ± 1.3) ng/L;pancreatic histopathological score 0.13 ±0.11,0.15 ±0.12,0.16 ±0.15],serum amylase (6 633.9 ±846.7),(9421.4 ± 1 031.8),(8 755.6 ± 734.5) IU/L,TNF-α (87.6 ± 3.3),(113.3 ± 10.2),(100.2 ± 2.3) ng/L and pancreatic histopathological score (8.58 ± 0.63,13.41 ± 0.79,16.78 ± 0.87) in group S were increased significantly at 6,12 and 24 h (P ＜ 0.05).The pancreatic damage at 24 h was the most severe,and the peak concentration of AMY and TNF-α reached at 12 h.Compared with group S,pancreatic histopathological scores 6.52 ± 0.54,9.37 ± 0.35,12.43 ± 0.69,the level of serum amylase (6 032.8 ± 534.9),(7 475.8 ± 834.2),(6903.4 ±377.1) IU/L and TNF-α (67.5 ±2.5),(93.0 ±4.9),(86.7 ±6.6) ng/L in group Ⅰ were significantly decreased at corresponding time points (P ＜ 0.05).Conclusions Early application of recombinant human IL-10 can attenuate SAP inflammatory response and relieve the histopathological injury of pancreas by inhibiting the release of TNF-α.IL-10 can be used for the treatment of SAP.

ObjectiveTo evaluate the expression of RANKL′s protein for the diagnosis and assessment of tumor metastatic potential and prognosis in patients with gastric carcinoma.MethodsThe expression of RANKL was detected in 45 cases of gastric carcinoma, 26 cases of paracancerous mucosa and 10 cases of healthy control by using ABC immunohistochemical method. Data were tested by ? 2 test for statistical significance.ResultsPositive expression of RANKL protein was detected in 21 out of 45(46 7%) cases. The expression of RANKL significantly increased in tumors ≥5?cm in diameter, with serosa infiltrated, positive lymph node, and in tumors of stage Ⅱ,Ⅲ,Ⅳ( P

Objective To investigate the role of p38 mitogen-activated protein kinase (MAPK) signal transduction pathway in hypocaleaemia and parathyroid hormone receptor 1 ( PTHR1 ) of rats with acute necrotizing pancreatitis (ANP).Methods Seventy-two male health adult Spragne-Dawley rats were randomized into three groups:ANP group,ANP treated with SB203580 group (SB group),sham operation group (SO group).Every group was sub-divided into 3,6,12 h group with 8 rats in each one.ANP model was induced by retrograde infusion with 5% sodium taurocholate solution into the biliopancreatie duct.In the SB group,rats were treated with the specific p38MAPK inhibitor:SB203580 30 minutes before the induction of ANP model.The serum level of calcium was determined,the change of phosphorylated p38MAPK and TNFalpha were measured by western blot and the expression of PTHR1 mRNA was determined by quantitative real time RT-PCR.Results 6 h after ANP model induction,the serum levels of calcium in ANP,SB and SO group were (2.50±0.08 ) mmol/L,(2.11±0.06 ) mmol/L and (2.35±0.10 ) mmol/L,respectively;the expression levels of pbosphorylated p38MAPK in bone tissue were 0.14±0.04,0.80±0.06 and 0.33±0.05,respectively;the expression levels of p38MAPK TNF-alpha were 0,0.91±0.04 and 0.44±0.03,respectively;the expression levels of PTHR1 mRNA were 1.00±0.12,0.23±0.04 and 0.44±0.06,respectively.The expression levels of p38MAPK and TNF-α in SB group were significantly lower than those in the ANP group (P ＜ 0.01 );while the expression levels of PTHR1 mRNA and calcium were significantly higher than those in the ANP group (P ＜0.01 ).Conclusions P38MAPK signal transduction pathway may mediate the development of hypocaleaemia in the course of ANP,and hypoealcaemia could be improved by blocking this pathway.

Objective To investigate the mechanism of cyclic adenosine monophosphate / protein kinase A signal transduction pathway in severe acute pancreatitis(SAP)-associated lung injury.Methods Seventy-two male healthy SD rats were completely randomized into three groups:sham operation (SO) group(n =8),SAP group and SAP plus H89 (cAMP inhibitor) group,then the latter two groups were divided into four sub-groups with eight rats in each sub-group according to the sampling time of 3,6,12 and 24 h,and the total numbers of groups were nine.The content change of TNF-α and IL-1β in serum,protein levels of cAMP-dependent protein kinase catalytic subunit (PKA C) and phosphorylated vasodilator-stimulated phosphoprotein(p-VASP) and the expression of VSAP mRNA in lung tissue were detected by enzyme-linked immunosorbent assay (ELISA),immunohistochemistry and quantitative real time PCR,respectively.Pathological changes of the pancreas and lung tissues were also observed.Results Compared with the SO group,the serum levels of TNF-α and IL-1β in the SAP group were obviously increased at different time points(P ＜0.05).Pathological changes of the pancreas and lung tissues were aggravated significantly.The protein levels of PKA C,p-VASP and the expression of VSAP mRNA in lung tissue were increased significantly (P ＜0.05)which peaked at 12 h in the SAP group [TNF-α was (266.07 ± 17.14) pg/mL,IL-1β(169.17 ±25.92) pg/mL,PKA C(210.69 ±6.32) × 103,p-VASP (56.62 ±0.57) × 103,VASP mRNA(2.06 ±0.21)],which had positive correlation with the serum level of TNF-α and IL-1β.Compared with the SAP group,pathological changes of the pancreas and lung tissues were alleviated significantly,the protein levels of PKA C,p-VASP and the expression of VSAP mRNA in lung tissue were decreased significantly in the SAP plus H89 group at different time points(P ＜ 0.05).Conclusion The cyclic adenosine monophosphate / protein kinase A signal transduction pathway is found to participate in the pathological process of SAP-associated lung injury through the up-regulations of TNF-α,IL-1 β and phospho-VASP.

Objective To explore the role of IL-1β in capillary leak syndrome by observing the alterations of AQP-1 expression,apoptosis,and ultrastructural of vascular endothelial cells under the action of IL-1β.Methods Umbilical vein endothelial cells (UVEC) in vitro were randomly allocated into 3 groups:time,concentration,and control.In the time group,UVECs were treated with culture medium containing 20 μg/L IL-1β for3 h(T1),8 h(T2),12 h(T3) and 24 h(T4).In the concentration group,UVECs were treated with culture medium containing 0.2 μg/L(C1),2 μg/L(C2) and 20 μg/L(C3) IL-1β for 24 h.In the control group,UVECs were treated with culture medium without IL-1β for 24 h.The changes of AQP-1 mRNA and protein expression were detected by real-time PCR and Western blot.Apoptosis was detected by flow cytometry,and cell ultrastructural changes were observed by electron microscopy.Results AQP-1 mRNA and protein expression of T1-T4 in the time group and C1-C3 in the concentration group were lower than those of the control group (P ＜ 0.05).The apoptotic rate was increased,and mitochondrial swelling,vacuolar degeneration,karyolysis and necrosis were observed under electron microscopy.These were more pronounced with time or concentration increases.Conclusions IL-1β can cause a decrease of AQP-1 mRNA and protein expression,increase in apoptotic rate and increase in damage to the cells'ultrastructure.This is an important reason for damage to the vascular endothelial barrier and may be associated with capillary leak syndrome.

ObjectiveTo evaluate the clinical application of Kugel hernioplasty via anterior approach for inguinal hernia repair.MethodsA retrospective study was made to analyze the clinical data of 851 cases(956 hernias) treated with Kugel hernioplasty via anterior approach for inguinal hernias from November 2005 to May 2011.ResultsOperative duration was(42 ± 11) minutes.The postoperative complications were detected on 21 hernias of seroma,8 hernias of hematoma,12 hernias of sub dermal ecchymosis,26 hernias of foreign body sensation and 5 hernias of recurrence.No incision infection occurred.Conclusions Kugel hernioplasty via anterior approach can repair and strengthen the whole anatomy area of myopectineal orifice.It is available for various kinds of inguinal hernias.

ObjectiveTo study the changes of serum levels of tumor n(ee)rosis factor-α (TNF-α),diamine oxidase (DAO),the expression of tight junction protein-1 (zonula occludens 1,ZO 1 ) in acute necrotizing pancreatitis (ANP) rats after ulinastatin intervention.Methods SD male rats were randomly divided into sham operation (SO) group,ANP group and ulinastatin treatment group.ANP model was induced by injecting 5％ sodium taurocholate into biliary and pancreatic duct.The rats were sacrificed at 6 and 24 hours,and then the levels of TNF-α,DAO and pathology change in pancreatic and intestinal were determined.The expression of bowel mucosa ZO-1 mRNA and protein was detected by RT-PCR and immunohistochemistry.ResultsSix hours after ANP induction,massive pancreatic necrosis and inflammatory cells infiltration were present,while epithelium necrosis of villi in ileum,vessel hemorrhage and inflammatory cells infiltration was found.The pathologic injury of pancreas and ileum in ulinastatin group was reduced when compared with that in ANP group.The serum levels of TNF-α were ( 10.83 ± 0.96),( 181.89 ± 4.93 ),( 128.23 ± 2.40) ng/L in SO group,ANP group and ulinastatin group; and the activities of DAO were (354.79 ±3.67),(117.21 ±5.58),(282.98 ± 9.12 ) U/L; the expressions of ZO 1 protein were 10.00 ± 1.87,1.20 ± 0.84,5.80 ±2.86; and the expressions ofZO 1 mRNA were 0.878 ±0.015,0.466 ±0.023,0.778 ±0.033.The serum level of TNF-α in ANP group was significantly higher than that in SO group,while the activities of DAO,expressions of ZO 1 mRNA and protein in ileum were significantly lower than that in SO group ( P ＜ 0.05 ).The serum level of TNF-α in ulinastatin group was significantly lower than that in ANP group,while the activities of DAO,expressions of ZO 1 mRNA and protein in ileum were significantly higher than that in ANP group (P ＜ 0.05).ConclusionsUlinastatin may inhibit the over release of TNF-α and improve plasma DAO activity,then increase the expression ofZO-1 mRNA and protein,thus protect the intestinal mucosa barrier.

Objective To investigate the expression and significance of E-selectin in lung tissue of rat of acute necrotizing pancreatitis (ANP)-induced lung injury.Methods Rats were randomly divided into control and ANP groups.ANP model was induced by retrograde injection of sodium taurocholate into the biliary and pancreatic duct.The rats were sacrificed at 3,6,12 and 24 h.Serum amylase,albumin,Ca2+ and lung wet/dry (W/D) weight ratio were determined,and pancreas and lung tissues underwent routine pathological examination and histopathological scores were evaluated.The expression of E-selectin mRNA and protein in lung tissue of rat was measured by real-time fluorescence quantitative RT-PCR and immunohistochemistry.Results In ANP group at 6h,the serum level of amylase,histopathological scores of pancreas and lung tissues,lung W/D weight ratio were (3978 ± 476) U/L,8.22 ± 0.63,( 12.31 ± 1.58,5.21 ± 0.20,which were significantly higher than those in control group [ (843 ± 90)U/L,0.22 ± 0.36,0.13 ± 0.34,4.46 ±0.17,P ＜ 0.05 or ＜ 0.01 ],the serum level of albumin was (12.9 ± 1.0)g/L,which was significantly lower than that in control group [ ( 15.6 ± 0.7 ) g/L,P ＜ 0.01 ],the serum level of Ca2 + at 12 h was ( 2.33 ±0.15) mmoL/L,which was significantly lower than that in control group [(2.57 ± 0.23)mmoL/L,P ＜ 0.01 ].E-selectin was located in the cell membrane and cytoplasm of vascular endothelial cells.Expression of E-seleetin mRuNA and protein in the lung tissue at 6h was significantly higher than those in control group (3.51 ±0.45 vs 0.95 ± 0.16,0.174 ± 0.019 vs 0.060 ± 006,P ＜ 0.01 ).Conclusions Pulmonary expression of E-selectin of vascular endothelial cell is significantly up-regulated in a time dependant manner when ANPinduced ALI occurs; and it is involved in leukocyte mural and extravasation,and can promote lung injury.