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.

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.

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 effects of methylprednisolone on neurocyte apoptosis in rats with severe acute pancreatitis(SAP).Methods Thirty-six SD rats were divided into sham operation group,SAP group and methylprednisolone group(12 rats in each group).SAP model was constructed by injecting 5%sodium taurodeoxycholate into biliary-pancreatic duct.Serum amylase,interleukin-6(IL-6),tumor necrosis factor α (TNF-α),volume of aseites and histopathological changes of pancreas were determined.The mRNA expressions of Bcl-2 and Bax in brain tissue were analyzed by RT-PCR.and neuroeyte apoptosis was detected by TUNEL method.Results The levels of serum IL-6 and TNF-α were significantly increased:the expression of Bcl-2 mRNA in brain tissue was down-regulated;the expression of Bax mRNA was up-regulated;the Bcl-2/Bax ratio Was decreased:the apoptosis of the neurocytes was increased in SAP group.Compared with SAP group,the levels of serum IL-6 and TNF-α were significantly decreased;the expression of Bcl-2 mRNA was unchanged but the expression of Bax mRNA was down-regulated in brain tissue,so the Bcl-2/Bax ratio was elevated significantly;the rate of the ueurocyte apoptosis in brain tissue were reduced in methylprednisolone group.Conclusions The apoptosis of neurocytes in brain tissue may be one of the factors causing pancreatic encephalopathy.Methylprednisoione can inhibit the release of IL-6 and TNF-α.improve the balance of Bcl-2 and Bax expression and decrease the apoptosis of neurocytes in brain tissue.

Objective To improve the management of blunt pancreatic trauma, and to explore the strategy of preserving the pancreatic endocrine and exocrine function to the full extent. Methods 20 cases of blunt pancreatic trauma were reviewed and analyzed retrospectively. The methods of operative treatment were analysed. Results All patients were cured. Depending on the general condition, abnomial signs and main pancreatic duct(MPD) injuries at the time of admission, patients received immediate operation or nonoperative treatment. Because of severe peritonitis and demonstrated MPD injury, 10 patients underwent immediate operations, including simple drainage in 6 cases, distal pancreatectomy in 1 patient, external drainage of the injured pancreatic duct for the second operation in 3 cases. Without the demonstrated MPD injury or clinical deterioration, 10 patients received nonoperative treatment under strict observation initially. 3 patients completed the nonoperative course and 7 patients underwent delayed operations, including Roux-en-Y pancreatic cyst-jejunostomy in 3 cases, external drainage of pseudocyst in e cases, pancreaticoduodenectomy in 1 patient because of the expanded hematoma in pancreatic head. Conclusions Blunt pancreatic trauma could receive individual pancreas-preserving treatment, which could improve the operational safety, avoid the resection of pancreas and preserve the pancreatic endocrine and exocrine function to the full extent.

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.

Objective To investigate the role of individualized and staged enteral nutrition in the treatment of severe acute pancreatitis(SAP).Methods The clinical data of 204 cases of SAP treated with individualized stage enteral nutrition in our hospital from January 2000 to March 2008 were retro-spectively analyzed, Results The liver function and serum lipid and diet returned to the normal level after the treatment.Pancreatic encephalopathy disappeared.The patients recovered and were dis-charged from the hospital with the extraction of feeding tube.Enteral nutrition was adjusted based on the monitoring results in the hospitalization period that brought less effect to the pseudocyst of pancre-as, and then discharged from the hospital with the feeding tube.The pseudocyst in 49 cases disap-peared spontaneously and it was cured with internal drainage for 3 months in other 32.The time of en-teral nutrition was 20-95 d.Conclusion Enteral nutrition is safe and necessary after the acute stage of SAP.To ensure the enteral nutrition to play a more important role in the treatment of SAP, we must pay more attention on the individualization and stage of enteral nutrition.

ObjectiveTo investigate clinical features,diagnosis and treatment of hyperlipidemic severe acute pancreatitis(HSAP) in late pregnancy. MethodsA retrospective analysis was made on 12 HSAP cases. ResultsHSAP accounting for 20%(12/60) of severe acute pancreatitis (SAP) cases, develops during the period of 28~36 weeks of pregnancy. There were 5 cases in SAP type Ⅰand 7 cases in SAP type Ⅱ. Multiple organ dysfunction syndrome (MODS) was complicated in 4 cases. HSAP is featured with severe hypertriglyceridemia (29?14)mmol/L, significant systemic inflammatory response syndrome (SIRS), large amount of lipidemic bloody ascites. All cases underwent successful. Cesarean section followed by pancreatic operation and were cured. ConclusionHSAP in late pregnancy is a specific type of SAP with fulminant clinical course leading to fetal distress. Effective management of pregnant hypertriglyceridemia helps to prevent HSAP.