Pancreatic carcinoma is one of the malignancies of the gastrointestinal tract with the most dismal prognosis.As a consequence of its anatomic and biological behavior,the 5-year survival is only 10％- 20％ even after curative resection.There are many problems which need to be solved in the diagnosis and treatment of pancreatic cancer.This paper aims to discuss the preoperative assessment of resectability,histological diagnosis,radical surgery,multidisciplinary and multimodality treatment to help to raise the standard of diagnosis and treatment of pancreatic cancer in China.

BACKGROUND:With the in-depth study of cancer stem cels, increasing evidence has shown that cancer stem cels are the reason for cancer metastasis and recurrence, and therefore it is of great significance to isolate and identify cancer stem cels that can elucidate the pathogenesis of cancer and development of anticancer drugs.
OBJECTIVE: To isolate and culture gastric cancer stem cels and then to detect its biological characteristics.
METHODS: Cancer tissues from 16 patients with gastric cancer were cultured using adherent method and enzymic digestion methods to isolate gastric cancer stem cels. The cel morphology was observed under inverted microscope to drawn out growth curves. Osteogenic and adipogenic ability of cels were also detected.
RESULTS AND CONCLUSION: Gastric cancer stem cels were isolated successfuly by both two methods. Under the microscope, the cels were fusiform- or polygon-shaped. At confluence, the cels grew in a vortex or radial manner. The cel growth curve showed that 1-3 days were latent period, 4-9 days were logarithmic growth phase, and over 10 days were growth plateau phase. Flow cytometry results showed that passage 3 gastric cancer stem cels highly expressed CD90, CD29, CD44, but lowly expressed CD34, CD45 and HLA-DR. After osteogenic induction, calcified nodules were clearly visible in the gastric cancer stem cels at passage 3; after adipogenic induction, bright and tiny fat droplets were seen in the cytoplasm. These findings indicate that cancer stem cels exist in the gastric cancer tissues, and have similar morphology, biological property and multipotent differentiation ability to normal cels, which are probably involved in gastric cancer occurrence and development.

Objective To study the clinical feature, diagnosis and surgical treatment of mixed hepatocellular and cholangiocellular carcinoma(MHC).Methods The clinical materials of 14 surgically treated patients with MHC were retrospectively analyzed.Results There were nine males and five females, with age ranging from 33 to 62 years (mean 50 years). Some patients had a history of hepatitis B(71%), and cirrhosis(64%). Elevation of serum alpha-fetaprotein(AFP) was observed in nine patients(64%). The resection rate was 86%(12/14), and postoperative overall 1-, 3-, 5-year survival rates were 71%(10/14)?43%(6/14)?and 29%(4/14), respectively. In the tumor-resected patients, the 1-, 3-, 5-year survival rates were 83%(10/12)?50%(6/12)?and 33%(4/12),respectively. Conclusions MHC patients lack typical clinical manifestations. Radical surgery is an effective treatment for this disease. The cholangiocellular carcinoma component appears to determine the prognosis.

objective: To study the properties of keepers treated with different methods. Methods: Eighteen Z 3 magnetic attachments were divided into three groups at random. Cobalt chromium alloy was used for root cap. The keepers in the first group were cast to the caps, those in the second group were welded to the caps by Nd:YAG laser welding apparatus. Keepers in the third group were untreated. Universal testing machine was adopted to measure the breakaway retention of the attachments. The roughness of keeper surfaces was measured by roughness tester. Results: No statistical difference was observed as to the breakaway retention between magnetic attachments and laser welded coping keeper or between those and cast coping keepers. But retention of the keepers in the two groups was slightly lower than that of untreated keepers. Defects of pits were found on the surfaces of the cast coping keepers. The surface smoothness of the cast coping keepers was inferior to that of the laser welded coping keepers. Conclusion: Laser welded keepers and cast coping keepers can meet clinical demands for the use of magnetic attachments.

Objective To investigate the possible effects of COL8A1 on the proliferation, invasion and drug sensitivity of murine hepatocarcinoma cell line Hca-F, we used an RNA interference (RNAi) approach to silence COL8A1 expression. Methods The expression levels of COL8A1 in HcaF/siRNA cells were assessed by RT-PCR and Western blot. The inhibitory effect of RNAi on Hca-F cell invasion in vitro was demonstrated by ECM invasion assay. The in vitro proliferative ability and drug sensitivity of COL8A1-deficient cells were determined by MTT assay. Results The expression of COL8A1 was significantly reduced in COL8A1/siRNA cells after 30h transfection, compared with both the RNAi control and the Hca-F cells. The reduced COL8A1 expression also attenuated the proliferative, invasive ability, as well as increased drug sensitivity of Hca-F/siRNA cells. Conclusion Our current results indicate that the expression of COL8A1 functionally mediates tumor cell proliferation, invasion, and drug sensitivity, and is a potential target for therapeutic anti-cancer drugs.

Objective To investigate the expression of proinsulin, insulin, C-peptide in insulinoma and normal pancreas and their roles. Methods Thirty-eight cases of insulinoma and 20 cases of normal pancreas from Sep. 2006 to Dec. 2009 in our hospital were selected. Immunohistochemistry was used to determine the expression of proinsulin, insulin, C-peptide. Results Proinsulin, insulin, C-peptide was expressed in insulinoma and normal pancreas. Proinsulin, C-peptide were strongly expressed in 100%insulinoma, while they were weekly expressed in 55% ～60% normal pancreas; insulin was expressed as + + +in 79% insulinoma, while it was expressed as + + + + in 85% normal pancreas. Proinsulin, C-peptide positive cell accounted for 80% ～ 100% of 38 insulinoma, and insulin positive cell accounted for 50% ～ 70%,the proinsulin/insulin ratio ＞ 1 accounted for 78.9%; while the corresponding values were 20% ～ 80%, 60% ～90%, 10.0% in normal pancreas, and the difference was statistically significant ( P ＜ 0.05 ). Conclusions The proinsulin/insulin ratio ＞ 1 is 78.9% in insulinoma, and detection of proinsulin may help to diagnose insulinoma.

Objective To explore the feasibility of carrying out the common imprecision range among different biochemical systems in different laboratories.Methods Biochemical professionals visited 18 third-grade class A hospitals in Hebei Province,investigated the internal quality control data of 21 biochemical tests and made classification according to certain parameter criterias.Data were collected from April to September,2010 and calculated for cumulative mean,standard deviation (s) and CV.Data were compared according to 1/3,1/4 of TEa established by CLIA'88 and allowable CVb％ derived from biological variants.Results Among 18 hospitals,5 (27.8％) set their target value by mean value of 6 months,5(27.8％) by continuous 20 days and 8(44.4％) by the given value of the supplier.CVs of 21biochemical tests were quite different among 18 biochemistry laboratories,in which LDH was 6.79 times and CK was 76.79 times different from one another.35.5％-94.1％ biochemical tests met the requirement of CV ＜ 1/3TEa and 0.0％-91.7％ met the requirement of CV ＜ 1/4TEa.0.0％-94.1％ of tests were below allowable CVb％ 16/21 (76.2％) tests could satisfy the requirement of CV ＜ 1/3TEa.The top five tests which didn't meet the requirements were Na,Urea,TBIL,ALT and Glu.Conclusions The internal quality control among biochemistry laboratories in Hebei Province has not been standardized yet.According to the survey data,biochemistry laboratories of third-grade class A hospitals may set 75％ point of imprecision as a reference.After a period of improvement,we will set common imprecision range among biochemistry laborotories in Hebei Province and even in China.

Objective To investigate the clinical significance of pre-operative ancl intra-operative insulinomas localization, and improve the diagnostic accuracy. Methods 75 patients with suspected insulinomas who were treated surgically were enrolled; all the patients had pathological evidence of insulinomas. The data of pre-operative ultrasound, CT, MRI and intra-operative ultrasound and surgical palpation were collected and analyzed. Results The sensitivity of localization procedures was as follows: ultrasonography 30.7% ( 23/75 ), CT 40.0% (24/60) , MRI 45.4% ( 22/48 ) , while surgical palpation was 80.4% , intra-operative ultrasound 96.4%. The accuracy of intra-operative procedures was higher than that of pre-operative procedures. Conclusions It was difficult to accurately localize insulinomas before operation, but intra-operative palpation and iutra-operative US was easy to perform and highly accurate. Therefore, too much emphasis should not be placed on pre-operative imaging tests.

Objective To summarize the diagnosis and therapeutic experience of insulinoma in order to improve the surgical success rate and prognosis. Methods The clinical data of 138 patients with insulinoma from 1966 to 2007 were retrospectively analyzed. Results In this group of patients, hypoglycemia of different levels and Whipple triad were detected. 64 patients expressed different psychic symptom, 12 patients' psychic symptom were still present after blood glucose normalized after operation. Fasting serum insulin values in 88 patients were measured, and the insulin release index was higher than 0. 3. Before operation, tumor was detected in 8 of 75 patients by B-ultrasound scan, and in 17 of 68 patients by CT, and in 5 of 10 patients by MRI. The intra-operative B-ultrasound (IOUS) examination was applied in 44 cases, and 43 cases were successfully detected. The operations included enucleation of insulinoma (n=88) , resection of the body and tail of pancreass (n = 44) , pancreaticoduodenectomy (n=2) , and biopsy (n=1). The blood glucose symptoms normalized postoperatively in 132 patients. The blood glucose rebound in 110 patients, but blood glucose normalized within 2 weeks. After operation, 20 patients developed pancreatic fistula, 32 patients developed acute pancreatitis. Conclusions Insulinoma could be qualitatively diagnosed according to Whipple triad and the insulin release index. Operations with IOUS were simple and effective methods to localize the tumors. The only way to cure insulinoma was operation, and IOUS guided operation could avoid main pancreatic duct and vessel injury, decrease post-operative complications.

Objective To detect the expressions of interleukin-17(IL-17) and interleukin-23(IL-23) in esophageal tissues of rats with reflux esophagitis(RE) and explore the role of IL-23/IL-17 axis in the pathogenesis of RE.Methods Thirty SD rats were randomly divided into 3 groups,namely,control group,sham-operated group and model group.RE was induced by adopting partial pyloric ligation plus cardiomyotomy.Then rats in each group were fasted for 24 h but had free access to water.They were fed 24 h after operation.Four weeks later,rats were killed and pathological changes of esophagus mucous membrane were observed by HE staining in each group.The expressions of IL-23p19 and IL-17 mRNA in esophageal tissues were examined by real-time fluorescent quantitative reverse transcriptase polymerase chain reaction(RT-FQ-PCR).IL-17 protein content in esophageal tissues was measured by ELISA.Results After four weeks,compared with control group,model group had significant pathological changes of esophagus mucous membrane.Expressions of IL-23p19 and IL-17 mRNA in the esophageal tissues of model group were significantly higher than those of the other two groups;the content of IL-17 protein was significant higher in model group than in the other two groups.There were no significant differences between control group and sham-operated group.Conclusion IL-23/IL-17 axis is an important cellular factor involved in the pathogenesis of RE and may be involved in the chronic inflammation of RE.