More than 25％ pancreatic cancers are locally advanced and unresectable.For patients underwent pancreatectomy,about 80％ of patients had pancreatic cancer recurrence in 2 years.The aim of palliative treatment for locally advanced and metastatic pancreatic cancer is to relieve the disease-associated symptoms,including biliary obstruction,duodenal obstruction,and intractable abdominal pain.Surgical strategies,such as palliative resection (R1 resection ),biliary drainage and gastroenterostomy have been widely used.During recent years,neoadjuvant chemotherapy and radiation have been recommended as the palliative treatment of choice for patients with locally advanced and metastatic pancreatic cancer.However,The controversy still exists.This article summarized current data of surgical and non-surgical strategies for the treatment of locally advanced and metastatic pancreatic cancer.

Most of the pancreatic cancer was diagnosed at advanced stages and the resection rate was only 10％-20％.Vascular invasion was a common event in the pathogenesis of pancreatic cancer.However,in the traditional view,vascular invasion is a contraindication of pancreatic resection.With the development of surgical techniques and perioperative management,radical resection of pancreatic cancer with vascular resection and reconstruction was performed in some large centers.Preliminary results suggested that this procedure could increase the resection rate and 5-year survival to 26％-46％ and 20％ respectively,without increasing morbidity and mortality.Radical resection of pancreatic cancer with vascular resection and reconstruction was a safe and effective method for the surgical treatment of advanced pancreatic cancer,which should be performed by experienced pancreatic surgeons.

Mitochondrial DNA(mtDNA),a double-stranded circular molecular,encodes several genes essential for mitochondrial and cellular functions despite its small amount of genetic information.Damage of mtDNA can lead to changes of cellular structures and functions and this fact is drawing more and more attention.This review summarized the recent research about mtDNA damage and its influence on cells.

Objective　To study the therapeutic effect of hepatic artery and portal vein dual perfusion chemotherapy (AVPC) combined with intratumoral injection of lipiodol-ethanol (ITILE) for unresectable primary hepatic carcinoma (PHC). Methods　138 pathologically proved and unresectable PHC cases were divided into two groups: Group A (80 cases), treated with AVPC through hypodermic implanted drug delivery pumps. Group B (58 cases), treated with AVPC plus ITILE. Results　　The secondary resection rate was 2.5% in group A, while 　 12.1% in group B, (P<0.05); The 0.5, 1, 2 years survival rate in group A was 56.3% 45.0% and 21.2%, in group B 81.0% 61.2% and 39.6% respectively. there were significent difference between two groups in 0.5,1,2 years survival rate respectively (P<0.05); the complication occurrence rate was found no significant difference between two groups (P>0.05). Conclusions　The therapeutic effect of AVPC plus ITILE for unresectable PHC is much better than that of AVPC alone.

The majority of the pancreatic cancer was diagnosed at advanced stage.The tumor may invade portal vein and/or superior mesenteric vein.Moore et al.firstly reported pancreaticoduodenectomy combined with portal vein and superior mesenteric vein resection and reconstruction in 1951.This procedure has improved the resection rate of pancreatic cancer.A 72-year-old man suffered from pancreatic cancer was admitted to the Southwest Hospital in September 2011.Because the tumor invaded the confluence of portal vein and superior mesenteric vein,thus the patient underwent a pancreaticoduodenectomy combined with portal vein and superior mesenteric vein resection and reconstruction.The patient recovered smoothly without any complication,and he had a normal liver function and CA19-9 value,and no local and remote metastasis was detected during the follow-up.

Objective To study the changes of transport protein Mrp2 excreting bilirubin across the canalicular membrane in obstructive jaundice rats. Methods The Mrp2 transcription and protein levels of hepatocytes was measured by RT PCR and immunofluorescence microscopy in obstructive jaundice rats. A correlation analysis of the transcription and protein levels with TNF ? and serum bilirubin was conducted. Results The Mrp2 transcription and protein levels were significantly lower in hepatocytes following bile duct obstruction and negatively correlated with TNF ? and bilirubin in rat serum. Conclusion Overexpression of inflammatory factor TNF ? may cause downregulation of transcription and protein levels of Mrp2 gene in obstructive jaundice rats. Bilirubin secretion across canalicular membrane can be inhibited. These may lead to or exaggerate hyperbilirubinemia.

Objective To study the effects of high cholesterol diet and activated macrophages (M) on glycoprotein secretion from the gallbladder tissue of guniea pig.Method Forty guniea pigs were randomized into group A fed with ordinary diet and group B fed with a diet containing 1.2% cholesterol for one week.Glycoprotein secretion from guinea pig gallbladder was observed in tissue culture using ~3H-glucesamine as a precursor,and in the meantime,with hydrocortisone and activated M to understand the effects on glycoprotein synthesis and secre- tion function of gallbladder epithelium.Results The activity of peritoneal M was significantly increased in guinea pigs fed with high cholesterol diet.High cholesterol diet induced significant release of ~3H-glucosamine-labeled gly- coprotein into the tissue culture medium as compared with the control level of guinea pig fed with normal diet.The gallbladder tissues were co-cultured for 16 hours with peritoneal M of guinea pig fed with high cholesterol diet. Mucin secretion had an evident increase compared with the controls (with the peritoneal M of guinea pig fed with normal diet at 10~4,10~6 cell/ml).Hydrocortisone (10~(-6),10~(-5),10~(-4)mol/l) caused a reversible dose-dependent inhibition on glycoprotein secretion from the gallbadder tissues of guinea pig fed with high cholesterol diet.Hydro- cortisone (10~(-4)mol/l) also inhibited the stimulatory effect of M activated by high cholesterol diet on glycoprotein hypersecretion in the gallbladder tissues of guinea pig fed with ordinary diet.Conclusion (1) High cholesterol diet can induce the increase of glycoprotein secretion from gallbladder tissues of guinea pig;(2) M can be actvi- ated by high cholesterol diet,which stimulates glycoprotein secretion from the gallbladder tissues of guinea pig. Considering the results of experiment using an animal gallbladder stone model,these findings suggest that the hy- persecretion of glycuprotein from guinea pig gallbladder tissue may be related to guinea pig M activated by high cholesterol diet and stimulated to release TNF,IL-I,etc.

Objective To evaluate the effects of recombinant human growth hormone (rhGH) applied perioperatively on the surgical tolerance, safety, and recovery in obstructive jaundice (OJ) rats. Methods A total of 146 Wistar male rats were randomly divided into five groups: SHAM, CBDL, REF, CBDL-GH, and REF-GH. rhGH was injected subcutaneously at the dose of 0.5 u/kg per day. One-week mortality was observed. Liver function indices, prealbumin (PA), TNF-?, and urine DBIL were measured. Results One-week mortality in REF-GH group was much lower than that in REF group (P

Objective To explore the role of multidrug resistance-associated protein 1 (Mrp1) on bilirubin metabolism in rat obstructive jaundiced (OJ) models. Methods Eighty Wistar male rats were randomly divided into three groups: sham operation group in which the common bile duct was educed but not ligated; common bile duct ligation (CBDL) group in which the common bile duct was ligated and cut off; bile reflow group in which on day 14 after common bile duct ligation operation, the internal drainage from common bile duct to duodenum by silica gel duct was performed. Serum prealbumin, serum total bilirubin and urine direct bilirubin were assayed routinely. The expressions of mrp1 mRNA and protein were detected in the liver tissues by semi-quantitative RT-PCR and indirect immunofluorescence respectively. Results Serum prealbumin was descending significantly (P

Objective To study the effect of mitochondrial permeability transition(MPT) after ischemia/reperfusion(I/R), and to find the relationship between MPT and apoptosis of hepatocytes in rats. Methods SD rats were divided into three groups:sham operation group, I/R group, and I/R+CsA group. A model of hepatic I/R in rats was made according to the method of Nauta. Active caspase-3 in cytoplasm was examined by immunohistochemistry, and the content of cytochrome C protein was evaluated by Western blotting. The incidence of apoptic hepatocytes was determined by TUNEL method. Cyclosporine A(10 mg?kg -1?d -1) was used as an inhibitor of MPT owing to its inhibitive effect on mitochondrial permeability transition pore(PT pore), and the influences of CsA were analyzed. Results Pretreated with CsA ameliorated injury after reperfusion. The number of apoptotic liver cells was decreased. CsA significantly prevented the release of cytochrome C from mitochondria, demonstrating its effect on MPT through preventing PT pore from opening. Conclusion MPT may play a key role in the apoptosis of liver cell after I/R. CsA, a powerful inhibitor of PT pore, is capable of abating the effect of MPT, reducing the release of cytochrome C, retarding the activation of caspase-3 and hence ameliorates apoptosis of hepatocytes following I/R procedure.