Objective To investigate the therapeutic effects and mechanisms of propofol on acute necrotizing pancreatitis (SAP) in rats.Methods 54 male Sprague-Dawley rats were randomized into three groups with 18 rats in each group:sham-operation group,ANP group,propofol-treatod group.After ANP models were induced,propofol(10 mg·kg~(-1)· h~(-1)) were injected by dorsal vein of penis in the propofoltreated group.The rats in all groups were sacrificed at 3,6,12 hours after induction of the model.The serum amylase,lipase,nitric oxide (NO),TNF-a,superoxide dismutase (SOD),IL-6 were detected;the histopathological score of pancreatic tissue were evaluated.Results At 6 h,the levels of serum amylase in sham-operation group,ANP group,propofol-treatod group were(1743± 370) U/L,(7745± 1030) U/L and (5529± 874) U/L;the levels of serum lipase were(274.9± 36.1)U/L,(1672± 262)U/L and(1219± 207 )U/L;the levels of serum TNF-a were (1.110± 0.276)mg/L,(3.191± 0.279)mg/L and (2.361±0.281 )mg/L;the levels of serum IL-6 were (102.6±28.5)ng/L,(334.1±34.0)ng/L and (268.6±29.8)ng/L;the levels of serum NO were (42.2±18.1)μmol/L,(120.7±22.3)μmol/L and(73.6±19.3)μmol/L;the levels of serum SOD were(120.6± 20.1)U/ml,(54.1± 15.3)U/ml and(85.7± 17,1)U/ml;the histopathological scores were 0.333± 0.408,4.417± 0.665 and 3.500±0.707.The serum levels of amylase,lipase,NO,TNF-a,IL-6 and the histopathological score of pancreas in ANP group were significantly higher than those in sham-operation group group(P＜0.05 ),while the serum levels of SOD were significantly lower(P＜0.05).The serum levels of amylase,lipase,NO,TNF-a,IL-6 and the histopathological score of pancreas in propofol-treated group were significantly lower than those in the ANP group(P＜0.05),while the serum levels of SOD were significantly higher(P＜0.05).Conclusions Propofol could decrease the levels of serum amylase and lipase,reduce pancreatic tissue damage,and had therapeutic effects on ANP in rats.

Objectives To evaluate the effect of probiotics enteral nutrition therapy on the inflammatory reaction and immune function in acute necrotizing pancreatits(ANP)in rats.Methods 100 SD rats were divided randomly into control group(C group,n=20),ANP gruop,enteral nutrition group (EN group,n=20),probiotics group(P group,n=20)and enteral nutrition plus probiotics group(PEN group,n=20),ANP were induced by retrograde injection of 5% sodium tautocholate(1.5ml/kg)into the biliary and pancreatic duct.The nasojejunal tube was placed via gastric route.The rats were sacrificed at 12h,24h,48h and 72h after ANP modeling.Serum MIF and amylase levels,as well as CD_3~+,CD_4~+,CD_8~+were measured and MIF was determined by immunohistochemistry and the histopathological changes in pancreatic tissue were observed.Results Serum MIF and amvlase levels were all increase when compared with that in C group.72h after ANP modeling,srum MIF leves in EN,P,PEN groups were(117.59±1.86)μg/L,(108.39±1.99) μg/L and (95.33±1.96) μg/L,respectivdy;serum amylase levels were (2799±161)U/L,(2482±140)U/L and (2146±572 )U/L,respectively;the values in P and PEN groups were significantly lower than that of EN group(P＜0.05),the values in PEN groups were significantly lower than that of P group (P＜0.05 ).After ANP induction,CD_4~+/CD_8~+ values in EN,P and PEN groups were 0.93±0.12,1.31±0.13,1.51±0.10,respectively;the values in P and PEN groups were significantly higher than that of EN group(P＜0.05 ),the values in PEN groups were significantly higher than that of P group (P＜0.05 ).MIF positive rates in C,ANP,EN,P and PEN group were 45%,96%,95%,65% and 60% ,respectively;the values in P and PEN groups were significantly lower than those of ANP and EN group (P＜0.05 ).At 72 h,the damage of pancreatic tissue was more severe in EN and P groups than that in PEN group.Conclusions Probioties enteral nutrition could effectively regulate inflammation mediator and cytokines in rats with ANP,and enhance immune function.

Objective To investigate the expression and clinical significance of intergrin linked kinase (ILK) in pancreatic carcinoma.Methods ILK protein was detected by immunohistochemistry and Western blotting in 60 cases of pancreatic carcinoma and 32 cases of normal pancreatic tissue,and the relationship with the clinicopathological characteristics were analyzed.Results Immunohistochemistry showed ILK was expressed in cytoplasm and membrane of pancreatic carcinoma cells and the positive rate was 65% (39/60),which was significantly higher than 18.75% (6/32) of normal pancreatic tissue(P ＜0.05 ).Western blotting showed the expression of ILK in pancreatic carcinoma tissue was 303933±195116,which was significantly higher than 144613±30074 of normal pancreatic tissue(P＜0.05 ).In pancreatic carcinoma,the expression of ILK was correlated with clinical stage and lymph metastasis(P＜0.05 ),but not correlated with tumor cell differentiation(P＞0.05 ).Conclusions ILK protein was highly expressed in pancreatic carcinoma tissue and it was correlated with the degree of malignancy.

Objective To investigate the expression of pancreatic thioredoxin-1 (TRX-1) in rats with acute necrotizing pancreatitis (ANP) and the effect of pretreatment of melatonin on its expression. Methods Male Spraque-Dawley rats (n = 12) were randomly divided to ANP group, melatonin group, control group with 24 rats in each group. The rats in ANP group received three intraperitoneal injections of 25 ml/kg body weight 6% L-arginine at an interval of 1 h to induce ANP. The rats in melatonin group received intraperitoneal injections of 25 ml/kg body weight 6% melatonin 30 min before ANP induction; rats in ANP group and control group received intraperitoneal injections of same amount of saline. Rats were sacrificed at 6 h, 12 h and 24 h after ANP induction. The serum level of amylase was measured and the pathological evaluation of pancreatic tissues was performed. The concentrations of malondialdehyde (MDA) and myeloperoxidase (MPO) in pancreatic tissues were measured. The expressions of TRX-1 protein were detected by immunohistochemistry and the expressions of TRX-1 mRNA in pancreatic tissues were determined by RT-PCR.Results In ANP group, serum level of amylase, MDA, MPO, TRX-1 mRNA and TRX-1 protein in pancreatic tissues were (3 012 ±1 425) U/L, (4.13 ± 1. 85)nmol/mg prot,(7.45 ± 1.26)nmol/mg prot, 0.68 ±0. 18, 66.8 ±8. 1, while they were (1 835±499)U/L, (3.03 ±2.12) nmol/mg prot, (5. 32 ± 1.06) nmol/mg prot, 0.50±0.09, 80. 29 ±8. 14, respectively in melatonin group, the values in melatonin group were significantly lower thanthose in ANP group (P < 0.05). The peak value of TRX-1 mRNA and TRX-1 protwein expressions shifted from 12 h after ANP induction in ANP group to 6 h after ANP induction in melatonin group. Conclusions The expression of pancreatic TRX-1 protein and TRX-1 mRNA in rats with ANP was significantly increased. Melatonin pretreatment could promote pancreatic tissues to express TRX-1 protein and TRX-1 mRNA, and may be protective for pancreatic tissues damages.

Objective To investigate the apoptosis of Kupffer cell (KC) induced by lipsomal clodronate in rat with acute necrotizing pancreatitis (ANP). Methods Lipsomal clodronate was prepared by means of thin film, the model of ANP was established by injection of 5% sodium taurocholate of 4 ml/kg into the pancreatic capsule. The Kupffer cells were obtained from ANP rat. After exposure to different doses of lipsomal clodronate (0, 50, 100, 150 μl) , then the proliferation and apoptosis of KC was measured by MTT, flow cytometry and agarose gel electrophoresis of DNA. Results The prepared lipsomal clodronate had an average size of 100～200 nm, the spherical shape of liposome was uniform and confirmed by transmission electron microscope. When exposed to different concentration of lipsomal clodronate for 24 h, the growth suppression rate was 17. 4% , 24. 2% and 31. 1% , respectively, while the apoptosis rate of the KC was (14. 12 ±0.37)% , (18.74±0.43)% and (27.51 ±0.39)%, respectively; the difference was statistically significantly (P<0. 01) , the DNA of KC began degradation and gradually showed clear and characteristic ladder. Conclusions Lipsomal clodronate could induce apoptosis and suppress the growth of Kupffer cells in ANP rats.

Objective To investigate the effect of low dose low molecular weight heparin (LMWH) on acute pancreatitis (AP). Methods 98 AP patients who were admitted in our hospital from 2002 to 2008 were randomly divided into anticoagulant therapy group (n = 40) and control group (n = 58). Anticoagulant therapy group consisted of 15 cases of severe acute pancreatitis (SAP) and 25 cases of mild acute pancreatitis (MAP) ; while there were 19 cases of SAP and 39 cases of MAP in control group. The patients of control group received conventional treatment, and conventional therapy together with 3 000 U LMWH subcutaneous injection every 12 hours were used in anticoagulant therapy group for two weeks. The changes of APACHE II score, complication rate, mortality and length of hospital stay were observed and the coagulation changes before and after anticoagulant therapy were documented. Results 7 days later, the APACHE II score, complication rate, mortality and length of hospital stay of SAP patients in the anticoagulant therapy group were 9. 9 ±4. 9, 20% , 13.3% , (20.6 ±10.4)d, respectively; while they were 12. 2 ±4.8, 42. 1%, 47.4%, (28. 2 ± 12. 5) d, respectively, in the control group, and the difference was statistically significant (P < 0. 05). The corresponding values were not statistically significantly different among MAP patients in the two groups. The coagulation after treatment in anticoagulant therapy group was not statistically different with that before treatment. Conclusions Low dose LMWH could reduce the rate of complication rate, mortality and decrease the length of hospital stay, without complication of hemorrhage, which should be recommended in the early phase of SAP.

Objective To assess the efficacy of proton pump inhibitors for preventing post-endoscopio retrograde cholangiopancreatography (post-ERCP) pancreatitis and hyperamylasemia. Methods A total of 250 patients, who underwent successful ERCP, were randomized into control group (n = 126) or treatment group (n=124) after ERCP. All patients received octreotide, the patients in treatment group received omeprazole 40 mg i. v. every 12 h; while the patients in control group received same amount of normal saline. The serum level of amylase at 4, 24 h and TNF-a were determined and the incidence of post-ERCP pancreatitis was documented. Results There were no differences in age, sex and proportion of therapeutic procedures performed between the two groups. The serum amylase and TNF-a levels at 4, 24h were (221 ± 31) U/L, (181 ±39) U/L, (0.264 ±0.052) ng/ml and (0.257 ±0.071) ng/ml in treatment group, respectively; which were significantly lower than (272 ±32) U/L, (227 ±30) U/L, (0. 372 ±0.047) ng/ml and (0.422 ±0.026) ng/ml in the control group (P<0.05). The incidence of pancreatitis in proton pump inhibitors group was 1.6%, which was significantly lower than that in control group (5.6% , P = 0. 04) . Conclusions Combination of proton pump inhibitors and octreotide could effectively decrease the incidence of post-ERCP hyperamylasemia and pancreatitis.

Objective To summarize the experience in the diagnosis and treatment of solid pseudopapillary tumors of the pancreas. Methods Ten consecutive patients who underwent surgery with pathologically confirmed solid pseudopapillary tumors of the pancreas between October 2005 and December 2008 were retrospectively reviewed. Results All of the 10 patients were female and the median age at diagnosis was 24 years (range, 11 -39 years). Abdominal discomfort or pain were the most common presenting symptoms. 4 patients had palpable abdominal mass at physical examination. The tumors appeared on ultrasonography and/or CT, MRI as solid or cystic masses. The preoperative serum biochemical parameters and tumor markers level were within the normal range. All the patients underwent surgical treatment. The tumors were located in the head/neck (n = 6) or the distal part (n = 4) of the pancreas. The surgical procedures included enucleation (n=3) , distal pancreatectomy (n=3 , two with preservation of the spleen, one combined with splenectomy, distal gastrectomy and partial colectomy) , segmental pancreatectomy with pancreaticojejunostomy (n=3) and pancreaticoduodenectomy (n = 1). Pancreatic fistula (n = 2) was observed postoperatively and resolved with conservative treatment. The median resected tumor size was 5. 9 cm. All patients were alive and remained recurrence and metastasis free after a median followk-up of 19. 2 months (range, 8～42 months). Conclusions Solid pseudopapillary tumor of the pancreas was rare neoplasm occurred predominantly in young women with low malignant potential. Aggressive resection should be attempted and could result in excellent prognosis.

Objective To investigate the diagnostic value of measurement of SARP2 methylation in peripheral blood for detection of pancreatic cancer in human. Methods Peripheral vein blood of 12 patients with primary pancreatic cancers, 10 patients with chronic pancreatitis and 6 health volunteers were collected. Serum free DNA were extracted from blood samples, and were modified with bisulfate, and SARP2 gene extron 1 were amplified through BSP and sequencing of the production. Results There were 12 patients (83 %) with pancreatic cancer and 10 patients (40%) with chronic pancreatitis had obvious methylation in SARP2 gene in peripheral blood. The rate of CpG methylation in SARP2 gene extron 1 of pancreatic cancer, chronic pancreatitis and health volunteers was 16. 8% , 10. 4% and 2. 2% respectively. There was statistically significant difference among the three groups (P<0.01 or P< 0.05). Conclusions Aberrant methylation of SARP2 gene could be detected in peripheral blood in patients with pancreatic cancer, the detection of SARP2 gene methylation may have potential clinical implication for diagnosis of pancreatic cancer.

Objective To establish a predictive model and to find the preoperative predictors for the nature of lesion in the setting of chronic pancreatitis. Methods The 121 patients from 7 tertiary medical centers in Shanghai from July 1998 to April 2007 with focal mass lesions in the setting of chronic pancreatitis were selected as the study population. The final diagnosis had to be confirmed histologically by surgical specimens (n =97) or by follow-up (n = 24). A case control study was conducted; the patients were divided into pancreatic cancer group and chronic pancreatitis group. The age, sex, past history, initial clinical presentations, lab results and imaging exams were collected by reviewing the medical records of these patients. χ~2 test and t test was used for univariate analysis, then the factors with P≤0. 25 were selected for further multivariate analysis, and multivariate logistic regression model was used to estimate odds ratio and 95% CI. Results Of 121 , 21 patients had a final diagnosis of pancreatic cancer and other 90 patients had a final diagnosis of chronic pancreatitis. Abdominal tenderness, direct bilirubin, CA19-9 and CEA were independent predictors of cancer in patients with focal mass lesions. Their odds ratios (95% CI) were 5. 691 (1.468, 22.070) , 1.011 (1.001 , 1.021) , 1.003 (1.001, 1.005) , 101.9 (0.988, 1.051) , respectively. Their P values were 0. 012, 0. 030, 0.003 and 0. 23 , respectively. Conclusions The logistic regression model may accurately predict the nature of lesion in the setting of chronic pancreatitis and may have certain clinical implication.