Pancreatic cancer has the highest mortality among malignant cancers. Known asthe king of cancer,it lacks early symp-toms, diagnostic methods and oncologic markers. Early lymph node metastasis could be found in this disease. Moreover, advanced panereatic cancer is incurable by surgery. Due to the limited efficacy of surgery, as well as radiotherapy and chemotherapy tolerance, therapeutic methods for pancreatic cancer are being explored. L1 cell adhesion molecule (L1CAM) is a member of the cell adhesion molecule inmunoglobulin (Ig) super family that is usually expressed in normal developing nervous tissues. L1CAM is highly expressed in pancreatic cancer cells, binds withα5-integrin to activate downstream factors that mediate tumor metastasis and invasion via the TGF-β1/JUK/slug signaling pathway, induces epithelium-mesenchymal transition, and resists chemotherapy drugs. However, L1CAM forms abnormal vessels that increase the invasiveness of pancreatic cancer cells. This abnormal L1CAM expression in pancreatic can-cer cells is a new therapeutic target in pancreatic cancer treatment. Therefore, future studies on L1CAM could promote the develop-ment of pancreatic cancer therapy and provide new treatment methods.

Objective: To expeore the effectiveress of partial splenectomy for treating splenic benign tumor.Methods: The 16 patients of splenic benign tumor were performed partial splenectomy. Six patients in all were adopted partial splenectomy plus great omentum encapsulation. Ten patients were used partial splenectomy plus glue spray.The postoperative complication was analyzed. Results: Only 1 patient suffered from left subphrenic abscess, one patient took place partial splenic necrosis, the rest had't complication. The average hospieal stay was 12 days.Conclusion: The partial splenectomy has few complications and the hospital stay is much short.This procedure is safe for treating splenic benign tumor.

Objective To explore the feasibility of local enucleation of pancreatic cystadenoma. Methods From Jan 2001 to Dec 2007, 11 patients with pancreatic cystadenoma underwent operation in Department of General Surgery, first affiliated hospital of China Medical University were enrolled and the clinical features, complications and prognosis were analyzed retrospectively. Results Of the 11 cases, the average age was 47 years old with 2 males and 9 females, the average size of the neoplasm was 4.8cm and 1 located in the pancreatic head, 10 in the body or the tail. Among which 3 cases were serous cystadenoma and 8 were mucinous cystadenoma confirmed by pathological evidence. Three patients developed temporary hyperglycemia and returned to normal after 1~2 weeks; one patient developed incisional infection; two cases developed pancreatic fistula postoperatively. All cases were followed up between 28 and 67 months. No neoplasm re-occurrence or diabetes mellitus occurrence were observed. Conclusions It was safe and feasible to perform enucleation for pancreatic cystadenoma with tumor size less than 6 cm.

Objective To investigate the experiences in the diagnosis and treatment of space-occupying lesions of the head of pancreas.Methods The clinical data of 247 patients with space-occupying lesions of the head of pancreas who were admitted to the First Affiliated Hospital of Chinese Medical University from January 2011 to April 2014 were retrospectively analyzed.All the patients received enhanced computed tomnography and (or) magnetic resonance imaging of the pancreas.The levels of alpha-fetal protein (AFP),CA19-9,CA125 and carcinoembryonic antigen (CEA) were detected,and the serum level of IgG4 was detected in patients who were suspected of autoimmune pancreatitis.Intraoperative pathological examination was applied to patients who were diagnosed as with cancer of the head of pancreas.Pancreaticoduodenectomy,extended pancreaticoduodenectomy or bilio-jejunostomy or (and) gastrointestinal anastomosis were applied to patients according to the stage and infiltration of the tumor.Duodenum-preserving pancreatic head resection or pancreaticoduodenectomy could be selected after informed consent.The adjacent tissues and organs should be preserved on the premise of complete tumor resection for patients with benign and low-grade malignancy.Results A total of 194 patients had solid spaceoccupying lesions of the head of pancreas,including 125 with pancreatic head cancer,45 with mnass in the head of pancreas,9 with chronic pancreatitis with mass in the head of pancreas,11 with autoimmune pancreatitis,4 with insulinoma.Fifty-three patients were with cystic space-occupying lesions,including 12 with mucinous cystadenoma,8 with serous cystadenoma,17 with pancreatic cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.The positive rates of AFP,CA19-9,CA125 and CEA of the 71 patients who were confirmed as with pancreatic cancer by pathological examination were 7.0％ (5/71),94.4％ (67/71),42.3％ (30/71) and 0,respectively.The positive rates of AFP,CA19-9,CA125 and CEA of the 12 patients with chronic pancreatitis with mass in the head of pancreas were 1/12,4/12,1/12 and 0,respectively.Seventynine patients with pancreatic head cancer,mass in the head of pancreas and chronic pancreatitis with mass in the head of pancreas received intraoperative pathological examination.A total of 119 patients received operation,including 71 with pancreatic head cancer,7 with chronic pancreatitis with mass in the head of pancreas,4 with insulinoma,1 with pancreatic tuberculosis,8 with mucinous cystadenoma,4 with serous cystadenoma,6 with pancreatic pseudocyst,1 with huge lymphangioma,1 with lymphoepithelial cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.Of the 247 patients with space-occupying lesions of the head of pancreas,61 received pancreaticoduodenectomy,4 received duodenum-preserving pancreatic head resection,4 received pancreatic head and neck resection,2 received partial resection of the uncinate process of the pancreas,9 received enucleation of the tumor,38 received bilio-jejunostomy or (and) gastrointestinal anastomosis,22 received endoscopic retrograde cholangio-pancreatography + stent installation,18 received percutaneous transhepatic cholangial drainage + stent installation,1 received exploratory lapartomy and the other 88 patients were untreated.Conclusions The diagnosis and differential diagnosis of the space-occupying lesions of the head of pancreas depend on the clinical presentation,medical history,laboratory examination,sonography,computed tomography or magnetic resonance imaging.Individualized treatment plan based on the feature of the tumor and kinds of the lesions combined with intraoperative pathological examination is helpful for selecting the surgical procedures.

Object To establish a proper research evaluation system for level-two general hospital.Method By using Delphi method,experts were invited by letter to review research evaluation indices for three times.Result Totally 62 indices were weighted and evaluated,including two primary-degree indices,14 secondary-degree indices,and 46 third-degree indices. A research evaluation system was preliminarily established in a level-two general hospital.Conclusion The evaluation system is simple and practicable,and can reflect the main aspects of research in the leveltwo general hospitals.

Objective To investigate the effects of interferon-γ (IFN-γ) on interleukin-10 (IL-10) and mononuclear macrophages in a mouse model of gallbladder cancer.Methods Mouse models of gallbladder cancer were constructed by inoculating the human gallbladder cancer cell line GBC-SD subcutaneously in 20 BALB/C mice,and then all the mice were randomly divided into the IFN-γ group and the control group (10 mice in each group).Murine recombinant IFN-γ (0.1 mL,1 × 105 kU/L,diluted with normal saline) was injected into the tumors in the IFN-γgroup,and normal saline was injected into the tumors in the control group.The expression of IL-10 was detected by ELISA,and the numbers of CD14 + cells (mononuclear macrophages),CD64 + cells (M1 macrophages) and CD206+ cells (M2 macrophages) were counted by the immunohistochemistry.All data were analyzed using the Student's t test.Results The mouse models of gallbladder cancer were successfully constructed 1 week later.Nine mice survived in the IFN-γ group,and 7 mice survived in the control group.The tumor weight was (518 ± 138)mg in the IFN-γ group and (669 ± 128)mg in the control group,with a significant difference between the 2 groups (t =2.240,P ＞ 0.05).The volume of the tumor was (456 ± 172)mm3 in the IFN-γ group and (505 ± 146)mm3 in the control group,with no significant difference between the 2 groups (t =1.503,P ＞ 0.05).The concentration of IL-10 was (58 ± 16) μg/g in the IFN-γgroup,which was significantly lower than (102 ± 45) μg/g in the control group (t =2.796,P ＜ 0.05).The number of mononuclear macrophages was 81 ± 16 in the IFN-γ group,which was significantly greater than 50 ± 21 in the control group; the number of M1 macrophages was 66 ± 12 in the IFN-γ group,which was significantly greater than 9 ± 4 in the control group ; the number of M2 macrophages was 15 ± 4 in the IFN-γgroup,which was significantly lower than 40 ± 14 in the control group (t =3.214,13.127,6.914,P ＜ 0.05).Conclusions IFN-γ could decrease the concentration of IL-10 in the tumor microenvironment,and it could induce the mononuclear macrophage to infiltrate into the stroma of the gallbladder cancer cells,and most of the monocytes and macrophages were differentiate to M1 macrophages.Gallbladder neoplasms; Interleukin-10; Interferon-γ; Mononuclear macrophages

Background and purpose:The prognosis of pancreatic cancer is poor. This study aimed to evaluate the value of pancreatic CT perfusion on biological behavior assessment in pancreatic cancer. Methods:This study collected 78 cases of pancreatic cancer which diagnosed by the method of pancreatic CT perfusion, and detected the differences of the values of blood lfow (BF), blood volume (BV), permeability (per), peak value (PE) and time to peak (TTP) between normal pancreatic tissues and tumor tissues. Combined with clinical and pathological data. Besides, this study evaluated the relationship between perfusion parameters of tumor tissues and tumor size, lymph node metastasis, distant metastasis, preoperative serum CA199 level, Ki-67, p53, CEA, CA199, CD34 expression of tumor tissues. Results:The values of BF, BV, per and PE in pancreatic tumor tissue were signiifcantly lower than those in normal pancreatic tissue. The BF values of cases with high levels of serum CA199 and with CA199 positively expressed tissues were signiifcantly higher than those with negative expression. The PE values of cases with positive tissue expression of Ki-67 were significantly higher than those with negative expression. The TTP values of cases with positive tissue expression of CEA were signiifcantly lower than those with negative expression. The per values of well differentiated cases was signiifcantly higher than those of moderately/poorly differentiated cases. Conclusion:CT perfusion may have its value on assessment of tumor biological behavior in pancreatic cancer.

Objective To study the expression of Survivin and the relationship with proliferative activity in pancreatic carcinoma(PC).Methods The expression of SurvivinmRNA was investigated by reverse(transcriptase) polymerase chain reaction(RT-PCR) in 62 cases of PC samples,12 cases of chronic(pancreatitis)(CP) samples,and 10 cases of normal pancreatic tissue samples.Meanwhile,the expression of proliferative cell nuclear antigen(PCNA) was detected by immunohistochemical assay.Results The(expression) of Survivin gene was detected in a significantly greater proportion in PC(74.2%) than CP(0/12) and normal pancreatic tissue(0/10)(P

Objective To discuss clinical effects of combined use of duodenoscopy and laparoscopy in the treatment of acute billiary pancreatitis(ABP).Methods The clinical data of 94 ABP patients who underwent minimally invasive treatment from February 2001 to Feburary 2006 were retrospectively reviewed.Among 94 ABP patients,59 patients had gallbladder stones were given laparoscopic cholecystectomy(LC)alone;14 patients had common bile duct stones received endoscopic nasobiliary drainage(ENBD),combined endoscopic sphincterotomy(EST)and LC;21 patients had both gallbladder and common bile duct stones received combined EST and LC.Results Postoperatively,in the whole group,only one patient had recurrent pancreatitis,one patient had hemobilia,and both cases followed ERCP+EST;two cases had lung infection,and one case had infection of abdominal incision.All of the 5 cases with postoperative compllcations were successfully treated by conservative therapy.The effective rate for the whole group was 100%.Conclusions Combined use of duodenoscopy and laparoscopy is significantly effective for treatment of acute biliary pancreatitis and this minimally invasive treatment is the ideal therapy for acute biliary pancreatitis.

Objective:To investigate the relationship between high mobility group box-1 protein (HMGB1) expression and gut mucosal barrier dysfunction during murine severe acute pancreatitis (SAP). Methods:Forty-eight male health adult Wistar rats were divided randomly into Control group and SAP groups. The concentration of plasma D-lactate and the activity of myeloperoxidase (MPO) in the intestinal tissue were determined. The expression of HMGB1 mRNA in intestinal mucosa was detected by reverse transcription polymerase chain reaction (RT-PCR) and the activity of HMGB1 was determined by Western blot. Results:Plasma D-lactate and MPO reached a peak level at 24h (16.41?4.65)?g/mL for Plasma D-lactate and(26.76?3.63)U/g for MPO respectively, (P