With the characteristics of complicated etiologic factors,multiple complications and high mortality,severe acute pancreatitis (SAP) has been treated by all kinds of clinical management.Management of SAP is a hot topic in recent decades.Researches on the pathophysiology of SAP have advanced dramatically during the past 20 years.As the number of randomized controlled studies of SAP has steadily increased,mainly in the United States and Europe,evidence based management was demanded for the management of SAP.The main improvement of the treatment results was achieved following internationally accepted recommendations; however,some aspects of the management are different and need to be discussed.There has been no consensus regarding the treatment of SAP.Failure to provide definitive treatment may potentially put a patient at risk of a fatal episode of SAP.The aims of this study,therefore,were to survey the currently adopted practice of the management of SAP,to evaluate the impact of various subspecialty interests on the practice adopted,and to suggest pathways towards a better implementation of the guidelines and other evidence-based management approaches.

Objective To evaluate multiple minimally invasive techniques in the treatment of severe acute pancreatitis (SAP).Methods The clinical data of 93 patients with SAP who received minimally invasive treatment at the First Affiliated Hospital of Harbin Medical University from January 2005 to July 2010 were retrospectively analyzed.Percutaneous catheter drainage (PCD),endoscopic retrograde cholangio-pancreatography (ERCP),endoscopic sphincterotomy (EST),endoscopic nasobiliary drainage (ENBD) and laparoscopy were applied according to the condition of the patients.The efficacies of different treatment methods were evaluated.Results On the basis of comprehensive treatment,32 patients received 1 kind of minimally invasive treatment,41 patients received 2 kinds of minimally invasive treatment,14 patients received 3 kinds of minimally invasive treatment and 6 patients received 4 kinds of minimally invasive treatment.Sixty-nine patients received ultrasoundguided PCD; 28 patients received ERCP,EST and (or) ENBD; 29 patients received laparoscopy; 19 patients received treatments with stepped approach; 4 patients were complicated with abdominal bleeding,and received interventional treatment.The mean time of abdominal pain relief and duration of hospital stay were (37 ± 18)hours and (31 ±21 )days,respectively.The abdominal infection rate,laparotomy transfer rate,curative rate and mortality rate were62％(58/93),4％(4/93),91％ (85/93) and 9％ (8/93),respectively.Conclusion Multiple minimally invasive techniques combined with individualized treatment may significantly improve the curative rate of SAP.

Diagnosis, Differential ; Ependymoma ; metabolism ; pathology ; Female ; Hemangioblastoma ; metabolism ; pathology ; Humans ; Ki-67 Antigen ; metabolism ; Meningeal Neoplasms ; metabolism ; pathology ; surgery ; Meningioma ; metabolism ; pathology ; surgery ; Middle Aged ; Mucin-1 ; metabolism ; Neoplasm Recurrence, Local ; Vimentin ; metabolism

The method of homogeneity evaluation for active pharmaceutical ingredient (API) spatial distribution in lyophilized product was investigated for the first time with confocal micro-Raman spectroscopy mapping, using pemetrexed disodium for injection as a model drug. Certain areas of the lyophilized product were scanned to obtain Raman spectra. The classical method ("peak clipping" method) was employed for mapping with characteristic Raman peaks of the API and the excipient. Due to the API being finely dispersed in the excipient in lyophilized products, the classical method cannot discriminate between the two ingredients making the distribution homogeneity difficult to evaluate. The "ratio of characteristic peak intensities" method was then utilized. Using this method, the relative intensity of the characteristic Raman peaks of the API to the excipient was applied for mapping and the relative content of API to excipient was calculated for a homogeneity evaluation of the drug distribution. The validation of this method showed a good linear relationship between the relative intensity and the relative content of API to excipient (r² > 0.99), and the precision and recovery were adequate for homogeneity evaluation of API by Raman spectroscopy mapping. Five products of pemetrexed disodium for injection from different manufacturers were tested through Raman maps applying this method and the histograms of relative Raman intensity were also plotted by frequency to help the homogeneity evaluation of drug distribution. The results showed that there were obvious differences in the drug distribution homogeneity from different products, where a more homogeneous API distribution was found in the brand product. This research provides a reliable method for the homogeneity evaluation of API distribution, which facilitates quality evaluation and process optimization of lyophilized products.

Objective To investigate the utility of P504S(?-methylacyl-COA racemase), CK34?E12,p63 and PSA immunohistochemistry in the pathological diagnosis of prostatic adenocarcinoma (PAC).Methods The specimens of 46 cases of PAC,8 cases of prostatic high-grade intraepithelial neo- plasia (HGP1N) and 35 cases of benign prostatic hyperplasia (BPH) tissues were immunohistochemically stained with P504S,CK3413E12,p63 and PSA antibody,respectively.Results Of the 46 PAC cases,42 (91.3%) cases showed positive for P504S,including 25 cases (54.3%) who showed strongly and diffusely positive (+++) for cytoplasmic staining.In 7 (87.5%) of the 8 HGPIN cases,the specimens were also positive for P504S,and only 1(2.9%)of the 35 BPH cases showed focally weakly positive (+) for P504S.All the 8 HGPIN cases (100%) and 33 (94.3%) of the 35 BPH cases showed positive for CK34?E12 and p63,while all the 46 PAC cases showed negative for CK34?E12 and p63.In 44 (95.7%) of the 46 PAC cases,the specimens were positive staining for PSA.Conclusions P504S has high sensitivity and good specificity in the diagnosis of PAC.P504S staining in combination with HE,CK34?E12,p63 and PSA staining can improve the accurate diagnosis of PAC.

Actins ; metabolism ; Angiomyoma ; metabolism ; pathology ; surgery ; Cranial Fossa, Middle ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Melanoma-Specific Antigens ; metabolism ; Middle Aged ; Perivascular Epithelioid Cell Neoplasms ; immunology ; S100 Proteins ; metabolism ; Skull Base Neoplasms ; metabolism ; pathology ; surgery

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell ; genetics ; metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Kidney Neoplasms ; genetics ; metabolism ; Male ; Matrix Metalloproteinase 2 ; genetics ; metabolism ; Middle Aged ; Transforming Growth Factor beta1 ; genetics ; metabolism ; Tumor Cells, Cultured ; Young Adult

Adenocarcinoma ; metabolism ; pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; metabolism ; pathology ; Carcinoma, Squamous Cell ; metabolism ; pathology ; DNA-Binding Proteins ; metabolism ; Female ; Humans ; Lung Neoplasms ; metabolism ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Transcription Factors ; metabolism ; Tumor Burden ; beta Catenin ; metabolism

OBJECTIVETo investigate the function of nuclear factor (NF)-κB in the epithelial to mesenchymal transition induced by hypoxia in pancreatic cancer cells.

METHODSFor cultured pancreatic cancer cells (BxPC-3 and Panc-1) under hypoxic and normoxic conditions, the differences in the morphology were observed by optical microscope. The expression of markers of epithelial and mesenchymal phenotypes, E-cadherin, vimentin and N-cadherin, were determined by Western blot. NF-κB P65 activity was measured by electrophoretic mobility shift assay. Invasion and gemcitabine resistance of pancreatic cancer cells were evaluated in matrigel invasion assay and cell counting kit-8 assay. Both molecular and pharmacologic means of inhibiting NF-κB P65 were used in these hypoxic cells and then the above resulting phenotypes were compared with those of the control-treated cells.

RESULTSAfter cultured pancreatic cancer cells under hypoxic conditions for 48 h, normoxic cells exhibited a polygonal shape and formed tight clusters of cells, whereas hypoxic cells took on an elongated, fibroblastoid morphology associated with a more highly invasive character and resistance to gemcitabine; hypoxic cells exhibited an suppression of E-cadherin and increase in vimentin and N-cadherin expression. NF-κB P65 activity was elevated in hypoxic cells. On the contrary, on molecular or pharmacologic inhibition of NF-κB P65, hypoxic cells regained expression of E-cadherin, lost expression of N-cadherin, and reversed their highly invasive and drug resistant phenotype.

CONCLUSIONSPancreatic cancer cells underwent epithelial to mesenchymal transition exposed to hypoxia, exhibited highly invasive and drug resistant phenotype. Inhibition of NF-κB P65 under hypoxic conditions, pancreatic cancer cells regained expression of E-cadherin, lost expression of N-cadherin, and reversed their highly invasive and drug resistant phenotype.

Antigens, CD ; metabolism ; Cadherins ; metabolism ; Cell Hypoxia ; Cell Line, Tumor ; Drug Resistance, Neoplasm ; Epithelial-Mesenchymal Transition ; Humans ; Pancreatic Neoplasms ; metabolism ; pathology ; Transcription Factor RelA ; metabolism ; Vimentin ; metabolism

OBJECTIVETo study the histopathologic changes of primary brain stem injury and to investigate their significance in the diagnosis of primary brain stem injury.

METHODSSixty-five autopsy cases died of primary brain stem injury and other diseases were enrolled into this study. The cases were subdivided into brain stem injury group (n = 25) and control group (including 20 cases died of cardiovascular disease and 20 cases died of non-cardiovascular diseases). The brain stem tissue sections were stained with hematoxylin-eosin and silver impregnation techniques. Immunohisto chemical study for glial fibrillary acidic protein, neurofilament, amyloid-beta and myelin basic protein was carried out. The widest cross diameters of 10 axons highlighted by immunostaining were measured in each low power field (x 100) through light miscroscopy in all the cases studied.

RESULTSIn comparing with that of the control group, there were differences in the degree of contusion lesion, reactive astrocytosis, edema and pathologic changes of neuronal cells present in the brain stem injury group and was statistically significant (P < 0.05). The axons locating in the brain stem injury group showed a distinctive histology by the appearance of significantly larger diameters (P < 0.05).

CONCLUSIONSPrimary brain stem injury demonstrates certain distinctive histopathologic changes and measurement of axonal diameters provides an additional quantitative index useful in autopsy diagnosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Amyloid beta-Peptides ; metabolism ; Axons ; metabolism ; pathology ; Brain Injuries ; metabolism ; pathology ; Brain Stem ; injuries ; metabolism ; pathology ; Female ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Myelin Basic Protein ; metabolism ; Neurofilament Proteins ; metabolism ; Young Adult