Objective To determine the expression of CD4+ CD25+ FOXP3+ regulatory T cells(Treg cells) in peripheral blood of patients with hepatocellular carcinoma (HCC) and investigate the clinical significance of Treg cells determination in clinical practice. Methods Flow cytometry was employed to measure the levels of CD4+ CD25+ T cells and CD4+ CD25+ FOXP3+ T cells in peripheral blood of 18 HCC patients, 26 hospitalized patients without HCC (clinical control) as well as 24 healthy persons (healthy control). Results The percentage of CD4+ CD25+ T cells in total CD4+T cells isolated from the HCC patients(4.25% ± 3.98 % ) was elevated significantly compared to that in the clinical control group (1.34% ± 1.14%) or healthy control group (1.29% ±0.95%) (both P＜0.01). There was no difference in the percentage between the clinical control group and the healthy control group (P＞0.05). Meanwhile, the ratio between CD4+ CD25+ FOXP3+ T cells and CD4+ T cells in HCC patients (2.94%0.91%) also increased significantly compared to that in the clinical control group (0.76% ± 0.34%) or healthy control group (0.81% ± 0.29%) ( both P＜0. 001), which showed a more obvious increasing tendency than the ratio of CD4+ CD25+ T cells and CD4+ T cells. No difference in percentage of CD4+ CD25+ FOXP3+ T cells in CD4+ T cells was found between the clinical control group and the healthy control group (P＞0.05). Conclusion As the more accurate regulatory T cells, CD4+ CD25+ FOXP3+ T cells are able to detect the increase of population in HCC patients. Therefore, it is important to determine the levels of CD4+ CD25+FOXP3+ T cells in HCC patients for prevention and treatment of malignancy.

Pancreatic cancer is a highly malignant tumor in the digestive system and has a low rate of surgical resection and poor prognosis. Since pancreatic cancer has unique biological behaviors, surgical resection alone cannot meet the need of clinical treatment. With the popularization of the concept of multimodality therapy, multidisciplinary collaboration can integrate the superior resources of disciplines and develop standardized and individualized diagnosis and treatment process based on patients′ conditions. It can help clinicians to observe the indications for neoadjuvant therapy in patients with pancreatic cancer and develop individualized surgical and adjuvant treatment regimens and has achieved a good effect in the treatment of pancreatic cancer. This article summarizes the advances and challenges in the multidisciplinary diagnosis and treatment of pancreatic cancer, in order to improve the level of multidisciplinary diagnosis and treatment of pancreatic cancer in China and the prognosis of patients with pancreatic cancer.

Diabetes secondary to pancreatic exocrine insufficiency is commonly referred to as pancreatogenic diabetes or type 3c diabetes.Among all diabetic patients in the western population,the prevalence of type 3c diabetes is about 5%-10%,but some patients with pancreatogenic diabetes are misdiagnosed as type 2 diabetes.So far,researches on pancreatogenic diabetes are being explored.The definition,diagnosis,prevalence,pathogenesis,clinical features and treatment status of pancreatogenic diabetes are described and analyzed in this paper.

The insulinoma, which is the most common pancreatic neuroendocrine tumor, can be misdiagnosed and mistreated easily.Recently, the misdiagnosis rate has decreased significantly owing to the establishment of diagnosis and treatment system.However, the misconception about its diagnosis and treatment still exists because the diagnosis and treatment level varies greatly among different centers.This article aims to summarize the experience in the diagnosis and treatment of insulinoma in Peking Union Medical College Hospital, and introduce the qualitative and localization diagnosis, surgical and interventional treatment and perioperative management about insulinoma, so as to standardize the diagnosis and treatment procedure in China.

Laparoscopic pancreaticoduodenectomy (LPD) is one of the most complicated operations in laparoscopic field.After been widely reported nowadays, LPD has been cautiously regarded as feasible and safe for radically resection.At present, several large pancreatic surgery centers in China have successively carried out this kind of surgery, with over one thousand cases in all.However, partly due to its complexity and steep learning curve, this procedure only remains limited to a few selected large pancreatic centers.Large sample prospective random control test studies are still required.We suggest that in China, LPD should only be developed steadily and step by step by highly skilled open and laparoscopic surgeons who have minimally invasive concept, contrary to fears and could grasp technical expertise.

Objective To assess the feasibility of sound touch elastography(STE)and sound touch quantify(STQ)in convex transducer and linear transducer for female levator ani muscles stiffness assessment.Methods A total of 69 healthy volunteers underwent STE and STQ examinations of the right levator ani muscles at three different locations(anterior,middle,and posterior)during rest,contraction,and stretch states.The study analyzed the success rate,variability,and measurements(Young's modulus)of the detection techniques,as well as assessed the inter-operator and intra-operator consistency.Results Both convex transducer STE and linear transducer STQ techniques exhibited higher overall success rates and lower variability in detecting the middle segment of the levator ani muscles compared to convex transducer STQ and linear transducer STE techniques,with statistically significant differences(all P<0.05).There was statistically significant difference in the measurements of levator ani muscles detected by convex transducer STQ technique and linear transducer STE technique(P<0.05).There was no statistically significant difference in the measurements of levator ani muscles detected by convex transducer STE technique and linear transducer STQ technique(P>0.05).The inter-operator and intra-operator consistency of convex transducer STE and linear transducer STQ technology were determined to be 0.869,0.919,0.772,0.850,respectively.Conclusion Both convex transducer STE and linear transducer STQ techniques demonstrate high success rates and low variability in assessing levator ani muscles stiffness,and there was no significant difference in the measurements of them,they were suitable for clinical promotion widely.

Pancreaticoduodenectomy is cumbersome and difficult to operate,with a long operative time and high risk of postoperative complications,thus it is one of the most complicated operations among general surgery.With the popularization and progress of minimally invasive techniques,minimally invasive pancreaticoduodenectomy (MIPD) has obtained a well developing.It has been confirmed that MIPD is noninferior or even superior to the traditional open pancreaticoduodenectomy in term of the feasibility,safety and effects of radical cure.However,the relevant conclusions are mostly from single-center retrospective studies,without high-quality evidence support.The authors has reviewed the recent research progress of MIPD in the indications and contraindications,safety,feasibility and tumor curative effect,and illustrated the current status and prospects of MIPD with clinical experience and related literature,contributing to the standardization of MIPD in China.

Pancreatic neuroendocrine tumors are a group of rare neoplasms originating from the neuroendocrine cells of pancreas.They can be classified into functioning or non-functioning groups according to hormone secretion.Due to the application of high-resolution imaging techniques,the incidence of incidental non-functioning pancreatic neuroendocrine tumors has been rising for decades.Although the optimal prognosis,nonfunctioning pancreatic neuroendocrine tumor are heterogeneous,and the complication morbidity is high.So controversy still exists for the choice of treatment approach.This article aims to summarize and analyze the progress and current controversy about the treatment of incidental non-functioning pancreatic neuroendocrine tumors,and discuss about the appropriate treatment choice for patients.

Objective: To test the expression of miR-1178 in pancreatic cancer and study its clinicopathological significance and mechanism. Methods: The expression of miR-1178 in 87 paired paraffin pancreatic ductal adenocarcinoma specimens and adjacent non- cancerous pancreatic tissue diagnosed by Pathology Department of Peking Union Medical College Hospital was detected by hybridization in situ. The relationship between the expression of miR-1178 and clinicopathological characters was analyzed.miR-1178 mimics and inhibitor were used to further detect the close relationship among miR-1178 and cancer invasion. Establish a nude mice subcutaneously transplanted tumor model, 4 weeks after vaccination for tumor volume and weight measurement.Student t-test, rank sum test, and χ² test was used respectively to compare the data between two groups. Cox regression was adopted to improve the single factor and multiple factors analysis. Results: The results of hybridization in situ showed the expression of miR-1178 was increased in 72 cases with pancreatic cancer compared to that in paired normal pancreatic tissues (50/72 vs. 11/72, χ²=43.26, P<0.05). miR-1178 expression was positively associated with tumor lymph node stage (χ²=4.189, P=0.041). Univariate and multivariate analysis revealed that miR-1178 was an independent adverse prognostic indicator for patients with pancreatic cancer (HR=2.364, 95%CI: 1.114-5.019, P=0.025). Transwell assay indicated the over-expression of miR-1178 increased the number of AsPC-1 cells that penetrated the ECM-coated membrane (177.0±19.8 vs. 119.7±15.9)(χ²=8.21, P<0.05). For the in vivo experiment, overexpression of miR-1178 significantly promoted tumor growth, compared with control group (tumor volume: (5 122.4±760.2)mm³ vs. (1 976.8±601.8)mm³, t=2.413, P<0.05; tumor weight: (1.55±0.21)g vs. (0.67±0.17)g, t=2.960, P<0.05). Over-expression of miR-1178 down-regulated the expression of Stub1 and elevated the expression of FAK/MMP-9 signal pathway(P<0.05). Conclusions MiR-1178 is overexpressed in pancreatic cancer, and is effective for predicting patients′ prognosis. MiR-1178 regulate Stub1/FAK/MMP-9 signal pathway and promote the invasion of AsPC-1 cells.

Objective: To investigate the expression of KLK7 in pancreatic cancer and its clinical significance. Methods: Immunohistochemistry was used to detect the expression of KLK7 protein in pancreatic cancer tissue microarray with 92 samples. Statistical analysis of the relationship between KLK7 and clinicopathological characteristics was finished. Pancreatic cancer cell lines were infected with lentiviuses in order to get cells with KLK7 stable overexpression.KLK7-siRNA was transfected into pancreatic cancer cells to knock down KLK7.Cell proliferation and chemosensitivity were detected by CCK-8 assay; Cell invasion and migration abilities were detected by Transwell assay. At the same time, subcutaneous xenograft tumor models were established in nude mice to observe the effect of KLK7 on tumor growth in nude mice. Data were statistically analyzed by rank sum test, χ² test and Logistic regression analysis. Results: The expression level of KLK7 in pancreatic cancer tissues was higher than that in paired adjacent tissues (P<0.05). KLK7 expression was correlated with vascular invasion(χ²=7.535, P<0.05). Further univariate and multivariate analysis showed that KLK7 expression was an independent risk factor for vascular invasion of pancreatic cancer(χ²=7.535, P<0.05). The overexpression of KLK7 in pancreatic cancer cell lines BxPC-3 and CFPAC can increase their proliferation abilities, reduce the chemosensitivity and promote their migration and invasion behaviour; The results of in vivo experiments showed that the volume of subcutaneously transplanted tumors in the overexpressing KLK7 group was significantly larger than that in the control group (t=4.479, P<0.05). The group of overexpressing KLK7 showed greater tumor weight than the control group(t=2.831, P<0.05). Conclusions The expression level of KLK7 in pancreatic ductal adenocarcinoma was higher than that in paired adjacent tissues and it is an independent risk factor for vascular invasion of pancreatic cancer.KLK7 can promote the proliferation of pancreatic cancer cells, reduce the chemosensitivity and increase the invasion and migration of pancreatic cancer cells.