Autoimmune pancreatitis (AIP)is a special type of chronic pancreatitis that originates from an autoimmune -mediated mecha-nism.AIP has unique radiological,serological,and histopathological features,often accompanied by peripancreatic lesions.AIP may be easily confused with pancreatic cancer and cholangiocarcinoma.It is necessary to diagnose AIP while integrating a variety of clinical indica-tors.Steroid therapy should be performed for patients diagnosed with AIP,and surgical treatment can be selected if necessary.

Pancreatic cancer is one of the digestive malignant tumors with the worst prognosis and has an overall 5 -year survival rate as low as 5%.Even though radical resection is performed,the 5 -year survival rate is only about 20%.Recurrence and metastasis are the most important influencing factors for the postoperative survival of patients with pancreatic cancer.Lymph node metastasis is an important feature of pancreatic cancer,and the extent of lymph node dissection has always been a hot topic in radical surgery for pancreatic cancer.This arti-cle summarizes the history and current status of the extent of lymph node dissection in pancreatic cancer and points out that standardized lymph node dissection is a key factor for improving patients′prognosis after pancreatic cancer surgery.

Ampullary tumors mainly manifest as obstructive jaundice and ampullary mass in clinical practice and are difficult to be identified in early stage due to a complex structure of the anatomical site,a deep location,and hidden symptoms.Sometimes a qualitative diagnosis cannot be made.Based on the experience in the treatment of ampullary tumors for many years in our center,this article summarizes the features of ampullary tumors from the aspects of clinical manifestations,diagnosis,treatment,and prognosis,especially the issues regarding imaging evaluation of ampullary tumors,selection of surgical procedure,and prognosis.An early diagnosis is the key to the treatment of ampullary tumors,and early identification and treatment of lesions have great impacts on patients' prognosis.Accurate preoperative imaging evaluation,a professional diagnosis and treatment team,accurate preoperative and intraoperative pathological analysis,and implementation of reasonable therapeutic strategy are the key to patients' recovery.

Objective To investigate the expression and clinical significance of toll-like receptor 9 (TLR9) and hypoxia inducible factor 1 α (HIF-1 α) in pancreatic cancer.Methods The real-time RT-PCR technique,western blot method and immunohistochemical method were used to examine the expressions of TLR9 and HIF-1α in 30 samples of pancreatic cancer,para-cancerous tissues,and 10 samples of normal pancreatic tissues.The relationship between TLR9 and HIF-1 α was determined,and the correlations between their expressions and clinicopathological parameters were measured,and the impact on survival was detected.Results The levels of TLR9 mRNA and HIF-1 α mRNA expression in human pancreatic cancer tissues was 2.32(1.41～3.22) and 2.26 (1.62～ 2.89) folds as many as that in normal tissues.The levels of TLR9 mRNA and HIF-1α mRNA expression in para-cancerous tissues were 1.23 (1.18 ～ 1.28) and 1.36 (1.17 ～1.55) folds as many as that in normal tissues.The expressions in human pancreatic cancer tissues were significantly higher than those in para-cancerous tissues (t =2.642,P =0.023 ; t =4.076,P =0.001).The positive rates of TLR9 and HIF 1α protein were 73.3％ (22/30) and 70.0％ (21/30),and the corresponding values were 33.3％ (10/30) and 36.7％ (11/30) in para-cancerous tissues,while the corresponding values were 20％ (2/10) and 10％ (1/10) in normal tissues,which showed a decreasing trend (x2 =13.99,P =0.001 ;x2 =13.15,P =0.001).The expressions of TLR9 mRNA in human pancreatic cancer tissues was positively associated with HIF 1 α mRNA (r =0.537,P =0.003).The expressions of TLR9 protein was also positively associated with HIF 1α protein (r =0.511,P =0.001).The expressions of TLR9 and HIF 1α were positively correlated with the degree of tumor differentiation,TNM staging and lymph node metastasis,but were negatively correlated with the survival.Conclusions TLR9 and HIF-1α are over-expressed in pancreatic cancer and they are associated with malignant biological behavior and poor prognosis.

Objective To investigate risk factors for early postoperative complications after pancreaticoduodenectomy(PD).Methods Clinical data of 221 patients undergoing PD in our hospital between September 2005 and January 2009 were collected and reviewed retrospectively,the risk factors in relation to early postoperative complications were analyzed with SPSS 15.0 software.Results The incidence of early postoperative complications was 17.6％.Univariate analysis showed that age ( ≥65 years),preoperative total serum bilirubin level ( ≥ 171 μmol/L),preoperative serum albumin level ( ≤30 g/L),intraoperative blood transfusion ( ≥ 1000 ml),operation time ( ≥5 h) were the relative risk factors,Logistic regression analysis revealed that age (≥ 65 years),preoperative serum albumin level ( ≤30 g/L),intraoperative blood transfusion ( ≥ 1000 ml),operation time ( ≥5 h) were the independent risk factors for early complications.Conclusions The risk of postoperative complications after PD is still high,so the dicision to perform a PD should be strictly balanced against its risk.For older or poor risk patients,preoperative management should be enhanced.The set up of surgical team may help standardize operation procedures control intraoperative bleeding,therefore decrease the incidence of postoperative complications after PD.

Objective To investigate the expression of TLR2 and HIF-1α in pancreatic cancer and explore the relationship between TLR2 or HIF-1α protein and the clinical or pathological changes in pancreatic cancer. Methods The mRNA of TLR2 and HIF-1α in 30 cases of pancreatic cancer and its adjacent tissues were detected with real-time PCR and with immunohistochemical methods in 65 cases of pancreatic cancer and 38 cases of corresponding adjacent tissues. The relationship between TLR2 or HIF-1α and pathologic features of pancreatic cancer was analyzed. The correlation between TLR2 and HIF-1α in pancreatic cancer was also assessed. Kaplan-Meier method was used to assess the impact of TLR2 or HIF1αexpression on survival. Results The relative quantification of TLR2 mRNA and HIF-1α mRNA in pancreatic cancer tissues was 0.84±0.17 and 0.87±0.11, respectively, which was significantly higher than that in adjacent tissues 0.70±0.13 and 0.68±0.13 respectively,P＜0.05. The protein expression of TLR2 and HIF-1α in pancreatic cancer tissues was 63. 10% and 70.8%, respectively, significantly higher than that in adjacent tissues (34.20% and 36.8%, respectively). There was no significant correlation between the expression of TLR2 or HIF-1α protein and the age, gender, tumor location, the degree of differentiation in patients with pancreatic cancer (P＞0.05). However, there was significant correlation between the expression of TLR2 or HIF-1α protein and tumor size, lymph node metastasis, venous invasion and clinical staging. TLR2 and HIF-1α had a significant impact on survival. Conclusion TLR2 and HIF-1α overexpressed in pancreatic cancer and TLR2 signaling pathway may promote development of the pancreatic cancer with HIF-1α together.

Objective To explore the method how PDX1 gene modified mesenchymal stem cells (MSCs) from human umbilical cord can be differentiated into islet β-like cells in vitro. Methods Recombined adenovirus vectors inserted with PDX1 (Adxsi-CMV-PDX1) was transfected into MSCs and multiple cytokines was combined to induce differentiation. The expressions of PDX1, insulin, ngn3, glut2,NKX6.1 were examined by RT-PCR and immunofluorescence staining. The levels of insulin and C peptide secretion were examined by chemiluminescence immunoassay. Flow cytometry was used to determine the positive rate of insulin cells. Results After Adxsi-CMV-PDX1 transfection and cytokines induction, MSCs were transformed from short spindle shape to long spindle shape and aggregated into islet-like cell clusters.Dithizone staining of these cells showed bright red color. PDX1, ngn3, NKX6.1, insulin, glut 2 mRNA were expressed in cells 17d after induction. Insulin and C peptide were expressed in cytoplasm. The levels of insulin and C peptide in cell culture supernatant were (473.1 ± 51.5)mU/L and (1.61 ± 0.41)ng/ml; the levels of insulin and C peptide secretion were (964.4 ± 68.1) mU/L, (3.72 ± 1.52) ng/mL, respectively, with 25 mmol/L glucose stimulation for one hour. Insulin (+) cells rate (11.6 ± 4.8) %. Conclusions Adxsi-CMV-PDX1 combined with cytokines can induce MSCs from human umbilical cord to differentiate into islet β-like cells.They can secret insulin and C peptide, and have the sensitivity to the stimulation of glucose.

Objective To investigate the changes of Toll-like receptor 2 and 4 gene expression in acute injury liver tissue of acute hemorrhagic necrotizing pancreatitis(AHNP) rats and the efficacy of intervention with chloroquine(CQ).Methods Seventy SD male rats were randomly divided into Sham-operated group(n=10),AHNP group(n=30) and Chloroquine-treated group(n=30).Levels of serum amylase,ALT,AST,NO and TNF-? were detected.TLR2/4mRNA expression in the livers were measured by RT-PCR.Results Comparing to shamoperated group,TLR2/4mRNA was markedly increased at 3 hours in liver(tissues) in AHNP group,peaking at 6～12 hours(P

Objective To investigate the expression of Pin1 and cyclin D1 in human pancreatic carcinoma and to discuss its role in oncogenesis of pancreatic cancer.Methods The mRNA expression of Pin1 and cyclinD1 in pancreatic tumor tissues and corresponding adjacent nontumor tissues 27 patients was detected by the real-time quantitative reverse transcription-polymerase chain reaction(RQ-RT-PCR).The results of RQ-RT-PCR were analyzed by one-way ANOVA and Fisher's exact probabilities test.Results Cyclin D1 and Pin1 were overexpressed at mRNA level in pancreatic carcinoma tissues compared with their adjacent nontumor tissues.Cyclin D1 overexpression were found in 14 of 20 pancreatic carcinoma tissue specimens and Pin1 overexpression in 13 of 20 carcinoma tissue specimens.The expression of cyclin D1 and Pin1 in pancreatic cystadenoma tissues was not different than that of corresponding adjacent nontumor pancreatic tissue.Pin1 overexpression positively correlated with an increase in cyclin D1 levels as shown by Fisher's exact probabilities test.However,Pin1 and cyclin D1 expression was not correlated with clinical stage and pathological parameters.Conclusions The overexpression of Pin1 in pancreatic carcinoma tissues could promote cyclin D1 expression,which might be a critical event in oncogenesis of pancreatic carcinoma.Pin1 may play a key role in pancreatic carcinoma.

Objective To explore changes of toll like receptor(TLR) 2, 4 in peripheral blood mononuclear cells (PBMC) in acute abdomen patients with systemic inflammatory response syndrome(SIRS) and their significance. MethodsA clinical study was done on 103 patients in which 65 were with SIRS. The mRNA expression of TLR2, 4 were detected by RT PCR; the expression of TNF ? and IL 6 were observed by ELISA; the correlation between TLR2, 4 mRNA, the level of TNF ? and IL 6,and the clinical course was evaluated. ResultsTLR2 mRNA, TNF ? and IL 6 were upregulated markedly on the first day of hospitalization, then decreased gradually; TLR2mRNA maintained on high level till the 5th day. The expression of TLR2, 4 mRNA was positive correlated with the level of TNF ? and IL 6, and the length of stay. TLR2, 4 mRNA expression increased in patients with multiple organ failure. ConclusionsIn acute abdomen patients with SIRS, the expression of TLR2, 4 of PBMC increased markedly, indicating its important role in the pathogenesis of SIRS.