Current consensus and controversy in neoadjuvant therapy for pancreatic cancer / 中华外科杂志

Pancreatic cancer is malignant and has a poor prognosis.At present, the treatment mode has changed from "Surgery First" to systemic therapy under multi-disciplinary team, but surgical resection is still the only way to cure pancreatic cancer. In systemic treatment of pancreatic cancer, the effect of postoperative adjuvant therapy is significant, and preoperative neoadjuvant therapy has gradually attracted widespread attention. Neoadjuvant therapy can improve the rate of R0 resection in patients with pancreatic cancer.There is a consensus on neoadjuvant therapy for patients who with borderline resectable and locally advanced, but for the patients who with resectable remains controversial.

Clinical efficacy and prognostic factors analysis of hilar cholangiocarcinoma in 322 patients / 中华消化外科杂志

Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1％,20.2％ and 9.5％,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0％,46.2％,25.0％ in 94 patients receiving radical resection and 7 months,29.9％,8.1％ and 2.3％ in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P＜ 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1％,45.1％,25.7％ in 73 patients undergoing hilar bile duct resection and 35 months,90.5％,49.8％,22.1％ in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P＞0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1％,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6％,49.5％,27.5％ in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P＜0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95％ confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P＜0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.

Simultaneous inhibition of XIAP and survivin expression on EMT and invasion of human pancreatic cancer cells / 中南大学学报(医学版)

OBJECTIVE@#To investigate the simultaneous inhibition of X-linked inhibitor of apoptosis protein (XIAP) and survivin expression on epithelial-mesenchymal transition (EMT) and invasiion of pancreatic cancer cells Panc-1, and its mechanism.@*METHODS@#On the established human pancreatic cancer cells Panc-1-XS, the expression of XIAP and survivin was inhibited simultaneously. Cell invasion and migration were detected by Transwell chamber experiments and scratch test, and the expression of epithelial marker E-cadherin, mesenchymal markers Slug, phosphatase and tensin homolog deleted on chromosome ten (PTEN) and P-Akt protein was determined by Western blot.@*RESULTS@#Cell invasion and migration of Panc-1-XS cells decreased significantly, accompanied by significantly upregulated protein expression of E-cadherin, and significantly declined protein expression of the Slug, indicating increased mesenchymal-epithelial conversion (MET); and increased protein expression of PTEN, and declined protein expression of P-Akt.@*CONCLUSION@#Simultaneously inhibiting the expression of XIAP and survivin can partially reverse EMT phenotype of pancreatic cancer Panc-1 cells, which then significantly reduces the cell invasion and migration of Panc-1 cell lines. This process may be regulated by PTEN/PI3K/Akt signaling pathway.

Proteomic identification of chemosensitivity-associated proteins in human colorectal carcinomas / 肿瘤

Objective:The study aims to screen chemosensitivity-associated proteins in colorectal carcinoma tissues by using two-dimensional gel electrophoresis (2-DE) and mass spectrometry,then identify some differentially-expressed proteins. Methods:The patients with advanced colorectal carcinoma were confirmed by clinical diagnosis. Fresh carcinoma specimens were collected by biopsy and preserved in liquid N2. The tissues were classified into two groups: high sensitivity group (HS) and low sensitivity group (LS) based on drug sensitivity test. The total proteins were extracted and separated by 2-DE. The images were composed, compared, and differentially analyzed to identify the proteins with differential expression in HS and LS groups. Then the differentially-expressed protein spots were incised from the gels and digested by trypsin. The peptide mass fingerprintings (PMF) was acquired after matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and the proteins were identified by data searching in the Mascot database. Two proteins with differential expression were detected by Western blotting.Results:The 2-DE spectrum of HS and LS groups were established. Most protein spots were distributed in the area with pH 4-8 and relative molecular weight of (20-100)×10~3. The average number of the protein spots was 842±23 in HS group and 793±19 in LS group,respectively. The mean matching rate was 90.7%. The number of differentially-expressed dots between HS and LS group was 79.00±13.56. Thirty protein dots were selected for mass spectrum and bioinformatic analysis, and 9 proteins were identified. Conclusion:Colorectal carcinoma with different chemosensitivity had differential protein expression profiles. The differentially expressed proteins may be associated with chemosensitivity and could be used for prediction of chemosensitivity of colorectal carcinoma.

Retrospective analysis of preoperative localization of insulinomas on CT / 中南大学学报(医学版)

OBJECTIVE@#To compare the value of CT using different equipment and scanning methods in preoperative localization of insulinoma and to investigate the possible causes that might influence the detection ratio on CT.@*METHODS@#A total of 47 patients with insulinomas confirmed by operation and pathologic examination from 1990 were collected, and the related clinical information and imaging data of CT were retrospectively analyzed.@*RESULTS@#The diagnostic accuracy for conventional CT with conventional enhancement scanning, spiral CT with pancreatic phase scanning, and multislice spiral CT with dual phasic enhancement scanning were 35.3%, 57.1%, and 81.3%, respectively, and the overall diagnostic accuracy of CT was 57.4%. The diagnostic accuracy of multislice spiral CT was greater than that of conventional CT (P or =1.5 cm was significantly higher than that of <1.5 cm (76.2%vs. 42.3%). Typical appearance of the lesions on CT was isoattenuation on plain scanning, and enhanced considerably after contrast enhancement.@*CONCLUSION@#The size of lesion is the major factor that influences the detection of insulinoma on CT. Multislice spiral CT with dual phasic enhancement scanning has a relatively high detection rate and is recommended for preoperative localization of insulinoma.

Expression and significance of VEGF-D and MMP-2 in pancreatic carcinoma / 中国医师杂志

Objective To investigate the expression of VEGF-D and MMP-2 and explore their relationship with tumor invasion and local metastasis in pancreatic carcinoma.Methods The expression of VEGF-D and MMP-2 in 30 patients with pancreatic carcinomas and 6 cases with normal pancreatic tissues were detected by SABC immunohistochemical method.Results The positive rates of VEGF-D and MMP-2 proteins were 60%(18/30)and 66.7%(20/30)respectively,no expression of VEGF-D and MMP-2 was detected in normal pancreatie tissues.The expression of VEGF-D was significantly correlated with lymph node metastasis(P＜0.05),and the expression of MMP-2 was significantly correlated with lymph node metastasis and tumor local invasion(P＜0.05).The expression of VEGF-D protein Was positively correlated with MMP-2 protein(rs=0.54,P＜0.01).Conclusions There is a significantly positive correlation between high expression of VEGF-D and MMP-2 proteins in pancreatic carcinoma,and they may contribute to the invasive properties of pancreatic cancer.

Degos' disease:A case report and review of literature / 北京大学学报(医学版)

A 18-year-old male patient's case was diagnosed as Degos'disease with pathognomonic skin lesions,accompanied by small bowel perforation,and reported here. Skin histopothological test show that the typical wedge-shaped necrobiosis and lymphocyte inflammatory infiltration. Vessels showed narrowing and thrombosis,with lymphocyte infiltration. Degos'disease is a systemic necrotizing vasculitis. Skin biopsy can confirm its diagnosis. Severe systemic complication should be prevented. Degos'disease should be considered in the differential diagnosis of skin lesions associated with systemic involvement.

A clinical analysis of unsuspected gallbladder carcinoma:a report of 37 cases / 中国普通外科杂志

0.05).However,the percentage of patients with cholecystolithiassis was 86.5% in IGC group,and 50.6% in GC group(P=0.000).Besides the percentage of IA stage in IGC group(29.7%) was relatively higher than that(9.0%)in GC group(P=0.03);the surgical resection rate of tumor in IGC group was 56.8% and 32.6% in GC group(P=0.01).Nevertheless,the percentage of advance stage in IGC group(43.2%) was relatively lower than that in GC group(74.2%)(P=0.001).The overall 1,3,and 5-year survival rate of IGC group was 70.0%,31.2% and 26.8% repectively,and the mean survival time was17 months(51?13);which were significantly higher than those in GC group,in which the 1,3,5-year survival rate was 27.0%,17.7% and 15.1% repectively and the mean survival time was(25?8),5 months(all P=0.006).Single factor analysis showed that the survival time in IGC patients was influenced by the TNM stage(P=0.000),pT-category(P=0.000),operation-category(P=0.008);however,postoperative pathological grade(P=0.080),age(P=0.188) and sex(P=0.234) had no influence on survival rate.According to multivariate analysis,pT-category(P=0.000)was an independent factor for the survival time of IGC.Conclusions Comparing with GC group,IGC has a higher percentage of cholecystolithiassis,IA tumor stage and surgical resection rate,and thus,it has relatively better progonosis.pT-category is the vital independent prognostic factor in IGC.If a patient in ICG has been misdiagnosed during the primary operation,the patient should be re-operated for radical excision as soon as possible,except when the tumor is in stage Tis or T1a.

Role of expression of X-linked inhibitor of apoptosis protein in polymorphonuclear neutrophils during acute pancreatitis / 中国普通外科杂志

Objective To explore the role of apoptosis and the expression of X-linked inhibitor of apoptosis protein(XIAP) in polymorphonuclear neutrophils(PMNs) during acute pancreatitis(AP).Methods Blood from normal control(NC,n=15),mild acute pancreatitis(MAP,n=15) and severe acute pancreatitis(SAP,n=15) were collected.PMNs apoptosis was detected by flow cytometry.PMNs were isolated from each group and XIAPmRNA and protein levels were assessed by RT-PCR and Western Blotting.Results PMNs apoptosis in SAP group was(2.15?0.40)%,MAP group was(4.16?0.14)%,NC group was(4.31?0.12)%.PMNs apoptosis rate in SAP and MAP groups was decreased compared to NC group(P

Screening of differential expression protein from human colorectal carcinoma and normal colorectal tissues by two-dimensional difference gel electrophoresis and mass spectrometry / 中国普通外科杂志

Objective To find early diagnostic biomarkers for colorectal carcinoma by comparing differential(expressing) proteins from colorectal carcinoma and normal colorectal tissues.Methods Colorectal carcinoma tissues and paired normal tumor-adjacent colorectal tissues were collected,and tissue total protein was (extracted);differential proteome profiles were established and analysed by means of immobilized pH(gradient-based) two-dimesional polyacrylamide gel electrophoresis(2D-PAGE) and matrix-assisted laser(desorption)/ionization time of flight mass spectrometry(MALDI-TOF-MS).Results Well-resolved,(reproducible) 2-DE profiles of human colorectal carcinoma tissues and paired normal tumor adjacent colorectal tissues were obtained.For tumor tissue,a total of 1098?28 spots were detected,and for normal tissue,760?45 spots were detected.For normal tissue,The average deviation of spot position was(0.542?(0.12))mm in IEF direction and(0.933?0.098)mm in SDS-PGE direction for tumor tissue.The average deviation of spot position was(0.745?0.130)mm in IEF direction and(1.233?0.272)mm in(SDS-PGE) direction.30 differential expressing proteins were analysed by mass spectrometry and bioinformation,16 of them were well characterized including Apolipoprotein A1(apoA1),calreticulin precursor,glutathione(S-transferase),hepatic fatty acid-binding protein、heat shock protein 27 ect.Conclusions Differential expression proteins can be candidate biomarkers for early diagnosis of colorectal carcinoma;and proteomic technique is valuable for screening the diagnostic biomarkers.

Expression of X-linked inhibitor of apoptosis in pancreatic carcinoma tissues and its relationship to chemoresistance / 中华消化杂志

Objective To explore the expression of X-linked inhibitor of apoptosis (XIAP) in pancreatic carcinoma tissues and SW1990 cell line, and to investigate its relationship to the chemoresistance. Methods The expression of XIAP in 23 pancreatic carcinoma tissues was detected by immunohistochemistry and the relationship of XIAP expression with the clinical stage and pathological grade was analyzed. 5-FU was used to induce the chemoresistant capability of SW1990 pancreatic cell line. The XIAP expression in SW1990 was examined by RT-PCR and Western blot. The XIAP level in the cells and its chemoresistance to 5-FU were analyzed by linear regression. Results The XIAP expression was detected in 89. 6% (20/23) of pancreatic carcinoma tissues and 33. 3% (4/12) of normal pancreatic tissues,respectively. The positive rate and expression level of XIAP were higher in pancreatic carcinoma than normal pancreatic tissues. In addition, 5-FU could induce the chemoresistance (P

Effect of nitric oxide on liver ischemic precondition in rats / 中国普通外科杂志

Objective To study the role of nitiric oxide (NO) in the liver ischemic precondition (IP) in rats. Methods 131 rats were randomly assigned to ischemia/reperfusion (I/R)group, IP group and sham-operation(S) group. The plasma NO, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the pathological change of liver and rat mortality were observed at 2 hours, 24 hours and 1 week after operation. Results (1) The plasma NO level grew soon after operation in group IP, and was significantly higher than that in group S in all three time points (P0.05), and higher at 1 week (P

Suppression of pancreatic cancer cell eypression of XIAP by RNAi and its effect on sensitivily to chemotherapeutics / 中国普通外科杂志

Objective To investigate the possibility of XIAP inhibition by RNA interference(RNAi) vectors,and the chemotherapeutic sensitivity change of pancreatic carcinoma cells of SW1990 after XIAP inhibition.Methods RNA interference vectors against XIAP was constructed and transfected into the pancreatic carcinoma cell line SW1990,the expression of XIAP was determined by RT-PCR and Western blot,while flow cytometry and Hoechst 33258 stain were employed to examine the apoptosis index of SW1990 induced by gemcitabine.The relationship between XIAP and apoptosis index was analyzed by linear regression.Results Four RNAi vectors against XIAP were constructed,two of the four RNAi vectors could instantaneous inhibit XIAP expression more than 50%,The sensitivity of SW1990 to gemcitabine increased after XIAP was inhibited(P

Experimental study of kansui root and LMWH combined therapy for severe acute pancreatitis / 中国普通外科杂志

Objective To investigate if there is a synergism of kansui root and low molecular weight heparin(LMWH) in combined treatment of SAP in rats.Methods SD rats were randomly divided into 5 groups:Sham group(A group),severe acute pancreatitis group(B group),kansui root treatment group(C group),LMWH treatment group(D group),combined treatment group(E group).The serum TNF-?,IL-6 level and the ratio of TXB2/6-keto-PGF1? in pancreatic tissue,and the histological examination were evaluated.Results The values of TNF-??IL-6 and the ratio of TXB2/6-keto-PGF1? in C,D,E group were significantly lower than those in B group at the time point of 6,12,24h.But there were no significant differences in C,D,E group at all the time points.The histological examination showed that the pancreas was normal in group A;the pathological changes were milder in C,D,E group than that in B group.Conclusions Combined treatment of kansui root and LMWH was effective in SAP,but there was no synergism,and also no side effects.

Surgical treatment of acute biliary pancreatitis / 中国普通外科杂志

Objective To investigate the timing of operation and the selection of surgical procedure for acute biliary pancreatitis.Methods The clinical data of 247 cases of acute biliary pancreatitis were retrospectively analysed.Results Among 10 non-operation patients,4 died;12 patients underwent emergency operation,5 had postoperative complications and 2 patients died after operation.169 patients underwent delayed operation after effective conservative therapy and 1 patient had postoperative complication;56 patients underwent(selective) operation without any postoperative complication or death.Conclusions Early emergency operation should be performed for relief of biliary obstruction in acute biliary obstructive pancreatitis.The patients with acute non-obstructive biliary pancreatitis should undergo conservative therapy at first and then,after(pancreatitis) has been controlled,delayed operation or selective operation to treat the biliary pathologic condition should be performed.

Therapeutic effect of kansui root on patients with severe acute pancreatitis / 中国普通外科杂志

Objective To investigate the therapeutic effect of kansui root on patients with severe acute pancreatitis(SAP). Methods Clinical data of 54 cases of severe acute pancreatitis treated with kansui root(kansui root group) were analyzed and compared with 54 cases of severe acute pancreatitis treated without kansui root (control group).Results The releivng time of abdominal pain was significantly shorter than that in control group( P

Cyclooxygenase-2 expression of pancreatic tissues in severe acute pancreatitis in rats / 中国普通外科杂志

Objective To study the expression of cyclooxygenase-2(COX-2) in pancreatic tissues of severe acute pancreatitis(SAP) in rats,and explore the possible role of COX-2 in the pathogenesis of the SAP. Methods Forty adult male Sprague-Dawley rats were randomly divided into SAP group(n=20) and control group(n=20). At 12h after operation,acites,serum levels of amylase activity,tumor necrosis factor-?(TNF-?),TXB 2 and 6-keto-PGF 1? and the expression of COX-2 in pancreatic tissue were detected.the pathological changes of pancreatic tissues were observed and scored under microscope;the survival rate in 72h and mortality in 24h in SAP and NC group were recorded.Results At 12h after the induction of SAP,the serum amylase activity,TNF-?,TXB 2 and 6-keto-PGF 1? were significantly higher in SAP group than those in NC group(P

Lentiviral vector-mediad RNA interference targeted against survivin inhibits survivin expression and induces cell apoptosis of human pancreatic cancer in vitro / 中国普通外科杂志

Objective To investigate the possibility of survivin inhibition by lentiviral vector-mediated RNA interference and the influence on cell apoptosis in pancreatic cancer cell line.Methods The lentiviral vector of SiRNA targeted against survivin(LV-shRNA-survivin-1,LV-shRNA-survivin-2,LV-shRNA-survivin-3) was constructed and transfected into the packaging cells 293T,and then the supernatant with virus was collected to transfect SW1990 cells.Quantitative real-time fluorescent PCR and Western-blot were used to detect the expression of survivin.DAPI staining and detection of enzymatic activity of caspase 3/7 were employed to examine cell apoptosis.Results Three lentiviral vector-survivin-shRNA were constructed successfully.In the LV-shRNA-survivin-1 group,the survivin mRNA and protein expression inhibitory rate was 73.50% and 87.64% respectively;when compared to control group,the activity of caspase-3/7 increased significantly,which showed a 14.5-fold increase,and apoptosis increased 11.95%.Conclusions Lentiviral vector-mediad RNA interference targeted against survivin can effectively inhibit survivin expression and increase cell apoptosis significantly.