Establish a gemcitabine-resistant pancreatic cancer cell line SW1990/GZ and research the relationship between SW1990/GZ and pancreatic cancer stem cell / 中华外科杂志

<p><b>OBJECTIVES</b>To establish a gemcitabine-resistant pancreatic cancer cell line SW1990/GZ, and to explore the relationship between drug-resistant cell line SW1990/GZ and pancreatic cancer stem cell.</p><p><b>METHODS</b>Gemcitabine-resistant pancreatic cancer cell line SW1990/GZ was obtained by treating parental cell line SW1990 in vitro with increasing dosage of gemcitabine in culture medium intermittently for 24 weeks. Stable cultures were obtained which were 77.2-fold increased in resistance relative to parental cells. Gene expressions of ABCB1/MDR1, ABCC1/MRP and ABCG2/BCRP were determined by real-time PCR. Tumorigenic potential was performed by nude mice xenograft transplant experiments. Side population analysis and CD24CD44 positive cells explore were determined by flow cytometry to examine cancer stem cell proportion.</p><p><b>RESULTS</b>Gemcitabine-resistant cell line SW1990/GZ underwent obvious morphological and functional changes. Compared with the parental cell line, SW1990/GZ cell was small and turned into round shape. SW1990/GZ had a higher gene expression level of ABCB1/MDR1, ABCC1/MRP and ABCG2/BCRP than SW1990 (P < 0.01). Nude mice xenograft transplant experiments showed that only 1 × 10(5) SW1990/GZ cells were sufficient for tumor formation, whereas an injection of 1 × 10(5) SW1990 cells did not initiate tumors. Flow cytometry analysis showed that SP proportion in SW1990/GZ was (11.0 ± 1.0)%, whereas in parental SW1990 it was (4.6 ± 0.9)%, CD44CD24 positive cells was (8.73 ± 0.81)% in SW1990/GZ, whereas (1.1 ± 0.4)% in SW1990.</p><p><b>CONCLUSIONS</b>Gemcitabine-resistant cell line SW1990/GZ has a higher proportion of pancreatic cancer stem cells compared to its parental cell line SW1990. CD44 is mainly responsible for acquired drug resistance, which can be a potential target to overcome acquired drug resistance in pancreatic cancer.</p>

Diagnosis and surgical treatment for non-functional islet cell tumor: a retrospective analysis of 44 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the methods of diagnosis and surgical treatment for nonfunctional islet cell tumor (NICT).</p><p><b>METHODS</b>Forty-four patients with non-functional islet cell tumor treated at the First Affiliated Hospital of Nanjing Medical University during January 1968 to June 2008 were analyzed retrospectively. There were 9 males and 35 females, aged from 7- to 70-years-old. Clinical manifestation: 15 cases (34.1%) of abdominal masses, 17 patients (38.6%) with epigastric or back pain, 5 cases of jaundice, 5 cases (11.4%) for upper abdominal fullness or vomiting, 10 cases (22.7%) of pancreatic tumor noticed by routine health checkups or imaging examinations. Imaging examination: CT scan, sonography, ERCP, MRI, upper GI series were performed in 33 (75.0%), 16 (36.4%), 6 (13.6%), 2 (4.5%), and 10 cases (22.7%) respectively. Operation methods: 39 patients (88.6%) underwent surgical resection and the other 5 patients did not.</p><p><b></b>RESULTS</p><p><b>COMPLICATIONS</b>pancreatic fistula in 7 patients (15.9%), intra-abdominal bleeding in 4 (9.1%), gastrojejunal anastomosis outlet obstruction in 1 (2.3%), biliary fistula in 2 (4.5%) and incisional infection in 3 (6.8%). Surgery related mortality happened in 2 patients (4.5%), both treated before 1999. Twenty-five patients underwent operation between January 1999 and June 2008 were followed up for 6 to 108 months. All survive except one died 75 months after the surgery for unknown reason.</p><p><b>CONCLUSIONS</b>No specific clinical manifestation is recognized for non-functional islet cell tumor. Spiral CT is an optimal diagnostic method, while surgery is the first choice for treatment. Middle segmental pancreatectomy has become an alternative surgical protocol for NICT.</p>

Therapeutic strategy for severe acute pancreatitis and pancreatic encephalopathy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical treatment of pancreatic encephalopathy (PE) complicated in severe acute pancreatitis (SAP) patients.</p><p><b>METHODS</b>Clinical data of 22 PE cases in 326 SAP patients admitted from January 1987 to December 2006 were collected and analyzed retrospectively. The incidence, clinical manifestation and therapy methods of PE were discussed respectively.</p><p><b>RESULTS</b>All the cases were divided into 2 subgroups according to the changing of treatment strategy for SAP in the past 20 years. Thirteen cases of PE complicated in 114 SAP patients during the first decade (1987 - 1996) with the incidence of 11.4%, including eight early pancreatic encephalopathy (EPE) ones and five cases of delayed pancreatic encephalopathy (DPE). Only one patient survived and the mortality was 92.3%. During the second decade (1997 - 2006), nine cases of PE (all EPE) were observed in 212 SAP patients. The incidence was 4.2% and they all survived. Patients with PE usually presented with dysphoria, disturbance of orientation, lethargy, illusion and even coma. Physical examination of nerve system could find signs of meningeal irritation, increased intracranial pressure and elevated amylase in cerebrospinal fluid. Fungal infection and body fluid and metabolic disturbance frequently complicated in DPE patients. The total incidence was 6.6% (22/326) and mortality was 54.5% (12/22). Death mostly happened in the first ten years and all died with multiple organ failure.</p><p><b>CONCLUSIONS</b>Elimination of different causes would be effective to decrease the incidence and intensive cerebral resuscitation and nerve nutrition therapy in the early stage is very important to decrease the mortality.</p>

Combined multiple organ resection in 16 patients with adenocarcinoma of the body or tail of the pancreas / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the feasibility and therapeutic results of multiple organ resection in patients with tumor of the body and tail of pancreas.</p><p><b>METHODS</b>The clinical and pathological data were analysed in 16 consecutive patients with neoplasm of the body and tail of pancreas from 1999 to 2004 retrospectively.</p><p><b>RESULTS</b>Multiple organ resection was performed in 6 cases of primary pancreatic adenocarcinoma of the body and tail (3 cases of pancreatic cancer, 2 cases of malignant glucagonoma, and 1 case of well-differentiated pancreatic stromal sarcoma) and 10 cases of extrapancreatic malignancy (4 cases of gastric cancer, 2 cases of gastric leiomyosarcoma, 1 case of duodenal cancer, and 3 cases of colon cancer of hepatic flexure). Distal pancreatectomy with splenectomy was performed in all cases. In addition, 10 patients received splenic flexure colectomy, 6 patients received distal gastrectomy, 3 patients received left nephrectomy, left colectomy, total gastrectomy, liver lobe resection, left adrenalectomy, and local diaphragma resection, and 2 patients received transverse colectomy, subtotal colectomy, proximal proctectomy, proximal gastrectomy, and duodenectomy. No perioperative death and severe complications were observed. Patients with primary pancreatic cancer or pancreatic stromal sarcoma died within 1 year. Two patients with malignant glucagonoma died 51 and 39 months later. The 3-year survival rate was 70% in 10 patients with extrapancreatic malignancy, among which 2 patients with enteric cancer have survived 37 and 48 months.</p><p><b>CONCLUSION</b>Radical combined multiple organ resection may be performed actively in appropriately selected patients.</p>