Research progress of the selective sphingosine-1-phosphate receptor 1 agonists / 药学学报

Sphingosine-1-phosphate (S1P) is a lysophospholipid signaling molecule that regulates important biological functions in both intracellular and extracellular compartments. It interacts with five G protein-coupled receptors subtypes (S1PR(1-5)) to generate multiple downstream signaling. Activation of S1PR1 has been validated to be involved in the process of immune modulation. Fingolimod (FTY720), the novel S1PR1 agonist, has been approved for the treatment of multiple sclerosis in clinical trials. The study towards discovery of selective S1PR1 agonists has become hot spot for immunological diseases. This article summarized the research progress of S1PR1 agonists, emphasizing their structure types, structure-activity relationship and direction of development.

The value of CT in assessing the prognosis of sever acute pancreatitis: a report of 62 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the relationship between CT imaging classification criteria and the prognosis of severe acute pancreatitis (SAP).</p><p><b>METHODS</b>From January 2000 to December 2009, 62 cases with SAP were analyzed, retrospectively. They were all executed CT examination in 72 h after admission, and their CT imaging were classified as grade C (n = 13), grade D (n = 26), and grade E (n = 23) according to the Balthazar classification criteria and also classified as grade I (n = 11), grade II (n = 39), grade III (n = 12) according to the Balthazar CT severity index (CTSI) criteria, respectively. The values of these two different classification criteria in assessing the prognosis of SAP were studied, such as length of hospital stay, fever days, fasting days, white blood cell recovery days, serum amylase recovery days, pancreatic pseudocyst, organ failure, need for transit operations, and death. By studying the receiver operating characteristic (ROC) curves, which were drawn by the area under cures, the values of the two different classification criteria were compared in assessing the prognosis of SAP.</p><p><b>RESULTS</b>The Balthazar classification criteria was valuable in assessing white blood cell recovery days (F = 4.035, P = 0.023) and pseudocyst (χ(2) = 8.066, P = 0.018). No statistical differences were found, however, between other clinicopathological parameters and the prognosis of SAP, according to the Balthazar classification criteria. The patients with low-grade of CTSI classification criteria enjoyed better prognosis, and patients in grade I or II got lower incidence of organ failure, need for transit operations and pseudocyst than that in grade III. The results above suggested that CTSI classification criteria, comparing with Balthazar CT classification criteria, was more valuable in predicting the incidence of organ failure, pseudocyst, need for transit operation, and mortality in SAP (P < 0.01).</p><p><b>CONCLUSION</b>The CTSI classification criteria has a great value in assessing the prognosis of SAP.</p>

Indications, technique and efficacy of organ preserving pancreatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the proper surgical management of pancreatic benign and low-grade malignant potential neoplasm.</p><p><b>METHODS</b>The experience of 72 cases who accepted organ preserving pancreatectomy from January 1990 to May 2010 was analyzed retrospectively. There were 24 male and 48 female, aged from 15 to 68 years with mean age of 46 years. There were 9 cases underwent duodenum-preserving resection of the head of the pancreas, 29 cases underwent spleen-preserving distal pancreatectomy, 11 cases underwent middle segmental pancreatectomy, 23 cases underwent tumor extirpation of huge pancreatic cancer in pancreatic head and body.</p><p><b>RESULTS</b>Pancreatic fistula and biliary fistula in 1 case respectively were cured among who accepted duodenum-preserving resection of the head of the pancreas. Pancreatic fistula was found in 3 cases who accepted spleen-preserving distal pancreatectomy. Pancreaticobiliary anastomotic bleeding in 1 case was cured among who accepted middle segmental pancreatectomy. Pancreatic fistula was found in 5 cases among who accepted tumor extirpation of huge pancreatic cancer in pancreatic head and body, and liver metastasis was found in 3 cases at 6, 12, 16 months after surgery respectively.</p><p><b>CONCLUSIONS</b>Organ preserving pancreatectomy can obviously reduce operative injury to patients, its therapeutic effect is similar to that of classical operation, it is the first option of benign and low-grade malignant potential neoplasm.</p>

Analysis of pancreatic leaking-related risk factors after pancreaticoduodenectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analysis the risk factors of pancreatic fistula after pancreaticoduodenectomy (PD).</p><p><b>METHODS</b>A retrospective clinical study had been done in 97 patients who underwent PD between June 2001 and June 2006. The two groups were first compared by the univariate analysis;logistic regression was then used to determine the effect of multiple factors on pancreatic fistula. A P-value of less than 0.05 was considered to be statistically significant.</p><p><b>RESULTS</b>Of the 97 patients, 13 patients were identified as having pancreatic fistula. Factors significantly increasing the risk of pancreatic fistula by univariate analysis included preoperative serum total bilirubin (P = 0.038), operative time (P = 0.003) and whether or not Braun anastomosis (P = 0.034), and prophylactic use of somatostatin (P = 0.003) after operation. A multivariate logistic regression analysis revealed the factors most highly associated with pancreatic fistula to be preoperative serum total bilirubin (OR = 11.687, P = 0.021) and postoperative prophylactic use of somatostatin (OR = 0.056, P = 0.020).</p><p><b>CONCLUSIONS</b>Preoperative serum total bilirubin more than 170 mmol/L was a risk factor of pancreatic fistula after PD, and postoperative prophylactic use of somatostatin was a protect factor of pancreatic fistula after PD.</p>

Surgical treatment of asymptomatic primary hyperparathyroidism / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis and management of asymptomatic primary hyperparathyroidism (PHPT).</p><p><b>METHODS</b>Clinical data of 46 cases of primary hyperparathyroidism from January 1990 to December 2006 were retrospectively analyzed. There were 5 cases of asymptomatic PHPT. Three out of the 5 cases obtained the diagnosis by routine health examination and 1 case was misdiagnosed as thyroid tumor before surgery, but was conformed as parathyroid adenoma by intraoperative biopsy. Remaining 1 case was diagnosed because of weakness. The serum calcium and the parathyroid hormone (PTH) levels were elevated in 4 cases, while only 1 being normal range. Unilateral neck exploration was performed in all 5 cases.</p><p><b>RESULTS</b>There were no operational death, recurrent nerve injury or other complications. All patients had the same pathological diagnosis as parathyroid adenomas. Three cases showed gentle circumoral paresthesia after surgery with normal serum level of calcium, but the symptoms were relieved with oral use of calcium gluconate. Only 1 patient had tetany with the lowest level of serum calcemia at 1.96 mmol/L in 24 h postoperatively. The signs and symptoms were all relieved by intravenous use of calcium gluconate for 3 d after surgery. Remaining 1 case has normal level of serum calcemia after surgery. Time range of following-up for 4 cases was from 2 months to 2 years. The level of serum calcemia was normal for them. One lost following-up.</p><p><b>CONCLUSIONS</b>Asymptomatic primary hyperparathyroidism could be diagnosed according to co-elevated serum calcemia and PTH without typical symptoms. Unilateral neck exploration was the best choice for the patients with accurate imaging localization. Conservative management including adequate hydration, dietary calcium intake and pharmacological approaches could be used for the patients who were unfit for surgery.</p>

Diagnosis and surgical treatment of 98 cases with adult primary retroperitoneal malignant tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and surgical treatment of adult primary retroperitoneal malignant tumor (APRMT).</p><p><b>METHODS</b>The clinical data of 98 cases with APRMT underwent resection from January 1990 to April 2003 were analyzed retrospectively.</p><p><b>RESULTS</b>Among the 98 cases, complete excision were performed in 79 cases (80.6%), palliative excision in 16 cases (16.3%), tumor biopsy only in 3 cases (3.1%). Resection of involved adjacent organs were carried out in 25 cases (25.5%) and the re-operation rate for recurrence was 28.6% (28 cases). The 1, 3, 5 year survival rates for 79 cases with complete resection were 93.7%, 73.4% and 34.2%, respectively. The 1, 3, 5 year survival rate for 16 cases with palliative resection were 75.0%, 6.3% and 6.3%, respectively.</p><p><b>CONCLUSIONS</b>Certain imaging examinations are crucial to the diagnosis and preoperative evaluation of APRMT. Resection of the involved organs could improve resection rate and prognosis. For the recurrent cases, earlier reoperation is strongly recommended.</p>

Expressions of p53 and Gadd45a proteins in human pancreatic cancer and their clinicopathological significance / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the expressions of p53 and Gadd45a proteins and their clinicopathological significance in human pancreatic cancer.</p><p><b>METHODS</b>The expression of p53 and Gadd45a proteins was detected with immunohistochemistry in a series of 59 pancreatic cancers. Their relationships with the clinicopathological parameters including gender, tumor site, TNM stage, histological differentiation, and the prognosis of pancreatic cancer patients were analyzed.</p><p><b>RESULTS</b>The positive expression rate of p53 protein was 67.8% (40/59) and that of Gadd45a protein was 42.4% (25/59). The positive expression rate of p53 protein is significantly higher in patients < 65 years than in patients > or = 65 years (chi squared = 4.711, P = 0.030). Gadd45a expression was not correlated to the age of the patients. No significant difference was found between the expression of p53 proteins and histological differentiation and TNM stage of the tumors. Gadd45a expression was correlated with histological differentiation of pancreatic cancer (chi squared = 10.052, P = 0.007), but not with TNM stage of the tumors. No significant differences in the prognosis were found between the groups with and without p53 expression (chi squared = 0.09, P = 0.764) and the groups with and without Gadd45a expression (chi squared = 0.14, P = 0.704).</p><p><b>CONCLUSIONS</b>Both p53 and Gadd45a are highly expressed in human pancreatic cancer and may be associated with biological features of pancreatic cancer. Their expression alone or co-expression may be not helpful to evaluate the prognosis of patients with pancreatic cancer.</p>