Factors influencing the diagnostic positivity of endoscopic ultrasound guided fine needle aspiration for small pancreatic cancer and the occurrence of postoperative advent events / 中华胰腺病杂志

Objective To evaluate the factors influencing the diagnostic positivity of endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) for small size pancreatic carcinoma (SSPC) and the occurrence of the adverse events after the aspiration.Methods 51 patients with SSPC ≤2 cm in diameter treated in Changhai hospital from February 2008 to January 2015 were retrospectively studied.The gender,age,tumor diameter,location,the dilation of pancreatic ducts,the number of aspirations and the needle passages,the usage of negative pressure during aspiration,the pathological examination of the specimens and postoperative adverse events and the like were collected.Univariate analysis and logistic regression analyze were applied to determine the factors influencing the diagnostic positivity of EUS-FNA for SSPC and postoperative adverse events.Results Among the 51 patients,positive cytology outcome were identified in 30 patients,which were negative in 21 patients.Univariate analysis identified that there were no statistical differences on the age,sex,dilated pancreatic duct,the number of aspirations and needle passages between two groups (P value ＞0.05).The diagnostic positivity using the 10ml minor negative pressure was obviously higher than that using 20 ml negative pressure,and the differences were statistically significant (P =0.028).Multivariate logistic regression identified 10ml minor negative pressure was easier to obtain positive cytology outcome (Odds Ratio 0.2810,95％ CI 0.093-0.851).In addition,the number of passages in patients with postoperative adverse events was greater than those without postoperative adverse events (30 vs 20),and the difference was statistically significant (P =0.034).Conclusions The introduction of 10 ml negative pressure could improve the diagnostic positivity of EUS-FNA for SSPC,and the increased number of needle passages may increase the occurrence rate of postoperative adverse events.

Comparison on the efficacy of EUS-guided celiac plexus radiation and celiac plexus neurolysis in treating abdominal pain of advanced pancreatic cancer / 中华胰腺病杂志

Objective To evaluate the efficacy of endoscopic ultrasonography-guided celiac plexus radiation with iodine-125 (125I) seeds and celiac plexus neurolysis with absolute ethanol for pain relief secondary to advanced pancreatic cancer.Methods A retrospective analysis of 43 patients of advanced pancreatic cancer with moderate to severe abdominal pain in the Department of Gastroenterology,Shanghai Changhai Hospital from January 2017 to April 2018 was performed.20 patients underwent EUS-guided celiac plexus neurolysis (CPN),and 23 patients underwent EUS-guided celiac plexus radiation (CPR) with the implantation of 125I seeds around the celiac ganglia.The postoperative VAS score of abdominal pain,mean analgesic (MS Contin [morphine sulfate]) consumption and complications were compared between the two groups.Results There were no statistically significant differences between the two groups in the sex ratio (male/female,10/10 vs 14/9),average age [(64 ± 11) vs (64 ± 12)],lesion location (head/tail,7/13 vs 8/15] and TNM stage (Ⅲ/Ⅳ,9/11 vs 7/16),and the two groups were comparable.Compared with preoperative ones,the VAS score (3.0 points vs 5.5 points) and morphine dosage (30 mg vs 52.5 mg) were significantly lower in the CPN group one week after operation.In the CPR group,the VAS score (5.0 points vs 6.0 points) and morphine dosage (50 mg vs 55 mg) at 2 weeks after the operation were lower than those before the operation;the VAS scores of 4,8 and 12 weeks after the operation decreased to 3.0 points,and the dosage of morphine decreased to 30 mg,25 mg and 30 mg,respectively.The differences were statistically significant (P＜0.0001).Compared with the CPR group,at 2 weeks postoperatively the CPN group demonstrated a significantly higher decrease of VAS score (3.0 points vs 2.0 points),degree of morphine reduction (30 mg vs 10 mg) and rate of partial pain relief (70.0％ vs 4.3％).However,from 4 to 12 weeks postoperatively,the decrease in VAS score,the decrease in the dosage of MS Contin and the rate of partial pain relief in the CPR group were all significantly higher than those in the CPN group (P ＜ 0.05).There was no complete relief of pain in the two groups.No procedure-related deaths or serious complications were observed and only mild gastrointestinal adverse reactions occurred.Conclusions Two methods can both relieve abdominal pain in patients with advanced pancreatic cancer safely and effectively.CPR takes effect late but has advantages of good extent and long duration of pain relief.

Construction and identification of RNAi eukaryotic expression vectors targeting human transcription factor glioma-associated oncogene homolog 1 / 中华胰腺病杂志

Objective To construct RNAi eukaryotic expressing vectors of human transcription factor glioma-associated oncogene homolog 1 (GLI1) with pGCsi-U6-GFP plasmid and to identify its activity in interfering GLI1.Methods Three GLI1siRNA targeting GLI1 were designed and synthesized according to the GLI1cDNA sequence in GeneBank,and then were cloned into pGCsi-U6-GFP to construct the recombinant plasmids,and transformed into E.coli DH5a,then it was amplified and plasmids were extracted,which were further confirmed by PCR reaction and DNA sequencing,pGCsi-U6-siRNA-C was negative as control wector.Then recombinant plasmids pGCs-U6-GLI1siRNA-1,pGCs-U6-GLI1 siRNA-2,pGCs-U6-GLI1siRNA-3 pGCsi-U6-siRNA-C and a eukaryotic over-expression vector pEGFP-N1-GLI1 were co-transfected into HEK293 cells by Lipofectamine 2000 respectively.The ceils were collected at 48 h after transfection.Semi-quantitative RTPCR and Western Blot were performed to detect the expression of GLI1 mRNA and protein to screen the optimal vector which had the best interfering effect.Results A 369 bp fragment was amplified from all three recombinant plasmids,(pGCs-U6-GLI1 siRNA-1,pGCs-U6-GLI1 siRNA-2,pGCs-U6-GLIlsiRNA-3),showing that synthesized shRNA oligonucleotide fragments were correctly inserted into three recombinant plasmids,which were further confirmed by sequencing.Expression levels of GLIlmRNA and protein in cells in pGCs-U6-GLI1 siRNA-1,pGCs-U6-GLI1 siRNA-2,pGCs-U6-GLI1 siRNA-3 were 0.290 ± 0.011,0.421 ± 0.018,0.373 ±0.018,and 0.318 ± 0.026,0.443 ± 0.021,0.381 ± 0.018,which were significantly lower than those in negative control group (0.834 ± 0.022,0.818 ± 0.024,P =0.000),the inhibitory rates were 65.8 ％,50.7％,55.7％,and 63.9％,48.3％,53.9％.The interfering efficacy of pGCs-U6-GLIlsiRNA-1 was the strongest among the three recombinant plasmids.Conclusions RNAi eukaryotic vectors pGCs-U6-GLIlsiRNA-1,pGCs-U6-GLI1 siRNA-2,pGCs-U6-GLI1 siRNA-3 are successfully constructed and the optimal vector is identified,and this can provide a solid experimental foundation for further functional study of GLI1 gene.

Monitoring 5-fluorouracil temperature-sensitive hydrogel interstitial chemotherapy for pancreatic cancer with endoscopic ultrasonography / 中华消化内镜杂志

Objective To evaluate the therapeutic effect of PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel interstitial chemotherapy for pancreatic cancer by using endoscopic ultrasonography.Methods PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel in vitro release experiments were performed in the following procedures:determination of lixivium drug concentration and calculation of its emission.Fifty nude mice with the pancreatic cancer cell line SW1990 were randomly divided into 5 groups,10 in each group.Group A was intratumorally injected with PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel at 4mg/kg ; group B with PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel at lmg/kg; Group C was intratumorally injected with 5-fluorouracil at 4 mg/kg ; Group D with PLGAPEG-PLGA matrix at 4mg/kg ;and group E was the control group.Tumor growth and audio-visual images of the nude mice tumor nodules were observed before administration,and 3,7,10,14 days after.Tumor growth curve was also drawn.Animals were sacrificed at 14 days Tumors were weighed to calculate the inhibitory rate and stained for pathological study.Results 1,3,5,8,10,and 14-day release of 5-fluorouracil temperature-sensitive hydrogel were 21.6％,33.8 ％,44.3％,63.6％,76.3％ and 91.8％.Tumor sizes of group A and group B were significantly different from those of other groups (P ＜ 0.05).Ultrasound endoscopic image characteristics were correlated with pathological findings.Conclusion PLGA-PEG-PLGA-5-fluorouracil temperature-sensitive hydrogel is able to release for 14 days in vitro,which constantly inhibits human pancreatic cancer cell line SW1990.Intratumoral injection of the agent can significantly inhibit the growth of pancreatic cancer of nude mice.Additionally,gelatinous preparations fixes better than liquid and is of clinical value.Therefore,monitoring temperature-sensitive 5-fluorouracil hydrogel interstitial chemotherapy for pancreatic cancer with endoscopic ultrasound is convenient and safe.

Clinical experience of 1064 cases of severe acute pancreatitis: medical treatment predominant therapy / 中华胰腺病杂志

Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.

Etiology of pancreatic pseudocyst / 中华胰腺病杂志

Objective To analyze the etiology in pancreatic pseudocyst (PPC). Methods Medical records were reviewed and analyzed for 366 PPC patients who were admitted in Changhai hospitals from April 2000 to December 2009 in terms. Demographic data, etiology and primary disorders of PPC patients were recorded. Results The causes of 366 patients varied as follow: gallstones in 158 patients (43.2%);idiopathic in 79 (21.6%); alcohol in 50 (13.7%); trauma in 17 (4.6%); pancreatic tumor in 9 (2.5%);hyperlipidemia in 8 (2.2%); post-operative in 7 (1.9%), other in 38 (10.3%). Depending on Atlantes classification systerm the PPCs were classified into acute PPC in 204 patients (64.2%), chronic PPC in 98 patients (30.8%) and abscess in 16 patients (5.0%). The 4 most common causes of acute PPC were gallstones, idiopathic, alcohol and trauma; the 3 most common causes of chronic PPC were gallstones,idiopathic, alcohol. Conclusions Gallstones is the main etiologic cause of the PPCs in China, followed by idiopathic and alcohol, which is significantly different with that in Western countries.

Expression of GLI1 and PTCH1 mRNA and yts correlation with clinical parameters in pancreatic cancer / 中华胰腺病杂志

Objective To investigate the expression of GLI1 and PTCH1 mRNA in pancreatic cancer and study its clinical significance. Methods Real-time fluorescence quantitative PCR (RFQ-PCR) was used to detect the expression of GLI1 and PTCH1 mRNA in 35 samples of pancreatic cancer tissues and 27 samples of adjacent normal pancreatic tissues, and the correlation of GLI1 and PTCH1 mRNA expression with clinical parameters was investigated. Results The relative expression of GLI1 mRNA in pancreatic cancer tissues was 1.12 ～ 3. 65 ( median 1.19), the relative expression of TCH1 mRNA was 1.82 ～ 4.36 ( median 2.36 ). The relative expression of GLI1 mRNA in adjacent normal pancreatic tissues was 0.23 ～ 2.76 ( median 0.87 ), the relative expression of PTCH1 mRNA was 1.11 ～ 2. 17 (median 0.58). Both the expression of GLI1 and PTCH1 mRNA in pancreatic cancer tissues were significantly higher than those in normal pancreatic tissues (P<0.05), and a positive correlation was found between GLIl and PTCH1 mRNA expression levels (P <0.05 ). The expression of GLI1 mRNA was significantly correlated with the differentiation degree and lymph node metastasis of pancreatic cancer (P < 0. 05). Conclusions GLI1 and PTCH1 may be involved in pancreatic carcinogenesis, and GLI1 may be related to invasion and lymph node metastasis of pancreatic cancer.

Strengthening the training of doctor-patient commmunication capability of the general practitioner / 中华医学教育探索杂志

Doctor-patient communication skills are one of the seven lowest requirements of global medical education.From the characteristic of doctor-patient communication in general medical practice,the paper explores the importance of strengthening the training of doctor-patient communication capability and analyzes the training methods.