复方番石榴制剂对2型糖尿病胰岛素抵抗大鼠脂肪代谢及胰腺组织病理形态的影响

目的:探讨复方番石榴制剂对2型糖尿病胰岛素抵抗大鼠脂肪代谢及胰腺组织病理形态的影响。方法:给高热量饲料喂养8周后的大鼠腹腔注射小剂量链脲佐菌素溶液,复制2型糖尿病动物模型,随机分为模型组、二甲双胍组、复方番石榴制剂高剂量组和低剂量组。另设正常组,饲以普通饲料。灌胃给药6周后处死大鼠,末次给药后禁食12 h,检测血脂及脂蛋白指标,并摘取胰腺组织观察组织病理形态。结果:与模型组比较,各治疗组可不同程度地降低胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和游离脂肪酸(FFA),显著升高高密度脂蛋白胆固醇(HDL-C)(P<0.05),其中,复方番石榴制剂高剂量组和二甲双胍组有明显的降脂作用。光镜下观察胰腺组织病理形态,可见模型组损伤最明显,复方番石榴制剂组及二甲双胍组均呈现不同程度的损伤。结论:复方番石榴制剂有明显的改善脂代谢紊乱及减轻胰腺病理损伤的作用。

红芪多糖HPS-3对2型糖尿病大鼠糖脂代谢和胰腺组织病理改变的影响

目的:探讨红芪多糖-3(HPS-3)对2型糖尿病(T2DM)大鼠糖脂代谢和胰腺组织病理改变的影响。方法:建立T2DM大鼠模型,按体重随机分为T2DM模型组、HPS-3不同剂量组(50、100、200 mg/kg)及二甲双胍组(200 mg/kg),均灌胃给药,5周后取血清测血糖、糖耐量、血脂(总胆固醇﹑甘油三酯﹑高密度脂蛋白胆固醇﹑低密度脂蛋白胆固醇);取肝大叶,用蒽酮-硫酸法测肝糖原;取胰腺切片染色,观察胰岛β细胞病理改变。结果:与模型组比较,HPS-3各剂量组(50、100、200 mg/kg)均可降低T2DM大鼠空腹血糖和糖耐量实验中口服葡萄糖后2h的血糖,改善了大鼠的糖耐量减退,其中以200 mg/kg最为明显。HPS-3能调节T2DM大鼠的血脂紊乱,抑制总胆固醇、甘油三酯、低密度脂蛋白胆固醇升高和高密度脂蛋白胆固醇降低;同时,在一定程度上有增加T2DM大鼠肝糖原含量的趋势和修复受损胰岛β细胞的作用。结论:HPS-3能降低血糖,对T2DM大鼠的糖脂代谢紊乱有一定的调节作用,能促进T2DM大鼠肝糖原的合成,修复受损的胰岛β细胞,减轻T2DM大鼠胰岛素抵抗。

脓毒症与非脓毒症死亡患儿胰腺功能的病理特征分析

目的 观察行胰腺功能系统检查的危重死亡患儿临床与病理特征,分析脓毒性休克、脓毒症,乳酸水平与胰腺损害的关系.方法 分析湖南省儿童医院2009年1月至2012年10月行胰腺功能系统观察,并因病情危重抢救死亡后行全身和胰腺病理检查的64例危重患儿临床及病理资料,观察所有病例的胰腺组织学特征,并进行病理学分级评分.结果 （1）脓毒性休克患者胰腺组织病理学评分、入院24h血脂肪酶最高值较非脓毒性休克患者显著升高,而住院期间Ca2＋最低值显著降低（P＜0.05）；（2）乳酸升高≥2倍组较乳酸升高＜2倍组及乳酸正常组胰腺组织病理学评分显著升高（P＜0.05）,但住院期间Ca2＋最低值、入院24h血淀粉酶、脂肪酶、尿淀粉酶含量乳酸升高≥2倍组与乳酸升高＜2倍组及乳酸正常组比较差异无统计学意义；（3）胰腺组织病理学评分＞4分组入院24h血淀粉酶、脂肪酶、尿淀粉酶含量较胰腺组织病理学评分≤4分组显著增高（P＜0.05）,但胰腺组织病理学评分＞3分组与胰腺组织病理学评分≤3分组比较差异无统计学意义.结论 （1）脓毒性休克患者,尤其是脓毒性休克合并高乳酸血症患者更容易造成胰腺功能损害；（2）胰腺组织病理学评分＞4分能作为判断胰腺损害的有效指标.

Cell-permeable Tat-NBD peptide attenuates rat pancreatitis and acinus cell inflammation response

AIM： To investigate the effects of Tat-NEMO-binding domain （NBD） peptide on taurocholate-induced pancreatitis and lipopolysaccharide （LPS）-stimulated AR42J acinus ceils inflammatory response in rats. METHODS： Sodium taurocholate （5%） was used to induce the pancreatitis model. Forty-eight rats from the taurocholate group received an intravenous bolus of 13 mg/kg Tat-NBD （wild-type, WT） peptide, Tat- NBD （mutant-type, MT） peptide, NBD peptide or Tat peptide. The pancreatic histopathology was analyzed by hematoxylin staining. LPS was added to the culture medium to stimulate the AR42J cells. For pretreatment, cells were incubated with different peptides for 2 h before LPS stimulation. Expression of IL-1β and TNF-α mRNA was analyzed using a semi-quantitative reverse-transcript polymerase chain reaction （RT-PCR） method. IL-1β and TNF-α protein in culture medium were detected by enzyme linked immunosorbent assay （ELISA）. NF-KB DNA-binding in pancreas was examined by electrophoretic mobility shift assays. P65 expression of AR42J was determined by Strept Actividin-Biotin Complex （SABC） method. RESULTS： Pretreatment with Tat-NBD （WT） peptide at a concentration of 13 mg/kg body wt showed beneficial effect in pancreaitis model. LPS （10 mg/L） resulted in an increase of IL-1β mRNA, IL-1β protein, TNF-α mRNA and TNF-α protein, whereas significantly inhibitory effects were observed when cells were incubated with Tat-NBD （WT）. Consisting with p65 expression decrease analyzed by SABC method, NF-KB DNA-binding activity significantly decreased in Tat-NBD （WT） pretreatment group, especially at the largest dose. No significant changes were found in the control peptide group. CONCLUSION： Our result supports that active NF-KB participates in the pathogenesis of STC-induced acute pancreatitis in rats. Tat-NBD （WT） peptide has anti- inflammatory effects in this model and inhibits the inflammation of acinus simulated by LPS.

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM： To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound （EUS）-guided fine needle aspiration （FNA） material in the differential diagnosis of pancreatic solid masses. METHODS： Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs （22G needle） were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Haterials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS： Length of the core specimen obtained for histological analysis was 6.5±5.3 mm （range 1-22 mm）. Cytological and histological samples were considered as adequate in 51 （82.3%） and 52 cases （83.9%）, respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Conbary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases （90.3%）, with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION： Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.

A case of long survival in poorly differentiated small cell carcinoma of the pancreas

Small cell carcinoma (SCC) of the pancreas is rare. It has similar histological features to pulmonary small cell carcinoma and is equally aggressive. Most patients with SCC in the pancreas reported in case studies died within 1 year after diagnosis. We present a case of unusually long-term survival after surgery and combined chemotherapy for SCC of the pancreas. A 62-year-old woman presented with epigastric pain and jaundice. Computed tomography revealed dilated common bile duct caused by external compression of the mass in the pancreatic head. Exploratory laparotomy and pancreaticoduodenectomy (PPPD) was performed with histopathological analysis confirming a primary small cell carcinoma of the pancreas. After an uneventful postoperative recovery, the patient was treated with 6 cycles of combined chemotherapy consisting of cisplantin and ectoposide. During the follow-up, there was no evidence of recurrence and the patient has remained in a good health condition for 36 mo since the diagnosis.

Experimental study on operative methods of pancreaticojejunostomy with reference to anastomotic patency and postoperative pancreatic exocrine function

AIM:To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods. METHODS: A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. After 4 wk ligation, a total of 36 piglets were divided randomly into four groups. The piglets in the control group underwent laparotomy only; the others were treated by three anastomoses: (1) end-to-end pancreaticojejunostomy invagination (EEPJ); (2) end-to-side duct-to- mucosa sutured anastomosis (ESPJ); or (3) binding pancreaticojejunostomy (BPJ). Anastomotic patency was assessed after 8 wk by body weight gain, intrapancreatic ductal pressure, pancreatic exocrine function secretin test, pancreatography, and macroscopic and histologic features of the anastomotic site. RESULTS: The EEPJ group had significantly slower weight gain than the ESPJ and BPJ groups on postoperative weeks 6 and 8 (P < 0.05). The animals in both the ESPJ and BPJ groups had a similar body weight gain.Intrapancreatic ductal pressure was similar in ESPJ and BPJ. However, pressure in EEPJ was significantly higher than that in ESPJ and BPJ (P < 0.05). All three functional parameters, the secretory volume, the flow rate of pancreatic juice, and bicarbonate concentration, were significantly higher in ESPJ and BPJ as compared to EEPJ (P < 0.05). However, the three parameters were similar in ESPJ and BPJ. Pancreatography performed after EEPJ revealed dilation and meandering of the main pancreatic duct, and the anastomotic site exhibited a variable degree of occlusion, and even blockage. Pancreatography of ESPJ and BPJ, however, showed normal ductal patency. Histopathology showed that the intestinal mucosa had fused with that of the pancreatic duct, with a gradual and continuous change from one to the other. For EEPJ, the portion of the pancreatic stump protruding into the jejunal lumen was largely replaced by cicatricial fibrous tissue. CONCLUSION: A mucosa-to-mucosa pancreatico- jejunostomy is the best choice for anastomotic patency when compared with EEPJ. BPJ can effectively maintain anastomotic patency and preserve pancreatic exocrine function as well as ESPJ.

Heterotopic pancreas in the gastrointestinal tract

Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 60-year-old man with carcinoid syndrome caused by heterotopic pancreatic tissue in the duodenum is described, along with a 62-year-old man with abdominal pain caused by heterotopic pancreatic tissue in the gastric antrum. The difficulty of making an accurate diagnosis is highlighted. The patients remain healthy and symptom-free after follow-up of 1 year. Frozen sections may help in deciding the extent of resection intraoperatively. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of gastrointestinal stromal tumor.

Chaiqinchengqi decoction regulates necrosis-apoptosis via regulating the release of mitochondrial cytochrome c and caspase-3 in rats with acute necrotizing pancreatitis

OBJECTIVE: To explore the effect and the mechanism of Chaiqinchengqi decoction(CQCQD) on the apoptosis-necrosis switch of pancreatic acinar cells in acute necrotizing pancreatitis(ANP) in rats.METHODS: Sixty Sprague-Dawley rats were randomized into the control group, the ANP group and the CQCQD group. The acute pancreatitis(AP)model was induced by intraperitoneal injections of4 g/kg 8% L-Arginine(PH 7.0) twice with a 1 h interval. Rats in the CQCQD group were intragastrically administered CQCQD(20 mL/kg every 2 h, 3 times,then 20 mL/kg every 6 h, 3 times). Rats were killed at the 6 and 24 h after the induction of AP.The pancreatic tissues were collected for pathology and to isolate pancreatic acinar cells and mitochondria.RESULTS: CQCQD significantly ameliorated the severity of ANP by reducing the pancreatic histopathology score, indicated by lactate dehydrogenase levels at the 6 and 24 h. The CQCQD group promoted the apoptosis of pancreatic acinar cells by raising the apoptosis index compared with the ANP group and the control group. Mitochondrial cytochrome c at the 6 and 24 h in the ANP group were lower than that in the control group or the CQCQD group(0.67±0.13 vs 1.54±0.03 vs 0.81±0.09; 0.71±0.08 vs 1.55±0.09 vs 0.89±0.16, P<0.01). The cytochrome c levels in the cytoplasm at the 6 and 2 h in the CQCQD group were higher than in the control group(1.36±0.15 vs 0.67±0.04, 1.46±0.08 vs 0.59±0.09, P<0.01), or the ANP group(0.96±0.13, P>0.05;0.97±0.09, P<0.05). CQCQD increased caspase-3 activity over the ANP group at the 6 h.CONCLUSION: CQCQD can induce apoptosis and relieve the necrosis of pancreatic acinar cells via promoting the release of mitochondrial cytochrome c and increasing pancreatic caspase-3 activity in ANP rats.