Pancreaticoduodenectomy with early superior mesenteric artery dissection

BACKGROUND: Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive human tumors. At present, surgical resection is the only potentially curative treatment. Early neck division is inadequate when invasion of the superior mesenteric artery (SMA) is suspected or in cases of replaced or accessory right hepatic artery. Malignant periampullary tumors often invade retroperitoneal peripancreatic tissues and a positive resection margin is associated with a poor long-term survival. DATA SOURCES: English-language medical databases, PubMed, ELSEVIER and SPRINGERLINK, were searched for articles on 'posterior approach pancreaticoduodenectomy', 'superior mesenteric artery first approach', 'retroperitoneal tissue', 'hanging maneuver', and related topics. RESULTS: The modification allowed the surgeon to early identify the nonresectability of a replaced right hepatic artery if present, enabling complete dissection of the right side of the SMA and portal vein as well as complete excision of the retroportal pancreatic lamina. CONCLUSION: Pancreaticoduodenectomy with early retropancreatic dissection is a useful and safe technical variant, which is indicated for the improvement of the safety and curative effect of the procedure. (Hepatobiliary Pancreat Dis Int 2010; 9: 579-583)

Effects of rapamycin in liver transplantation

BACKGROUND: Rapamycin is a potent new immunosuppressant with a mechanism of action that is distinct from that of calcineurin inhibitors, but few clinical data on rapamycin in liver transplantation are available. Hence it is necessary to evaluate the efficacy and side-effects of rapamycin-based immunosuppression in liver transplant patients. METHODS: We retrospectively analysed 39 liver transplantation patients who took rapamycin as an immunosuppressant. This series consisted of 28 patients with hepatocellular carcinoma, 9 patients with chronic fulminant hepatitis, and 2 patients with end-stage liver cirrhosis. Eight patients used rapamycin for monotherapy, and 31 used rapamycin-based immunosuppression. In the 31 patients, 7 patients used rapamycin instead of mycophenolate mofetil to treat acute rejection. RESULTS: In the 28 patients with hepatocellular carcinoma, the one-year survival rate was 67% without any tumor recurrence. The acute rejection in 7 patients was relieved in 1-2 weeks after the administration of rapamycin. All the 8 patients who received rapamycin monotherapy survived for at least 6 months and liver function tests and biopsy showed nothing abnormal. jaundice in 8 patients with chronic rejection was reduced sharply after use of rapamycin. CONCLUSIONS: Rapamycin given alone or in conjunction with calcineurin inhibitors appears to be an effective primary immunosuppressant regimen for orthotopic liver transplantation patients. Further studies are warranted to evaluate the efficacy and side-effect profile of rapamycin in liver transplant patients.

Expression of stem cell markers CK-19 and PDX-1mRNA in pancreatic islet samples of different purity from rats

BACKGROUND: Islet stem cells are more or less retained in the procedure of islet isolation and purification, and are transplanted together with islet grafts. Keratoprotein (CK-19) and pancreatic duodenal hox gene 1 (PDX-1) are markers of stem cells. This study was undertaken to examine the expression of these markers in pancreatic islet samples of different purity from rats. METHODS: A total of 30 male Sprague-Dawley rats were randomly assigned to 3 groups to undergo perfusion with V-type collagenase via the pancreatic duct, then the pancreas was excised, diced, shaken, digested and centrifuged to obtain islet sediments. The sediment from group A was not purified, while that from group B was purified with 25% Ficoll-400 and that from group C with 25% and 11% Ficoll-400. RNA was extracted from the different islet samples for reverse transcriptase-polymerase chain reaction (RT-PCR). The expression of the pancreatic stem cell markers CK-19 and PDX-1 was assessed. RESULTS: The purity of islets in samples was (43.6 +/- 6.29)% in group A; (65.3 +/- 4.40)% in group B; and (77.6 +/- 6.36)% in group C (P<0.05). The expression of CK-19 and PDX-1 mRNA was significantly higher in group A than in groups B and C, but group C showed the lowest level of expression. CONCLUSION: The expression of CK-19 and PDX-1 mRNA in islet samples of different purity suggests the presence of stem cells in all islet samples.

Study on substitution of wedge-shaped stomach for urinary bladder

To study the indications,effects and complications of substitution of wedge-shaped stomach for urinary bladder.Methods From May 1992 to December 2003 reconstruction of bladder with wedge-shaped stomach was performed in 61 bladder cancer patients who had undergone total cystectomy.All the patients had urethral urination.Postoperatively,urine continence,urethral urination and complications were observed,and urodynamic studies,imaging examinations,laboratory tests and cystoscopy were performed.Results All the 61 patients were followed up for 5 months to 12 years (mean,6 years).Of them 43 (70.49%) had normosthenuria.The urination interval was 2.0-4.5 h (mean,3 h).The urine volume was 280-520 ml (mean,385 ml).Qmax was 13-25 ml/s (mean,17 ml/s).The bladder capacity was 300-550 ml (mean,375 ml).The maximum urethral pressure was 20-60 cm H2O (mean,48 cm H2O,1 cm H2O=0.098 kPa).The filling bladder pressure was 5-14 cm H2O (mean,11 cm H2O).The maximum bladder pressure was 40-65 cm H2O (mean,55 cm H2O); and it was 25-60 cm H2O (mean,45 cm H2O) during urination.Six cases (9.84%) had urethral anastomotic stoma stricture,which was corrected by electro-resection.In 12 cases whose bladder necks were resected,postoperative incontinence occurred in 12 (100%,12/12),and incontinence was gradually remitted 3-6 months after surgery.Six cases (9.84%) had pain and ulcer of urethral meatus.Nine cases (14.75%) had left uroureter.Forty of 49 cases (81.63%) had residual urine (1-125 ml;mean,30 ml).Retention of urine occurred in 2 cases;urinary tract infection,in 5; hematuria-dysuria syndrome,in 10;aciduria (pH 4.5-7.0),in 61 (100%);epididymitis,in 1.No pyloric sphincter muscle spasm occurred.At 12 months after surgery anastomotic stoma tumor developed in 1,who underwent tumor resection.Nine cases died of tumor metastasis in 1-5 years after surgery.Postoperatively,cystoscopy showed that gastrocystic mucosa was even and smooth in white color without ulcer.Over 1 year gastrocystic mucosa was taken from 15 cases for microscopic and electron microscopic examination.There was gastrocystic mucosal interstitial infiltration of acidophils and lymphocytes.Blood,electrolyte tests and arterial blood gas analysis showed no obvious abnormality.BUN and Cr values were within normal range.Conclusion The operation of substitution of wedge-shaped stomach for bladder has satisfactory effect with less complications.For bladder cancer patients who undergo total cystectomy and cannot keep the urethral sphincter,substitution of wedge-shaped stomach for bladder with urethral urination should not be adopted.8 refs.

Experimental study on shRNA targeted hTERT gene to suppress bladder cancer cell growth

To explore the mechanism of shRNA targeted hTERT gene to inhibit bladder cancer T24 cell growth by decreasing c-myc and TGF-β1 expression.Methods shRNA-hTERT-pTZU6+1 vectors were constructed by RNAi-DNA vector technique,then the vectors were transfected into bladder cancer T24 cells,and the most effective vector and its optimal concentration were screened using RT-PCR to detect hTERT expression in T24 cells.The T24 cell growth,the alternative of cell phase,the expression of hTERT,c-myc and TGF-β1 were detected by flow cytometry,RT-PCR and immunohistochemistry.Results Three shRNA-hTERT-pTZU6+1 vectors were successfully constructed.The most effective vector was ph2-shRNA vector,and its optimal concentration was 1.0 μg.This vector decreased the cell growth and the cell number of S phase from 65.2% to 38.6%,increased the cell number of G0/G1 phase from 32.0% to 57.9%,and attenuated both mRNA and protein expressions of hTERT,c-myc and TGF-β1 in T24 cells.Conclusion Targeted hTERT gene with shRNA may inhibit the cell proliferation of bladder cancer; downregulating hTERT expression by attenuating the expression of c-myc and TGF-β1 is probably involved in the mechanism.17 refs.

Neuroprotective effects of heat stress on axonal injury

To investigate the expressions of heat shock protein 70 (HSP70) in neurons and oligodendrocytes after the stretch injury and the effects of heat stress on HSP70 expression and explore neuroprotective effect of HSP70 on axonal injury.Methods Fifty-seven male Wistar rats were randomly divided into four groups:control group (Group A with three rats),stretch-only group (Group B with 18 rats),heat stress-only group (Group C with 18 rats) and heat stress pretreatment plus stretch group (Group D with 18 animals).Stretch injury was induced in the right optic nerves of rats in Group B.Heat stress was applied to animals of Group C.Animals in Group D were subjected to the same stretch injury as Group B posterior to the heat stress similar to Group C.Three animals respectively from each group of Group B,Group C and Group D were killed at 4,8 and 16 hours,1,3 and 5 days,respectively.Morphological changes of optic nerves,retinal ganglion cells(RGCs) and oligodendrocytes (OLs) in optic nerves after stretch injury were examined under light microscope;and expressions of OLs HSP70 in RGCs and OLs after heat stress and/or stretch injury were observed using immunohistochemistry.Results Pathological changes of axons,RGCs and OLs after stretch injury to the optic nerves were identified morphologically or quantitatively,and signficantly ameliorated by pre-treatment with heat stress before stretch injury.An increase expression of OLs HSP70 and RGCs occurred in Groups B and C.A much more enhanced expression of HSP70 was found in Group D with an earlier peak and longer maitenance period.Conclusion Both neurons and glial cells are involved in pathological process after axonal injury.Heat stress can mmore effectively exert the neuroprotective role through enhancing,bringing forward and prolonging expression of HSP70.A new approach to management of DAI may be developed through the enhancement of intrinsic neuroprotective functions.17 refs,6 figs,2 tabs.

Establishment and evaluation of severe head injury model for treatment with mild hypothermia

To set up an animal model with severe head injury that is similar to clinical condition and treated with mild hypothermia.Methods A total of 120 SD rats were randomly divided into eight groups (n=15 in each group),ie,before cooling,cooling 6,12,24,48,72,96 and 120 hours groups.The model was induced by dropping a object of 60 g from a height of 50 cm onto the epidura and treated with mild hypothermia(32～34 ℃).Blood pressure and ECG were observed and serum K+,Na+ and Mg 2+ level measured.The change of neuron microstructure in rat cerebral traumatic tissue of every group was observed by transmission electron microscope (TEM).Results Animal mortality increased but serum K+ and Mg 2+ levels gradually decreased with the treating time lasting.Serum Na+ showed insignificant change.Bradytachycardia occurred in one rat of 72 hours group,two of 96 hours group and two of 120 hours group.TEM showed that the rat’s encephaledema presented gradual relief trend during mild hypothermia treatment.There was one rat in 96 hours group and one in 120 hours group with diffuse tubuli renales necrosis.Conclusion The established model is in conformity with the characteristics of vital sign,serum electrolyte and cerebral microstructure of clinical severe head injury treated with mild hypothermia.3 refs,1 tab.

Expression and significance of Pdlim2 in the glomerular podocyte of hyperlipidemic rate

Objective To investigate the expression changes and significance of Pdlim2 in the glomerular podocyte of hyperlipidemic rats.Methods Forty-five individuals of SD rats were divided randomly into 3 groups(n=15 in each group).The control group was fed with normal diet.The high fat group was fed with high fat diet.The