Objective To establish the model of pancreatoduodenal allotransplantation in pigs with enteric drainage (ED) and portal venous drainage (PVD). Methods Forty-six hybrid landraces were divided into two groups (donor and recipient groups) randomly, for pancreatoduodenal allotransplantation. Donors were perfused via abdomial aorta without clamping the portal venous outflow with UW solution after heparinization. Whole pancreatoduodenal graft was arvested with segments of abdomial aorta and portal vein and shaped under cold UW solution. Then, the end-to-end nastomosis was performed with the donor iliac artery bifurcation “Y” graft to the recipient superior mesenteric arteries and celiac artery. Furthermore, type Ⅰdiabete model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Meanwhile, the end-to-side anastomosis was performed with the donor common iliac artery bifurcation “Y” graft to the recipient abdomial aorta and the side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. The levels of blood glucose， insulin and glucagon in blood were measured before and during the operation and 1， 3， 5， 7 d after operation. Results Twenty-three cases of pancreatoduodenal allotranplantations were performed on pigs. One died from complication of anesthesia. Success rate of operation was 95.7％.Complications of operation happened in 2 cases in which one was phlebothrombosis, incidence 4.5％and the other was duodenojejunal anastomotic leak, incidence 4.5％. The level of blood glucose increased within 30 min and recovered on the 2nd day after removal of pancreas. The levels of insulin and glucagon decreased within 30 min and recovered on the 2nd day after removal of pancreas. Rejection curred at the 1st day and reached the worst level on the 9th day after transplantation without the change of insulin and glucagon in blood and clinical symptoms of rejection. Conclusion Pancreatoduodenal transplantation in pigs can treat type Ⅰ diabete. ED and PVD can keep the function of endocrine in normal. The technique of duodenal transplantation with ED and PVD may pave the way for the further development of pancreas transplantation in clinic.
Objective To investigate the diagnosis and treatment of pancreatic gastrinoma. Methods The clinical data of 13 patients with pancreatic gastrinoma who were admitted to Hainan Provincial People’s Hospital from Jan. 1990 to Dec. 2010 were retrospectively analyzed. Etiologic and localization diagnosis were preformed preoperatively according to the manifestation and the results of color Doppler ultrasound and computer tomography，respectively. All patients received chemoradiotherapy after operation according to the pathology results. Results All of the thirteen patients underwent operation. The location of pancreatic gastrinoma was found in the head of the pancreas in 9 cases，in the tail of the pancreas in 1 case，in the body of the pancreas in 2 cases， and 1 case with multiple pancreatic gastrinonma，respectively. The diameters of the pancreatic gastrinoma were 0.2-4.0cm and 11 patiens were above 2.0cm. One patient underwent resection of the body and tail of the pancreas and spleen，seven patients underwent tumor resection，two patients underwent resection of the choledocho-pancreatic junction， and three patients underwent pancreaticoduodenectomy. One patient complicated with pancreatic leakage and two with incision infection. Twelve patients were followed up for 16-120 months （mean 78 months）. Clinical symptoms such as diarrhea disappeared after operation in twelve patients. Results of electronic gastroscopy in 6 months after continuous treatment with proton pump inhibition agents showed that the gastric ulcer were healed，the 12 hour gastric juice volume and the level of the gastric acid were in the normal range. Ten patients were cured，but one patient died because of other disease in 1 year after operation，one patient died because of recurrence in 1.5 years after operation， and one patient died in 4 years after reoperation of liver metastases. Conclusion Surgical treatment is a effective method for pancreatic gastrinoma.
Objective To investigate the CT imaging features of pancreatic fatty replacement and its clinical significance. Methods Three patients with pancreatic fatty replacement detected by CT were retrospectively analyzed. CT examination included plain scan and contrast-enhanced scanning at the arterial and portal venous phases. The shape, size, density, pancreatic lobulation and interlobular spaces, course of the pancreatic duct were carefully observed. The clinic and laboratory data were also analyzed to determine the clinical significance of pancreatic fatty replacement. Results ①Imaging features: Two patients had complete fatty replacement involving the entire pancreas, another one had most fatty replacement sparing the posterior aspect of head and tail. Two patients had regular configuration of pancreas. The size of pancreas was slightly enlarged in 2 patients. Lobular atrophy and widening of interlobular spaces were present in all 3 patients. The pancreatic duct was normal in 3 patients. ②Clinic findings: Chronic diarrhea was present in 3 patients. Two patiens had diabetes （one had chronic cholangitis with choledochal lithiasis）， another one had small stone in the common bile duct. Serum lipase was low in 3 patients, of which one had low serum amylase. Conclusion Pancreatic fatty replacement demonstrates certain characteristic CT appearances, and is usually associated with disturbances of both the endocrine and exocrine functions of the pancreas.
ObjectiveTo explore the effect of endotoxin on insulin secretion from islet βcell of rat pancreas.MethodsAfter the model of endotoxemia was established in rats with intraperitoneal injection of LPS (2 mg/kg),the changes of insulin level in the serum and pancreas were dynamically determined, the expression of inducible nitric oxide synthase (iNOS) by situ hybridization and DNA damage in islet cells were also observed, the effect of sodium nitroprusside (exogenous NO) on synthesis and secretion of insulin from isolated islet βcell of normal rat pancreas under high glucose stimulation was also evaluated.ResultsThe level of glucose and insulin in plasma were significantly increased at 12th and 6th h, respectively and kept on 3 d after injection of LPS,but the insulin level in pancreas was not remarkably altered.The expression of iNOS and DNA damaged significantly enhanced at 6 d after endotoxemia. The high glucosestimulated insulin synthesis and secretion were bly inhibited by exogenous NO.ConclusionThese findings suggest that LPS be stimulate the expression of iNOS and NO product,which inhibites synthesis and secretion of insulin in islet βcells,but it stimulates insulin secretion by another mechanism,and results in dysfunction and destruction of the rat pancreas.
Objective To approach the recent advances in diagnosis and surgical treatment of pancreatic endocrine tumors （PETs）. Methods Articles relevant to diagnosis and treatment of PETs were collected and reviewed. Results PETs are characterized by their ability to over-produce peptides and hormones， which cause specific clinical syndromes. Because of rare incidence and complex clinical syndromes， there are still impediments to early diagnosis of these tumors. Monitoring of serum hormones and imaging method allow early tumor detection. PETs have been investigated for the past several decades. With the great knowledge of these tumors in molecular genetic level， clinical managements have been greatly changed. Conclusions Avoiding misdiagnosis is important for treatment of PETs. Surgical approach is still considered as the preferred option for curtailing the malignant progression of PETs and controlling the associated biochemical syndromes.
ObjectiveTo investigate the effects and mechanisms of differentiation of bone marrow mesenchymal stem cells (BMSCs) into insulin producing cells (IPCs) induced by injured pancreatic tissue extract of rat.
MethodsEighty 6-week-old Sprague Dawley rats were selected. Forty rats underwent removal of 60% pancreas and the injured pancreas tissue was obtained after 48 hours to prepare the injured pancreatic tissue extract; and normal pancreatic tissue extract was prepared from the other 40 rats. The BMSCs were isolated from the tibia and femur of 4-week-old Sprague Dawley rats. BMSCs at passage 3 were co-cultured with rat injured pancreatic tissue extract as experimental group, with rat normal pancreatic tissue extract as normal control group, and with cell culture medium as blank control group for 14 days. The expressions of pancreas development related genes and proteins were detected, and cell morphological changes were observed. Then the C peptide positive cell rate was detected by flow cytometry analysis and insulin secretion levels were detected by glucose stimulation experiment at 14 days.
ResultsInjured pancreatic tissue extract can induced BMSCs differentiating into IPCs. The pancreatic development related genes of pancreatic duodenal homeobox 1 (PDX-1), islet 1, Nkx6.1, glucose transporter type 2, proprotein convertase 2, neurogenin 3, and somatostatin were expressed sequentially in the differentiation process of experimental group; mature pancreatic proteins of PDX-1, insulin, C peptide, Nkx6.1 also were expressed. But there was no morphological changes and expression of pancreatic development related genes and proteins in normal control and blank control groups. The C peptide positive cell rate of experimental group (13.8%±1.8%) were significantly higher than those of normal control and blank control groups (1.6%±0.4%) (P<0.05). The insulin secretion of experimental group was significantly higher than that of normal control and blank control groups (P<0.05), but it was 1/40 and 1/47 of natural islet cells (P<0.05).
ConclusionAfter pancreatic injury, injured pancreas would secrete transcription proteins related to development, differentiation, and repair of pancreas, which can promote the differentiation of BMSCs into IPCs.
ObjectiveTo analyze the CT features of solid pseudopapillary tumor of pancreas (SPTP). MethodsEight patients with SPTP received triple phasic contrast-enhanced CT, and its consistency with pathological findings was analyzed. ResultsSPTP manifested as a solitary and exogenous mass, with a heterogeneous pattern composed of solid and polycystic parts. The shape of SPTP was spherical in four patients, oval in two patients, and shallow lobulation in another two patients. In contrast-enhanced phase images, the solid parts showed mild to moderate enhancement in both arterial and portal phases. Complete capsule was showed in seven patients, and nodules were found in the wall of mass in five patients. Hemorrhage was seen in two patients and calcification was showed in five patients. The dilation of pancreatic duct was found in one patient, liver metastases was showed in one patient, and the invasion of tumor to posterior gastric wall was found in one patient. Pseudopapillary structure, hemorrhage, necrosis, and cystic degeneration were showed in all patients by histological study. ConclusionSPTP has certain characteristic CT imaging manifestations consistent with histological features, which is helpful for the diagnosis and differential diagnosis of SPTP.
Objective To investigate the roles of cell apoptosis and the gene expressions of Fas, FasL, bcl-2 and bax in acute rejection of pancreaticoduodenal transplantation and to evaluate the function of duodenum biopsy for early detection of rejection in rats. Methods Wistar and SD rats were divided into two groups: ①Wistar rats that underwent allogenic pancreaticoduodenal transplantation from the organs of SD rats; ②Wistar rats that received homogenic transplantation. The grafts were then harvested on day 3, 5 and 7 after the transplantation, and all graft samples were observed with HE staining and TUNEL was also used to detect apoptotic cells. The expressions of Fas, FasL, bcl-2 and bax were measured by immunochemical method. According to Nakhleh’s score, pathologic features of transplanted pancreas and duodenum were ranged from one to three scores in order. Results The percentage of same or different scores between the pathological scores of pancreas and duodenum in allogenic pancreaticoduodenal transplantation group were 61.1% (11/18) and 38.9% (7/18) respectively, and there were 6 specimens of pancreatic tissue got higher scores with only one higher score for duodenum. There were significant differences of histopathologic rejection scores and apoptotic indices between the two groups, respectively (P＜0.05， P＜0.01). Apoptotic indices of pancreas and duodenum both showed positive correlations with histopathologic rejection scores (r=0.965， P＜0.01; r=0.942, P＜0.01). The rejection score and apoptotic index elevated, the expression of FasL increased, bcl-2 decreased, and Fas and bax changed over time after operation. Conclusion Apoptosis maybe significantly positive correlated with the degrees of damage of the acute pancreaticoduodenal allograft rejection, and the apoptotic index maybe valuable to estimate the damage. FasL and bcl-2 were significantly related to the impairment of acute pancreatic allograft rejection as well. Duodenum biopsy may contribute to the early diagnosis of the rejecting transplanted tissues.
【Abstract】Objective To investigate the effect of ischemia on the treatment of advanced body and tail carcinoma of pancreas. Methods In operation the proximal spleen artery was ligated, a chemotherapy pump was installed to connect the distal spleenic artery and urea solution (40%) was injected through the device during and after operation. The pathology and pathophysiology change in dogs were observed. Results All the eight dogs studied were alive after operation, no serious complication appeared, pancreatic cells were replaced by fibrosis. Conclusion Infusion of 40% urea solution is a safe and effective ischemic method, it can lead to all sorts of pancreatic cell necrosis and fibrosis. It may be a good madality in the treatment of advanced pancreatic carcinoma.
Objective To explore the effect of artemisinin on the apoptosis of pancreas acinar cells in acute pancreatitis (AP), and to study whether artemisinin can relieve the severity of AP. Methods ① In vivo experiment: twenty one Wistar rats were divided into the following 3 groups randomly: the normal control group, the AP group and the artemisinin group. The model of AP was established by injecting cerulein into the peritoneal cavity of rat. After establishment of AP in the artemisinin group, artemisinin was injected into the peritoneal cavity. Meanwhile normal saline was injected into the peritoneal cavity of rats of the normal control group and the AP group. The apoptosis of pancreas acinar cell was detected by terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL). The activity of myeloperoxidase was detected by absorption spectrometry. ② In vitro experiment: the pancreas acinar cells of normal rats were isolated through twostep enzyme digestion, and cultured. These acinar cells were divided into 3 groups: the normal control group, the AP group and the artemisinin group. Then, the cells of AP group were cocultured with cerulein, and those of the artemisinin group were cocultured with cerulein and artemisinin. The apoptosis of pancreas acinar cells were detected by AO dyeing and the measurement of the activity of caspase3. And the activity of LDH and AMS in the culture medium of each group were measured. Results ① In vivo: the apoptosis index of the artemisinin group was sigificantly increased and the activity of myeloperoxidase was obviously decreased compared with the AP group (P＜0.05). ② In vitro: the apoptosis index and the activity of caspase3 of the artemisinin group were significantly increased compared with the AP group (P＜0.05); the activities of LDH and AMS of the artemisinin group were more decreased than those of the AP group (P＜0.05). Conclusion Artemisinin could contribute to the apoptosis of rat pancreas acinar cells, decrease the releasing of trypsogen, alleviate the activation of neutrophil and relieve the severity of AP.
