Objective To evaluate the effectiveness and safety of gabexate mesylate in the prevention of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP）. Methods The literatures and corresponding references of randomized controlled trials （RCT） on gabexate mesylate in the prevention of PEP were searched from Cochrane library （1970 to December 2010），PubMed （1966 to December 2010），EMBASE （1966 to December 2010），and CBM （1978 to December 2010）.Literature screening，data extraction and methodological quality assessment were individually performed by two researchers.The software RevMan 4.2 of Cochrane Collaboration was used for statistical analysis. Results A total of 11 trails involving 3 012 patients were included. Meta analysis showed that high dose （≥1 000 mg）of gabexate mesylate with slow intravenous infusion （≥12 h） could effectively prevent from PEP （OR=0.27，95%CI： 0.11-0.64, P=0.003） and post-ERCP abdominal pain （OR=0.44，95%CI： 0.25-0.79，P=0.005） when compared with placebo. The low dose （≤500 mg） of gabexate mesylate with quick intravenous infusion （≤6.5 h） could not effectively prevent from PEP （OR=0.85, 95%CI： 0.59-1.34, P=0.570），post-ERCP hyperamylasemia （OR=0.86，95%CI： 0.69-1.07，P=0.180），and post-ERCP abdominal pain （OR=0.66，95%CI： 0.32-1.35，P=0.250）.When compared gabexate mesylate with ulinastatin, there was no statistical difference between them in the prevention of PEP （OR=1.57，95%CI： 0.39-6.24，P=0.520） and post-ERCP hyperamylasemia （OR=1.85, 95%CI： 0.83-4.13，P=0.130）. Conclusions The high dose （≥1 000 mg） of gabexate mesylate with slow intravenous infusion （≥12 h） other than low dose （≤500 mg） with quick intravenous infusion （≤6.5 h） is effective to prevent from PEP and post-ERCP abdominal pain，and can also prevent from post-ERCP hyperamylasemia to some extent.The effect which ulinastatin prevents PEP and post-ERCP hyperamylasemia is same to gabexate mesylate.The above conclusions remain to confirm by RCT with large sample and long-term follow-up of high-quality.
ObjectiveTo review the recent advances in the pancreatic cancer stem cells field and identify the research trend in future. MethodsCurrent literatures on pancreatic cancer stem cells were collected and reviewed. ResultsPancreatic cancer was a highly lethal disease and was usually diagnosed at a late stage, for which there were few effective therapies. Emerging evidence had suggested that pancreatic cancer cells proposed a heterogeneous organization. A subpopulation of stem celllike cells sustains tumor growth, propagation, metastasis, and resistance to standard chemotherapy. Cancer stem cells were identified based on their expression of different sets of cell surface markers and functional characteristics. Some important signaling pathways which maintain self-renewal and metastasis were upregulated in pancreatic cancer stem cells. ConclusionsCurrent findings clearly suggest that specific elimination of cancer stem cells is possible and therapeutically relevant. An improved understanding of the biological behavior of such cells may lead to the development of novel diagnosis and treatment regimens for pancreatic cancer.
Objective To compare the long-term outcome between breast-conserving therapy with mastectomy therapy for early stage invasive breast cancer through a Meta analysis of the randomized controlled trials published worldwide. Methods Cochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and so on. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicators for assessment including death number at the end of follow-up, locoregional and total recurrence. The results were analyzed with RevMan 4.2.2 software. Results Six articles were involved in the Meta analysis with total 3 933 patients. No statistical difference was found in the death at the end of follow-up between breast-conserving therapy group and mastectomy therapy group (OR=1.05, 95% CI=0.93—1.19， P=0.45). Locoregional and total recurrence rate of breast-conserving therapy group were statistical higher than those in mastectomy therapy group (OR=1.64, 95% CI: 1.10—2.44， P=0.01； OR=1.42, 95% CI: 1.22—1.64， Plt;0.01). Conclusions Breast-conserving therapy and mastectomy therapy have comparable effects on mortality in patient with early stage invasive breast cancer, even after long-term follow up. However, breast-conserving therapy is associated with significantly greater risk of locoregional recurrence.
Objective To explore a simple, effective and stable method for the isolation and purification of Kupffer cells from rat liver, enabling further study on the structure and function of these cells in vitro. Methods After laparotomy, a catheter was inserted into the portal vein and secured with artery clamp. Then, the rat liver was perfused and digested with solution Ⅰ and solution Ⅱ containing 0.05% collagenase Ⅳ respectively. The cell suspension was centrifuged with isopycnic sedimentation in a two-step Percoll gradient to harvest Kupffer cells. The isolated Kupffer cells were purified by selective adherence after 30 min of cultivation, and identified by evaluation of phagocytosis of India ink and peroxidase staining with DAB through light and electron microscopy. Results It was verified that the viability of isolated Kupfffer cells was more than 90% through Trypan blue staining. Those Kupffer cells could attach to plastic quickly and phagocytose ink, and had the appearance of “fried eggs” in positive peroxidase staining with a purity of 95%. Under the light microscopy, the appearance of newly isolated Kupffer cells was round with uniform shape and size. After two days of culture, Kupffer cells appeared to distend with irregular or stellate shape. The typical features were observed in the transmission electron micrographs. There were numerous pseudopods and occasional cup-like indentations in the cell membrane of Kupffer cells. The cytoplasm contained numerous types of lysosomes and other phagocytotic vesicles. Conclusion The method for isolating and culturing Kupffer cells in this study is effective and stable, and the biological characters are preserved in the cultured cells.
ObjectiveTo discuss the role of imatinib preoperative chemotherapy in treatment of advanced gastrointestinal stromal tumor(GIST). MethodThe related literatures about imatinib preoperative chemotherapy for GIST were reviewed. ResultsImatinib preoperative chemotherapy is an effective treatment for advanced GIST, which significantly improve the resection rate and prolong the overall survival time for patients with advanced GIST. ConclusionsPreoperative imatinib treatment has good effect for metastatic or locally advanced GIST. It should be individualized by gene type of the GIST, which is deserved to be further studied.
Objective To summarize the nutritional management strategies of patients undergoing electively gastrointestinal surgery. Methods This article reviewed the recent researches on perioperative nutritional management in electively gastrointestinal surgery, including four major directions: preoperative nutritional evaluation, glucose level control, nutritional type, and immunonutrition. Results At present, preoperative nutritional evaluation methods included anthropometry, laboratory tests, subjective global assessment (SGA), nutritional risk screening (NRS) 2002, Reilly nutritional risk screening, nutritional risk indicator (NRI), and so on. For preoperative nutritional assessment system, however, current data could not single out superiority for any nutritional assessment methods in the ability to predict surgery-related complications. The usage of enhanced recovery after surgery (ERAS) protocol to reduce surgical stress and preclude postoperative insulin resistance had recently been clearly linked to reductions in postoperative morbidity and adverse outcomes. There were specific criterias for perioperative parenteral and enteral nutrition in undernourished patients, who were defined in clinical guidelines recently, such as the Guidelines for Adult Perioperative Nutrition Support issued by Chinese Society of Parenteral and Enteral Nutrition (CSPEN). Several systematic reviews showed that immunonutrition could reduce both morbidity and length of stay after major electively gastrointestinal surgery. Conclusion Perioperative nutritional management can ensure patients benefit from nutritional support by nutritional assessment, can reduce the nutritional risk and metabolic disorder caused by operation, can achieve the goal of optimal nutrition support in surgical patients, and can ultimately reduce postoperative complications.
Objective To analyze the citation classics articles， and approach the research development history and the research direction in the future about surgical treatment for type 2 diabetes. Methods The most frequently cited articles had published in Social Sciences Citation Index database by the end of October 30， 2012 were retrieved. The 50 most frequently cited articles were selected. Articles were evaluated for several characteristics， including number of citations， publication time， country of origin， institution， journal， publication type of article， and authorship. Results The most frequently cited article received 1 751 citations and the least frequently cited article received 73 citations， with a mean of 242.76 citations per article. These citation classics were published in 18 high-impact journals， led by Annals of Surgery and Obesity Research as 10 papers. Of the 50 articles， 18 articles were clinical observational study， 20 articles concerned basic science， 10 articles were review articles， and 2 articles were commentary. These citation classics were published from 1990 to 2009， most of them （40） from 2000 to 2009. Three institutions produced 2 top-cited articles， including Medical College of Virginia， Monash University， and East Carolina University. These articles originated from 14 countries， the top was USA （22 articles）. Two persons authored 3 published papers （Cummings DE and Rubino F）. Conclusion Most “citation classics” in research about surgery for type 2 diabetes are observational studies published in high-impact journals by US-based authors after 1990.
【Abstract】Objective To investigate the production and possible significance of plasma trypsinogen activation peptides (TAP) in rat experimental acute pancreatitis. Methods Ninety SD rats were randomly allocated to five groups: group EP with retrograde ductal infusion of 3%sodium taurocholate; group NP with retrograde ductal infusion of 5%sodium taurocholate; group TP with retrograde ductal infusion of 3%sodium taurocholate and ulinastatin(UTI) intravenous infusion half an hour later; group CP with 0.9% NS retrograde ductal infusion; group OP with sham operation. Animals in each group were killed 3h,6h and 24h after infusion. Plasma TAP was determined by EIA.The histological severity of the pancreas were assessed by Schmidt method. Results The pancreatic pathological changes in group NP was significantly severe than in group EP. At 3h and 6h after infusion, plasma TAP concentration of group NP (4.798±0.169)nmol/L and (3.999±0.299)nmol/L were significant higher than that of group EP(2.416±0.148)nmol/L and (3.356±0.211)nmol/L. At 6h after infusion plasma TAP concentration of group TP 〔(1.611±0.113)nmol/L〕 was significant lower than that of group EP(3.356±0.211)nmol/L. The difference of plasma TAP concentration between group EP and group NP appeared prior to the difference of the histopathological changes of pancreas between two groups. Conclusion Plasma TAP concentration is connected with the severity of sodium taurocholate-induced rat pancreatitis. Plasma TAP concentration may be used as a marker for early assessment of the severity of this experimental acute pancreatitis.
Objective To evaluate the impact of total thyroidectomy on health-related quality of life （HRQOL） in patients with nodular goiter. Methods The patients who underwent total thyroidectomy from Jan. 2009 to Dec. 2011 in our hospital were retrospectively analyzed with regard to the quality of life （total thyroidectomy group）. The patients with similar demographic features who underwent hemithyroidectomy during the same period were matched as control （hemi-thyroidectomy group）. The validated HRQOL instrument， which was the Euro quality of life-5D （EQ-5D）， was applied to measure the HRQOL. Comparison of HRQOL in patients of 2 groups was performed， meanwhile， the data of total thyroidectomy group was compared with data of normal population who were obtained from The Forth National Health Survey. Results There were 26 and 28 valid questionnaires returned for the total thyroidectomy group and hemithyroi-dectomy group respectively. The demographic features of patients in 2 groups were comparable. No significant variancecould be found between the 2 groups that there were no significant differences on the mobility， self-care， usual activities，pain/discomfort， anxiety/depression， and visual analogous scales （P＞0.05）. Furthermore， no significant differences in HRQOL were found in EQ-5D questionnaire compared with normal population derived from The Forth National Health Survey （P＞0.05）， except that there were more patients complained of moderate and severe pain/discomfort in the total thyroidectomy group 〔30.8% （8/26） vs.9.2% （16 330/177 501）， P＜0.01〕. Conclusion Total thyroidectomy appears to have little impact on the quality of life in the patients with nodular goiter.