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To study the effect of low molecular weight heparin (LMWH) in the treatment of severe acute pancreatitis (SAP). Methods: A total of 265 SAP patients were randomly divided into two groups: firstly, the conventional treatment group (C group, n = 130; and secondly the conventional treatment plus the LMWH treatment group (LT group, n = 135). The clinical parameters, laboratory parameters and computed tomography (CT) score of pancreatic necrosis (CTSPN) in the two groups were compared. Results: On admission, all the clinical parameters, laboratory parameters and CTSPN in the two groups were not significantly different (p > 0.05). However, after treatment, in LT group, the clinical presentation improvement rate and laboratory parameters improvement were significantly higher than those in C group (p < 0.05–0.01), and the acute physiology and chronic health evaluation (APACHE) II score, complication rate, mortality and mean hospital stay in LT group were obviously lower than those in C group (p < 0.05–0.01). The CT score in LT group was much lower than that in C group (p < 0.05). Two weeks after treatment FBI decreased obviously in C group, but not in LT group, and no haemorrhagic complications occurred. Conclusions: LMWH can enhance the effect of conventional treatment for SAP, and can markedly decrease the mortality of SAP. LMWH is a simple, safe, economic and effective method for treatment of SAP. It is can be used in every hospital.

Objective: To investigate the effect on cell proliferation and chemosensitivity of human pancreatic cancer cells Panc-1 after X-linked inhibitor of apoptosis protein (XIAP) and Survivin are inhibited simultaneously, and to compare it with the separate gene suppression strategy by which expression of XIAP or Survivin is inhibited respectively., Methods: Panc-1 (Panc-1-X, Panc-1-S and Panc-1-XS) in which expression of XIAP and/or Survivin was inhibited, was established by using XIAP-shRNA lentiviral and Survivin-shRNA lentiviral we had built. The expressions of XIAP and Survivin mRNA and protein were evaluated by Real-time PCR and Semi-quantitatively Western blot analysis; cell proliferation was investigated by cell counting and colony formation assay; cell apoptosis was investigated by Caspase-3/7 activity assay kit and flow cytometry; gemcitabine (Gem) chemosensitivity was investigated by MTT assay., Results: The pancreatic cell line Panc-1 in which the expression of XIAP and/or Survivin was stablely inhibited was successfully established. The cell proliferation of Panc-1-XS cells decreased significantly. The colony formation rate of Panc-1-XS cells (10.12%± 1.33%), was significantly lower than that of Panc-1-XncSnc cells (96.61% ± 7.89%) and Panc-1 cells (100.28% ± 8.97%) respectively (P<0.05). After being treated by 0.5 mg/L Gem for 24 h, the Caspase-3/7 relative activity of Panc-1-XS cells (15.02 ± 0.57) was significantly higher than that of Panc-1 cells and Panc-1-XncSnc cells (8.87 ± 0.19 and 9.05 ± 0.23, respectively; P<0.05); and the rate of apoptosis of Panc-1-XS cells (24.09% ± 2.75%) was significantly higher than that of Panc-1-XncSnc cells and Panc-1 cells (12.09% ± 1.97% and 12.06% ± 1.22%, respectively; P<0.05). The IC50 value of Panc-1-XS cells [(0.47 ± 0.04) mg/L] was significantly lower than that of Panc-1-XncSnc cells [(2.18 ± 0.13) mg/L] and Panc-1 cells [(2.13 ± 0.18) mg/L, P<0.05]. Further testing also showed that, the IC50 value of Panc-1-XS cells [(0.47 ± 0.04) mg/L] was significantly lower than that of Panc-1-X cells [(0.76 ± 0.07) mg/L] and Panc-1-S cells [(0.87 ± 0.09) mg/L, P<0.05]., Conclusion: The cell proliferation of Panc-1 cells was significantly suppressed and the Gem chemosensitivity was significantly enhanced after expressions of XIAP and Survivin were inhibited simultaneously, and significantly better than the strategy in which expressions of XIAP and Survivin were inhibited separately.

Aim: To determine whether lentivirus-mediated shRNA targeting the X-linked inhibitor of apoptosis protein (XIAP) gene could be exploited in the treatment of pancreatic cancer., Methods: Human pancreatic cancer cells Panc-1, Mia-paca2, Bxpc-3 and SW1990, infected with lentivirus, were analyzed by real-time polymerase chain reaction (PCR). Western blotting was used to examine XIAP protein levels, survivin and p-Akt to confirm the result of real-time PCR and determine the possible mechanism. The 3-(4,5-cimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was used to measure IC₅₀ to determine chemosensitivity to the chemotherapeutic drugs 5-fluorouracil (5-FU) and gemcitabine. A colony assay, MTT assay and a tumorigenicity experiment were used to study cell proliferation in vitro and in vivo. Caspase-3/7 activity, 4',6-diamidino-2-phenylindole-staining and flow cytometric measurements were used to study apoptosis in SW1990 cells., Results: XIAP proteins were found to be differentially expressed among pancreatic cancer cell lines Panc-1, Mia-paca2, Bxpc-3 and SW1990. Data of real-time PCR and Western blotting showed that XIAP was reduced persistently and markedly by lentivirus-mediated shRNA. Downregulation of XIAP by transfection with XIAP shRNA resulted in decreased p-Akt expression. XIAP shRNA also inhibited the growth of pancreatic cancer cells in vitro and in vivo, enhanced drug-induced apoptosis and increased chemosensitivity to 5-FU and gemcitabine. Results also suggest that inhibition of XIAP and subsequent p-Akt depletion may have an anti-tumor effect through attenuating the ability of cancer cells to survive., Conclusion: Lentivirus-mediated gene therapy is an attractive strategy in the treatment of pancreatic cancer and justifies the use of lentivirus in pancreatic cancer gene therapy studies.

The aim of this study was to investigate the inhibitor of apoptosis proteins survivin and XIAP in pancreatic cancer by determining their biological characteristics and expression. XIAP and survivin are potential therapeutic targets for pancreatic cancer, and elucidating their association with cell proliferation and apoptosis may lead to the development of novel treatments for this disease. The human pancreatic cancer SW1990 cell line was infected with lentivirus and then analyzed by real-time PCR, and the results were confirmed by Western blotting. The MTT assay and the determination of caspase-3/-7 activity, DAPI-staining and tumorigenicity were used to measure cell proliferation and apoptosis in the human pancreatic cancer SW1990 cell line and in an experimental pancreatic cancer mouse xenograft model inoculated with the lentivirus-transfected SW1990 cells. The results revealed that the XIAP and survivin proteins were differentially expressed among the pancreatic cancer cell lines, and their decreased expression resulted in the inhibition of cell proliferation in vitro as well as in vivo. These findings suggest that lentivirus-mediated gene therapy targeting XIAP and survivin is a potential and attractive strategy for the treatment of pancreatic cancer.

Aim: To study the diagnosis of hepatocellular carcinoma (HCC) presenting as bile duct tumor thrombus with no detectable intrahepatic mass., Methods: Six patients with pathologically proven bile duct HCC thrombi but no intrahepatic mass demonstrated on the preoperative imaging or palpated intrahepatic mass during operative exploration, were collected. Their clinical and imaging data were retrospectively analyzed. The major findings or signs on comprehensive imaging were correlated with the surgical and pathologic findings., Results: Jaundice was the major clinical symptom of the patients. The elevated serum total bilirubin, direct bilirubin and alanine aminotransferase levels were in concordance with obstructive jaundice and the underlying liver disease. Of the 6 patients showing evidence of viral hepatitis, 5 were positive for serum alpha fetoprotein and carbohydrate antigen 19-9, and 1 was positive for serum carcinoembryonic antigen. No patient was correctly diagnosed by ultrasound. The main features of patients on comprehensive imaging were filling defects with cup-shaped ends of the bile duct, with large filling defects presenting as casting moulds in the expanded bile duct, hypervascular intraluminal nodules, debris or blood clots in the bile duct. No obvious circular thickening of the bile duct walls was observed., Conclusion: Even with no detectable intrahepatic tumor, bile duct HCC thrombus should be considered in patients predisposed to HCC, and some imaging signs are indicative of its diagnosis.

A 18-year-old male patient's case was diagnosed as Degos'disease with pathognomonic skin lesions, accompanied by small bowel perforation, and reported here. Skin histopothological test show that the typical wedge-shaped necrobiosis and lymphocyte inflammatory infiltration. Vessels showed narrowing and thrombosis, with lymphocyte infiltration. Degos' disease is a systemic necrotizing vasculitis. Skin biopsy can confirm its diagnosis. Severe systemic complication should be prevented. Degos' disease should be considered in the differential diagnosis of skin lesions associated with systemic involvement.

Background & Objective: Ezrin protein is a membrane cytoskeletal crosslinker between the cell membrane and cytoskeleton. Increasing evidence has shown that Ezrin may be associated with tumor invasion and progression. This study was to explore the correlation of Ezrin to metastasis of pancreatic carcinoma., Methods: The expression of Ezrin mRNA in fresh specimens of 32 pancreatic carcinoma, 19 metastatic lesions and 10 non-cancerous pancreatic tissues were assessed by reverse transcription-polymerase chain (RT-PCR)., Results: The mRNA expression of Ezrin was significantly higher in pancreatic carcinoma tissues (1.9+/-1.1) than in non-cancerous tissues (0.9+/-0.5)(P<0.05), significantly higher in metastatic lesions (2.6+/-0.8) than in the primary tumor focus (1.9+/-1.1) (P<0.05), and significantly higher in pancreatic carcinoma lesions with metastasis (2.1+/-1.2) than in those without (1.4+/-0.7) ( P<0.05). Ezrin mRNA was differently expressed in tumors with different clinical pathologic characters. It was highly expressed in poorly differentiated or distantly metastatic carcinomas., Conclusions: Ezrin gene is closely related to invasion and metastasis of pancreatic carcinoma, which might be used as a marker in predicting the metastasis of pancreatic carcinoma.

Objective: To explore an effective method of treating serious hepatic injuries., Methods: A retrospective analysis was conducted on 92 consecutive cases of serious hepatic injuries during recent 21 years., Results: Eighty-four cases were treated with operation, and 8 cases with nonoperation management (NOM). Of these patients, 77 (83.5%) were healed, and 15 (16.5%) died. There were complications in 30 patients (31.5%). Hospital stay was 22.3 days., Conclusion: Ultrasonography is a valuable diagnostic measure for hepatic injuries. When hemodynamic was stable, CT scanning was especially necessary for patients with complex injuries. Hemostasis is a key measure during operation. Debridement of nonviable hepatic parenchyma is effective management for the decrease of operative complications. If hypotension cannot be corrected actively, clamping of the upper abdominal aorta is an effective measure for patients with hepatic injuries. Serious hepatic injuries can be treated with NOM selectively.