OBJECTIVE: To assess individualized therapeutic protocol for patients with portal hypertension on the basis of accumulated knowledge about the mechanism of portal hypertension.
DATA SOURCES: Patients data on shunt and other surgical procedures from Ruijin Hospital, Shanghai, China and the published papers.
RESULTS: The direction of blood flow of the collateral vessels in the gastro-splenic region is an important factor in deciding surgical strategy because there is a close relationship between surgical risk and the classification of liver function. Clinically it is confirmed that each patient needs an individualized surgical procedure and that prophylactic operation is suitable for patients with splenomegaly, splenism associated with serious esophageal varices and hemorrhagic tendency under endoscopy but acceptable liver function. The shunt diameter (SD) (SD=0.67×PVD) is determined in our patients according to individualized hemodynamics. The rehemorrhagic rate after shunt being higher than that in others may be related to lesioned gastric mucosa caused by portal hypertension or bleeding and temporary melena. This finding is good for prevention of hepatic encephalopathy. The life quality and labor ability of patients will be improved because of hepatopetal flow in the portal vein. With strict indications for reoperation, selective operation is performed as soon as possible when hemorrhage is controlled conservatively and liver function improved. Once the patient with cirrhosis associated with portal hypertension is scheduled for liver transplantation, treatment of hemorrhage should aim to keep the patient in good condition and to avoid the protocol that may be disadvantageous to liver transplantation in the future.
CONCLUSION: Surgical procedures for patients with portal hypertension should follow the principle of individualization. To obtain the best outcome, the choice of reasonable surgical procedure is expected.

OBJECTIVE: To review the current state of research in non-alcoholic fatty liver disease (NAFLD).
DATA RESOURCES: Searching Medline (1994-2002) and Chinese Medical Journals Index (1998- 2002) for articles on NAFLD.
RESULTS: NAFLD is a new and challenging field with increasing recognition although its pathogenesis is poorly understood. “Two hits” hypothesis is still the leading theory guiding current research.
CONCLUSIONS: Genetic study is a promising way that might lead to breakthrough in NAFLD research. NAFLD study in China is at an initial stage and there is a long way to go.

OBJECTIVES: To investigate the activity alterations of enzymes in intestine grafts after liver/small bowel transplantation in rats and the relations of these changes to immune rejection of grafts.
METHODS: A model of liver/small bowel transplantation (LSBT) was established in closed colony SD and Wistar rats. The activity of enzymes including triphosphatase (ATPase), alkalinophosphatase (AKP), acytelcholinesterase (AchE), oxidesynthase (NOS) and monoamine oxidase (MAO) in bowel grafts was studied histochemically at regular postoperative intervals.
RESULTS: The activity of enzymes in the wall of the grafts disappeared eventually in isolated small bowel transplantation (SBT) rats. In contrast, the activity in LSBT rats remained and recovered postoperatively.
CONCLUSIONS: The rejection in grafted intestine could be prevented or delayed in LSBT rats. The changes in the activity of enzymes and neurons might be used to detect the rejection and function of the graft.

OBJECTIVE: To observe the effect of tail vein injection with donor hepatocyte and/or splenocyte on islets xenotransplantation rejection.
METHODS: New-born male pigs and BALB/C mice were selected as donors and recipients respectively. Islets xenotransplantation was performed in recipients just after the third time of tail vein injection with donor hepatocytes and/or splenocytes. Macrophage phagocytosis, NK killing activity, T lymphocyte transforming function of spleen cells, antibody forming function of B lymphocytes, and T lymphocyte subsets were taken to monitor transplantation rejection. The effects of this kind of transplantation were indicated as variation of blood glucose and survival days of recipients.
RESULTS: Streptozotocin (STZ) succeeded in inducing diabetes mellitus models of mice. Pre-injection of donor hepatocytes, and splenocytes or their mixture via tail vein was effective in preventing donor islets transplantation from rejection, which was demonstrated by the mentioned immunological marks. And each group of transplantation could decrease the blood glucose of recipients and prolong the survival days. Pre-injection of mixture of donor hepatocytes and splenocytes was more effective in preventing rejection than pre-injection of donor hepatocytes or splenocytes separately.
CONCLUSION: We propose that pre-injection of donor hepatocytes, splenocytes separately or their mixture before donor islets transplantation is a good way to prevent rejection.

OBJECTIVE: To assess the immune status of auxiliary liver transplantation and to clarify the immune protection of auxiliary liver to other allograft.
METHODS: Immunological markers and pathological changes in 3 patients undergoing auxiliary liver transplantation were analysed.
RESULTS: The lower the concentration of immunosuppressive agent, the less the rejection and the milder the intensity in the 3 patients. The function of allograft after auxiliary liver transplantation was excellent.
CONCLUSIONS: Patients are in a low immune reaction state after auxiliary liver transplantation. Auxiliary liver can protect other allografts by related immunological mechanisms. The side-effects of low-concentration immunosuppressive agents on auxiliary liver and other allografts are mild.

OBJECTIVE: To assess the value of argon supper-cryosurgery for 42 patients with middle and late stage liver cancer.
METHODS: Forty-two patients who had received argon supper-cryosurgery were analyzed retrospectively in terms of their clinical characteristics as well as the performance of argon supper-cryosurgery.
RESULTS: All patients were ameliorated in symptoms shortly after the operation, including pain alleviation, psyche straightening up, alpha-fetoprotein descending or recovery. Jaundice occurred in 1 patient and intraabdominal hemorrhage in 2. The levels of aspartate transaminase and alanine transaminase in all patients were elevated 1 month after the operation, and normalized after protective therapy of the liver. No operative death was noted.
CONCLUSIONS: Cold and heat reversed therapy of argon supper-cryosurgery can drastically destroy tumor tissue, especially the tumors which are too large to resect or close to the large vessels. It is applicable to increase the operative rate, decrease the operative death rate, and enlarge the therapeutic scope.

OBJECTIVE: To compare the merits of hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned liver lobe with those of Pringle’s maneuver.
METHODS: A total of 68 patients were divided into two groups A and B. In the group A (n=38), Pringle’s maneuver was employed, whereas in the group B (n=30), hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned side of the liver was used. Peri-operative blood loss, postoperative bleeding and drainage, time of liver function recovery as well as incidence of postoperative complications were compared between the 2 groups.
RESULTS: The mean perioperative blood loss, the mean amount of postoperative bleeding and drainage, the time of liver function recovery as well as incidence of postoperative complications were significantly higher in the group A than in the group B (P<0.01).
CONCLUSION: Hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned side of the liver is superior to Pringle’s maneuver.

OBJECTIVE: To assess the techniques for surgical excision of giant primary carcinoma in the medial liver lobe.
METHODS: Operative managements, complications and their causes during and after resection of giant carcinoma in the medial liver lobe were analyzed retrospectively in 166 cases treated from October 1996 through December 2001.
RESULTS: Of the 166 patients, 123 (74.1%) underwent tumor resection and 43 (25.9%) regular lobectomy, including left trilobectomy (8, 4.8%), medial lobectomy (21, 12.7%), right anterior lobectomy (11, 6.6%), and hemihepatectomy (3, 1.8%). All patients were subjected to surgery with intermittent interruption of the first porta hepatis under normothermia. The total interruption time was 7-68 minutes and average time was 24.5 minutes. The maximum single interruption time was 41 minutes. Intraoperative blood loss was 50-4000 ml, averaging 726 ml. The maximum blood transfusion was 5200 ml, averaging was 811 ml, and transfusion was not needed in 54 patients. Postoperative complications occurred in 9 patients (5.4%), of whom, 2 (1.2%) died of liver failure and acute respiratory distress syndrome respectively.
CONCLUSIONS: An adequate reserve of liver function is a prerequisite for a smooth recovery after operation. Careful intraoperative management is crucial to decrease postoperative complications.

OBJECTIVE: To investigate the origin of blood supply to cavernous hemangioma of the liver (CHL).
METHODS: To observe the relation of cavernous hemangioma of the liver to the hepatic artery and portal vein, we performed serial selective hepatic arteriography in 22 patients. Five patients after ligation of the right hepatic arteries underwent portography and liver staining by injection of methylene blue into the portal veins and 2 patients had hepatic specimens resected, which were made into a model cast by filling the hepatic veins (yellow) and portal venous branches (blue) with methyl methacrylate after vascular lavage.
RESULTS: Serial selective hepatic arteriography showed that hepatic arteries and hemangioma were displayed simultaneously, and that hemangioma was supplied by one to numerous arterial branches. In the portal phase of portography, contrast medium failed to enter the tumor and the intrahepatic branches of the portal vein were pushed aside by the tumor; in the liver parenchymal phase, however, the tumor appeared to be a low-density area. Hepatic arteriography and portography revealed that the fistula between the artery and portal vein may not be existed. The liver stained with methylene blue showed that the normal hepatic parenchyma could be stained with deep blue; in contrast, the tumor was not stained at all. The casting specimens showed that the eroded tumor left a round vacant area because of its total shedding, and no blue stained branches of the portal vein extended into the tumor.
CONCLUSION: Blood supply of CHL may originate from the hepatic artery.

OBJECTIVE: To determine whether the anatomic characteristics of the left hepatic vein, middle hepatic vein and common trunk could influence the operation procedures of left hepatectomy.
METHOD: Fifteen fresh human liver specimens were dissected and their anatomic characteristics were recorded.
RESULTS: The left hepatic vein and middle hepatic vein formed the common trunk of 1.2±0.4 cm in length in the 15 liver specimens. The angle between the left hepatic vein and middle hepatic vein was 91±18.3°.
CONCLUSION: The left hepatic vein should not be sutured and ligated blindly in left hepatectomy because there might be a potential damage to the middle hepatic vein.

OBJECTIVE: To establish a mouse model of HCV core expression and investigate the toxicity of HCV core protein or the possible pathogenic effects.
METHODS: A series of vaccinia viral expression vectors were engineered to express 5’ portion of HCV genes including 5’ non-translated region (NTR), core protein, and portion of the E1 gene. These HCV sequences were fused to a luciferase reporter gene and inserted into a vaccinia virus expression vector (pSC11) adjacent to the vaccinia virus promoter, p7.5. The recombinant DNA constructs were packed into infectious recombinant chimeric viruses. The expression of HCV core protein was examined in cultured cells after infection with these viruses. Death of the infected mice was investigated by specific correlation to the expression of HCV core protein and its expression levels.
RESULTS: The recombinant virus (VNCE-LUA) expressed HCV core protein and an envelopeluciferase fusion protein in cultured cells. When Balb/c mice were inoculated intraperitoneally with more than 107 pfu per mouse of VNCE-LUA, death occurred immediately. The mortality was dependent on the amount of VNCE-LUA virus inoculated. All mice inoculated with 3×108 pfu of VNCE-LUA died within 4 days of infection and 50% of mice inoculated with 3×107 pfu of VNCE-LUA died within 7 days of infection. No death occurred in mice inoculated with 3×108 pfu of a control recombinant vaccinia virus, which expressed luciferase but not the HCV core and envelope proteins. Deletion of core sequences from VNCE-LUA rapidly reduced the mortality of infected mice whereas deletion of envelope sequence did not. SCID mice infected with VNCE-LUA died 2-3 days after infection, suggesting that the HCV-core induced mortality is not dependent on host T- or B-cell responses to core protein.
CONCLUSIONS: HCV core protein can be lethal to mice when expressed in vivo and this specific lethality is independent of T-cells or B-cells. The findings and model itself provide a useful tool for further investigation on potential pathological effects as well as the potential toxicity of the HCV core protein.

OBJECTIVE: To identify a gene engineering antibody against cystic echinococcosis in liver.
METHODS: A single chain of variable fragment of human antibodies (ScFvs) was selected from the library by using affinity selection technique with the recombinant antigen on solid surface. The positive clones were demonstrated by ELISA and their DNA sequences were also determined.
RESULTS: The DNA sequence data showed that the antibody gene is composed of 768bp. In addition, a specific combination capacity with recombinant Echinococcus granulosus antigen B (r-EgB) was demonstrated by ELISA.
CONCLUSION: The obtained gene engineering antibody against r-EgB may have potential implications in immunological treatment and drug targeting delivery.

OBJECTIVE: To obtain recombinant antigen for development of anti-HEV ELISA kit and vaccine against hepatitis E virus infection.
METHODS: A 492 base cDNA was collected from 5’-terminus of open reading frame 2 (ORF2) among epidemic hepatitis E virus (HEV) isolated from Xinjiang, Western China. The fragment was digested with BamH Ⅰ and EcoRⅠ, and inserted into vector pGEX-4T-3 which was also digested by the same enzyme. The recombinant plasmid was transformed into E.coli TG-1 and the fusion protein expressed was confirmed by Western blot analysis using serum of a patient with hepatitis E.
RESULTS: The recombinant plasmid was identified and confirmed with enzyme digestion, polymerase chain reaction (PCR) and sequencing, respectively. A protein band of about 46 kDa was demonstrated by SDS-PAGE and designated GST-pORF2. The result of Western blot analysis suggested that the fusion protein reacted with anti-HEV positive sera at a dilution of 1∶100.
CONCLUSION: The recombinant protein GST-pORF2 may be useful in developing anti-HEV ELISA kit and vaccine against hepatitis E virus infection.

OBJECTIVE: To determine the effect of Salviae miltiorrhizae on cirrhosis and portal hypertension by inhibiting nitric oxide synthase type II (NOSII) in rats.
METHODS: Real time RT-PCR was used to detect the expression of NOSII mRNA. The enzymatic activity of nitric oxide synthase and the circulating levels of nitric oxide (NO), systemic and portal hemodynamics, and quantification of cirrhosis were measured with highly sensitive methods. Traditional Chinese medicine was utilized to treat cirrhotic rats and the function of NO was evaluated. Double-blind method was applied in the experiment constantly.
RESULTS: The concentration of NO increased markedly at all stages of cirrhosis, and so did the enzymatic activity of NOS, and the iNOSmRNA expressed greatly. Meanwhile the portal-venous-pressure (PVP), portal-venous-flow (PVF) increased significantly. NO, NOS and iNOSmRNA were positively correlated to the quantity of hepatic fibrosis. Salviae miltiorrhizae significantly inhibited NO production and inhibited the expression of iNOSmRNA.
CONCLUSIONS: The increased hepatic expression of NOSII is one of the important factors causing cirrhosis and portal hypertension. Salviae miltiorrhizae significantly ameliorates cirrhosis and portal hypertension.

OBJECTIVE: To study the relations among the expression of the multidrug resistance associated-protein (mrp) gene and clinicopathologic features, the influence of α-fetoprotein (AFP), and prognosis of patients who received adjuvant chemotherapy after resection of primary hepatocellular carcinoma (HCC).
METHODS: The expression of the mrp gene encoding MRP and mRNAmrp was determined in tissues from 54 untreated patients with HCC, adjacent tissues from 24 patients with HCC and archival paraffin-embedded tissues from 12 patients with posthepatitic cirrhosis. The relationship between the mrp gene expression and the change level of AFP was analyzed in the 24 postoperative HCC patients whose AFP level was measured after 2 weeks. All of the HCC patients were followed up.
RESULTS: The percentage of positive expressions of MRP and mRNAmrp in the three kinds of tissues was 57.40%, 25.00%, 16.67%, and 72.22%, 37.50%, 33.33% respectively. Significant difference was noted in the untreated HCC tissue, compared to the other two tissues (P<0.05). No difference existed between the mrp gene expression and such clinicopathologic findings, as age, sex, and tumor size (P> 0.05), but the expression was related to the degree of differentiation of HCC (P<0.05). The effective rate of AFP in the mrp gene positive expression group or postoperative chemotherapeutic patients was lower than that in the negative group (P<0.05). Although no difference was seen in the 1-, 3-, 5-year survival rates of HCC patients (P>0.05), the mean survival time of postoperative HCC patients or the negative mrp gene expression group was longer than that of the positive group (P<0.05).
CONCLUSIONS: Multidrug resistance (MDR) of HCC is related to mrp gene expression and initiates the intrinsic MDR. Detection of mrp gene expression is of great significance in accessing chemotherapeutic resistance of HCC, which provides evidence for reversing MDR in HCC. The mrp gene may be a useful marker in detecting prognosis of HCC patients because its expression is correlated with tumor differention and mean survival time of the patients.

OBJECTIVE: To investigate the effect of somatostatin analogue octreotide on angiogenesis induced by hepatocellular carcinoma (HCC) in vivo.
METHODS: LCI-D20 corneal micropocket model in nude mouse was used to dynamically observe angiogenesis under a stereoscopic zoom microscope and a digital camera system and to evaluate the effect of octreotide on angiogenesis. Male nude mice were subcutaneously implanted with LCI-D20 tumor tissues for tumor xenograft studies. Microvessel density in CD34-stained tumor sections was analyzed by immunohistoche- mical SP method.
RESULTS: Tumor tissues from LCI-D20 implanted into the corneal micropocket induced angiogenesis. When animals received systemic octreotide treatment, angiogenesis response in the cornea of mice was moderate, the appearance of vascular buds was delayed, and the new capillaries were sparse and grew slowly. Compared with the control group, the neovascularization induced by HCC in the cornea of mice was markedly inhibited on day 7, 9, 12, 15, 18 and 21 after implantation in the octreotide-treated group (P<0.05). Systemic administration of octreotide produced a significant suppression of the growth of LCI-D20.Immunohistochemical studies of tumor tissues revealed decreased microvessel density in the octreotide-treated animals as compared with the controls (21.7±4.27 versus 31.8±3.87, P<0.01).
CONCLUSION: Somatostatin analogue octreotide is able to inhibit angiogenesis induced by HCC in vivo and may provide a new approach to the treatment of HCC.

OBJECTIVE: To use 2.2.15 cell line to determine the effects of mycophenolate acid (MPA) on hepatitis B virus (HBV) replication and viral protein synthesis in vitro.
METHODS: The 2.2.15 cells were treated with different concentration of MPA (1-50 μg/ml) for 12 days. HBsAg and HBeAg were detected in the supernatant fluid by ELISA and intracellular HBV DNA was analyzed quantitatively by slot blot hybridization.
RESULTS: MPA could suppress the expression of HBsAg and HBeAg, and the higher concentration of MPA induced lower expression of HBsAg and HBeAg. The suppression rates of MPA for HBsAg and HBeAg at a concentration of 50 μg/ml were 34.2% and 24.1% respectively. The expression of HBV DNA was only 49% as compared with controls when treated with MPA at a concentration of 50 μg/ml.
CONCLUSIONS: Mycophenolate acid can suppress the expression of HBsAg and HBeAg as well as the replication of HBV DNA in the 2.2.15 cell. The suppressive degree is dose-dependent.

OBJECTIVES: To detect blood AFPmRNA in the nude mice bearing with human hepatocellular carcinoma (HCC) by using nested reverse transcriptase polymerase chain reaction (nested RT-PCR), and assess its significance in HCC distant metastasis.
METHOD: We detected 20 blood samples from the nude mice bearing with human HCC by nested RT-PCR to find out AFPmRNA.
RESULT: AFPmRNA was detected in 6 blood samples from the nude mice bearing with human HCC (30.0%), in which 4 mice developed distant metastasis.
CONCLUSION: AFPmRNA may be used as an efficient and sensitive marker to detect blood spread of HCC cells. It can predict the occurrence of HCC distant metastasis.

OBJECTIVE: To investigate the correlations between HBV DNA levels and viral antigen concentrations in patients with chronic hepatitis B and their significance in clinical practice.
METHODS: The HBV DNA levels and serological markers of 118 patients with chronic hepatitis B and 87 patients with liver cirrhosis who had not been treated with antiviral drugs were determined as well as the other parameters relevant to liver function.
RESULTS: The HBV DNA levels of the patients with chronic hepatitis and cirrhosis were expressed as geometric mean±SD, 3.83×10\+6±1.34 copies/ml and 6.98×10\+5±1.29 copies/ml, and their HBeAg concentrations expressed as the luminescent values rate of sample to control (s/co) were 35.40±1.26 and 4.05±1.28, respectively. The HBV DNA levels in HBeAg positive group were significantly higher than those in HBeAg negative group (P<0.0001). The correlation coefficient between HBV DNA level and HBeAg or HBsAg concentration was only 0.273 and -0.12. During the recovery of hepatic function, the reduction of ALT or AST in patients with high viral content was significantly lower than that in patients with low viral content. No correlation was observed between HBV DNA and ALT levels.
CONCLUSION: There are significant correlations between HBV DNA level and HBeAg concentration, but the coefficient is lower. HBV DNA level is not significantly related to ALT, but it could affect the recovery of liver function.

OBJECTIVE: To develop a surgical model of acute hepatic failure.
METHODS: Hepatectomy was performed in rats according to the method described by Higgins and Anderson. Ninety percent liver resection (removing the left lateral, median, and right lateral lobes) (n=7) and 95% liver resection leaving only half of the caudate lobe (n=13) were performed. Hypoglycemia was corrected by giving 20% glucose in the drinking water, coupled with repeated intraperitoneal injection of 5% glucose adapted to glycemia. While the survival rate, alanine transaminase (ALT) and bilirubin were observed.
RESULTS: 95% liver resection decreased survival rates of the rats from 86% (90% liver resection) to 23% (P<0.05), and increased bilirubin levels (4.04±2.84 mg/dL vs. 1.25±1.85 mg/dL [90% liver resection]).
CONCLUSION: 95% liver resection is a good rat model for acute hepatic failure.

OBJECTIVE: To assess the influence of different drainage procedures on the levels of serum endotoxin and tumor necrosis factor (TNF) in patients with malignant obstructive jaundice (MOJ).
METHODS: The levels of endotoxin and TNF in 46 patients with MOJ were measured before and after cholangiojejunostomy (CJ) or external bile drainage (EBD).
RESULTS: In the CJ group, the levels of postoperative serum endotoxin and TNF 10 days after operation were significantly lower than those before operation (P<0.01). In the EBD group, no significant changes were observed in endotoxin and TNF levels before and after operation (P>0.05). No significant differences were seen between the two groups before operation (P>0.05), but the levels of endotoxin and TNF in the CJ group were significantly lower than those in the EBD group after operation (P<0.01).
CONCLUSIONS: Cholangiojejunostomy other than external bile drainage can decrease the levels of serum endotoxin and TNF effectively, although both of them are able to release jaundice. Cholangiojejunostomy should be performed as soon as possible for patients with unresectable malignant tumor.

OBJECTIVE: To detect bile anaerobic bacteria and antibiotic susceptibility in 59 patients with gallstones who had had cholecystectomy.
METHODS: BACT/ALERT 120 microbe detection system and SCEPTOR microbe detection system were used to detect bile anaerobic bacteria, antibiotic susceptibility.
RESULTS: The ratio of anaerobic bacteria to the patients examined was 52.5% (31/59). Obligate anaerobe bile culture showed positive results in 4 patients. B. fragilis (37.8%) was the major type of anaerobic bacteria in bile. Most (81.8%) of anaerobic bacteria were sensitive to metronidazole, and imipenem was suitable for β-lactamase bacteria.
CONCLUSIONS: Culture of anaerobic bacteria in logarithmic phase can improve the positive rate of the culture. There are some relations between anaerobic infection and gallstone formation.

OBJECTIVE: To estimate the operative mortality in patients with malignant obstructive jaundice.
METHODS: Twelve risk factors were analyzed using multivariate discriminant analysis in 90 patients who had been operated on.
RESULTS: Operative mortality was significantly related to the following factors: age, duration of jaundice, packed RBC volume, white blood cell count and concentration of blood urine nitrogen; it was not significantly related to diseases and types of operation. The following formula was obtained: packed RBC volume×0.09954-age×0.04018- blood urine nitrogen×0.23693-duration of jaundice× 2.07388-WBC count×0.21118+ 5.26593. With this formula, an operative mortality of 77.8% was predicted.
CONCLUSION: With a positive value from the formula, the patient should be operated on; otherwise non-operative treatment is advocated.

OBJECTIVE: The main cause of bile duct injury (BDI) at laparoscopic cholecystectomy is misidentification of the common bile duct as the cystic duct (CD). The aim of this article is to introduce a modified technique, i.e., three-dimensional identification of the cystic infundibulum (CI)-CD junction, to prevent misidentification-induced BDI during laparoscopic cholecystectomy.
METHODS: The CI was extensively dissected to expose its anterior, interior-superior and inferior-dorsal aspects. With the CI nearly circularly dissected out, the CI and the appearance-indicated CI-CD junction might be three-dimensionally identified and the reality of the CI-CD junction as well as the reality of the CD could be precisely judged.
RESULTS: Overall 10 BDIs were documented in this group. Since BDI occurred in 8 of 4382 patients receiving laparoscopic cholecystectomy, the technique for prevention of misidentification-induced BDI was established. Among the late batch of 7618 patients, only two BDIs were noted.
CONCLUSIONS: Three-dimensional identification of the CI-CD junction is a reliable, feasible and relatively low experience-dependent technique to prevent most of misidentification-induced BDI.

OBJECTIVE: To summarize our experience in treatment of chronic pancreatitis (CP).
METHODS: Clinical data on 245 patients with CP treated at our hospital from May 1983 to October 2001 were reviewed.
RESULTS: Of the 245 patients, 122 suffered from CP for a year (49.8%) and 191 for 5 years (78.0%). The rate of positive diagnosis of B-ultrasound, CT, ERCP, B2-Ty-Para-aminobenzoic acid (PABA) for CP was 74.2%, 80.7%, 76.5% and 72.8%, respectively. 169 patients (69.0%) received surgical treatment. After the operation, 98.8% of the 169 patients experienced decreased pain with a complication rate of 1.2%.
CONCLUSION: Early diagnosis and appropriate operative time and management are of vital importance in improving patients’ quality of life and controlling the natural history of the disease.

OBJECTIVE: To examine the feasibility and significance of 13C-Hiolein breath test in evaluating chronic pancreatitis-related exocrine insufficiency and efficacy of enzyme treatment.
METHODS: The 13C-Hiolein breath test was used in 8 healthy volunteers (group 1), 8 chronic pancreatitis (CP) patients without steatorrhea (group 2), and 8 CP patients with steatorrhea (group 3). To evaluate the function of pancreatic exocrine, 13CO2 was determined following 13C-Hiolein diet. The 13C-Hiolein test was repeated in group 3 after enzyme supplement therapy.
RESULTS: Administration of 13C-Hiolein diet resulted in significantly higher cumulative percent dose of 13C recovery per 6 h (cPDR/6 h) and maximal PDR (PDRpeak) in the healthy controls (group 1) than the CP patients with steatorrhea (group 3) (11.22%±1.22% and 6.11%±0.59% vs. 2.87%±0.73% and 1.53%±0.36%, respectively, both P<0.01). In the CP patients with steatorrhea (group 3), a repeated test after enzyme supplementation therapy showed a significant elevation of both cPDR/6 h and PDRpeak (9.03%±0.84% and 2.33%±0.47%, both P<0.01 compared with those before enzyme treatment), but cPDR/6 h remained significantly lower than that in the healthy volunteers (group 1, P< 0.05). Both cPDR and PDRpeak in the CP patients without steatorrhea (group 2) were similar to those in the healthy controls (group 1, both P>0.05).
CONCLUSION: The results of 13C-Hiolein breath test well reflect fat metabolism status in CP patients, and the test can be used to monitor the efficacy of pancreatic enzymes therapy.

OBJECTIVE: To study the risk factors for death of patients with severe acute pancreatitis (SAP) within 24 hours after admission.
METHODS: Clinical and laboratory data of 74 patients with SAP were analyzed retrospectively. The 27 possible risk factors for death within 24 hours after admission were investigated using logistic regression (SPSS software package 10.0), and the equation of logistic regression was set up.
RESULTS: Among the 27 possible risk factors, arterial pH, APACHE Ⅱ scores, early shock, multiple organ failure were associated with mortality. Single logistic regression analysis of the 27 parameters showed that early shock, pleural effusion, arterial pH, complications and APACHE Ⅱ scores were associated with death of SAP patients, but using multiple logistic regression analysis showed that only acidosis (pH<7.35) was associated with death.
CONCLUSION: To maintain the function of organs and correct dysequilibrium of water-electrolyte and acid-base in early treatment of SAP is essential to lower the mortality.

OBJECTIVE: To investigate the effect of glucocorticoids on systemic inflammatory mediator release in rats with acute pancreatitis and the outcome of dexamethasone in treatment of acute pancreatitis.
METHODS: Sixty-eight Wistar rats were divided into sham, acute pancreatitis, and treatment (intravenous dexamethasone 0.5 mg/kg) groups. Experimental acute pancreatitis was induced by the injection of 5% sodium taurocholate (0.1 ml/100 mg body weight) into the pancreatic-biliary duct. The blood samples were obtained and examined for 6-keto-PGI1α, TXB2 and IL-6 postoperatively at 3, 6 and 12 hours, respectively. The pancreatic samples were evaluated by a blinded method. Twelve-hour survival rate was determined and compared between the groups.
RESULTS: The high serum concentrations of 6-keto-PGI1α, TXB2 and IL-6 were noted in the rats with acute pancreatitis associated with pancreatic hemorrhage and necrosis. Their 12-hour survival rate was 42.9%. The rats in the treatment group survived with significantly reduced serum concentrations of 6-keto-PGI1α, TXB2 and IL-6 (P<0.05). Their pancreatic morphology was normal.
CONCLUSION: Dexamethasone may reduce the serum concentration of 6-keto-PGI1α, TXB2, and IL-6, and the severity of acute pancreatitis while increasing the survival rate of rats with acute pancreatitis.

OBJECTIVE: To study the changes of platelet endothelial cell adhesion molecule-1 (PECAM-1) expression on polymorphonuclear leukocytes (PMNs) in peripheral circulation and pancreatic microcirculation in rats with acute edematous pancreatitis (AEP).
METHODS: The model of AEP was established with 50 Wistar rats, and the changes of PECAM-1 expression on PMNs from the splenic vein and inferior vena cava were determined by flow cytometry.
RESULTS: PECAM-1 expression on PMNs showed no significant difference between pancreatic microcirculation and peripheral circulation at AEP2h and AEP4h time points. From the AEP4h to the AEP8h time point, PECAM-1 expression in peripheral circulation was up-regulated, but PECAM-1 expression in pancreatic microcirculation was down-regulated. PECAM-1 expression had a significant difference between pancreatic microcirculation and peripheral circulation at the AEP8h time point (P<0.05).
CONCLUSION: PECAM-1 expression on PMNs is in a converse way between pancreatic microcirculation and peripheral circulation in AEP.

OBJECTIVES: To survey the gene expression profiles in pancreatic carcinoma by using cDNA microarray and detect target genes for further study.
METHODS: Three mixed samples from 2 cases of normal pancreatic tissue and 4 cases of moderate-differentiated pancreatic carcinoma were studied by means of cDNA microarray consisting of 18 000 genes.
RESULTS: 1484 and 1353 different expressed genes were observed in two cancer samples respectively. We identified 455 genes altered with the same tendency in both samples, including 102 up-regulated and 353 down-regulated genes. There were 274 known genes and 181 unknown genes; 27.8% and 52.0% genes respectively had an expression level in cancer that was 2-fold higher or lower than that in normal samples. Tumor suppressor genes, growth factors and receptor genes, signal conduction genes, transcription factor genes were identified.
CONCLUSIONS: cDNA microarray is an efficient and high-throughout method to investigate gene expression profiles in pancreatic carcinoma. MBD1, EDG1 and gene hypermethylation mechanism would play an important role in the pathogenesis of pancreatic carcinoma.

OBJECTIVES: To investigate the expressions of E-cadherin and alpha-catenin in pancreatic carcinoma and their relationship with biological behaviors, and clarify the mechanism of invasion and metastasis of pancreatic cancer.
METHODS: The expressions of E-cadherin and alpha-catenin was examined in 47 patients with infiltrative ductal adenocarcinoma of the pancreas and 12 specimens of normal pancreatic tissues by immunohistochemical technique (PicTureTM two-step method). Proliferation cell nuclear antigen (PCNA) was tested as an index of the proliferation degree of pancreatic cancer cells.
RESULTS: The immunoreactivity of E-cadherin and alpha-catenin was expressed by normal ductal and acinar cells with strong membranous staining at the intercellular border in 12 specimens of normalpancreatic tissues. The abnormal rate of E-cadherin expression in pancreatic cancerwas 53.2% (25/47), and it was significantly related to differentiation, high proliferation degree and lymph node and liver metastases (P<0.01, 0.05, 0.05 and 0.01, respectively). 61.7% patients with pancreatic cancer (29/47) showed abnormal expression of alpha-catenin. There was a good correlation among alpha-catenin expression, histological grade, and lymph node and liver metastases (P<0.05,0.05 and 0.01, respectively). No significant association was found among abnormal expressions of E-cadherin and alpha-catenin, tumor size, invasion, and 1-year survival rate of patients (P>0.05, all). There was a positive relationship between the expressions of E-cadherin and alpha-catenin in the 47 patients with pancreatic cancer (P<0.01, r=0.88).
CONCLUSIONS: Pancreatic cancer likely occurs in case of the inactivation of E-cadherin and alpha-catenin genes and abnormal expression of proteins, which significantly correlate with tumorigenesis, proliferation, differentiation, and lymph node or liver metastasis of pancreatic cancer.