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Objective: To isolate and identify the side population (SP) cells in pancreatic cancer and investigate the role of phosphatidylinositol 3-kinase/mammalian target of rapamycin (PI3K/mTOR) pathway in the survival and proliferation of them., Methods: Pancreatic cancer cell of the lines PANC-1, BXPC-3, ASPC-1, PC-3, and SW-1990 were cultured. Hoechst 33432 staining and fluorescence-activated cell sorter (FACS) were used to sort the SP cells. Verapamil, inhibitor of ATP binding cassette (ABC) transporter, was added before the Hoechst 33342 inoculation to observe its influence on the SP proportion. Media with LY294002, specific inhibitor of P13K, or rapamycin, specific inhibitor of mammalian target of rapamycin (mTOR), were used to culture PANC-1 cells to observe the survival of cells. Twenty-one NOD-SCID mice were randomly divided into 7 equal groups. Four groups were inoculated subcutaneously with SP cells of the concentrations of 5x10(5), 5x10(4), 5x10(3), or 1x10(3) at the right axillary fossa and with non-SP cells at the left then Hoechst 33342 staining, flow cytometric sorting were used to detect the content of SP cells at the left axillary fossa. The other 3 groups were injected subcutaneously with non-Hoechst 33342 treated cells of the concentrations of 5x10(5), 5x10(4), 5x10(3), or 1x10(3) at the right axillary fossa and PBS at the left axillary fossa. Ten weeks later the mice were killed to undergo pathological examination., Results: All cell lines were found to exhibit verapamil-sensitive SP cells except BXPC-3 cells. The SP cell proportion of the PANC-1 cells was 7.84%. No SP cell was found in the cells treated with verapamil. The colony-formation ability of the SP cells was (43.7+/-3.1)%, significantly higher than those of the non-SP cells and cells without Hoechst 33342 cells [(8.3+/-1.6)% and (10.2+/-1.9)% respectively, both P=0.000]. The tumorigenic ability of the SP cells was 100 times as those of the non-SP cells and Hoechst 33342 un-treated cells. After addition of LY294002 and rapamycin the fractions of the SP cells in the in PANC-1 cells decreased from (7.60+/-0.27)% to (1.90+/-0.22)% and (1.14+/-0.20)% respectively, both P=0.000, and they preferentially inhibited the SP cells rather than non-SP cells., Conclusion: SP cells are enriched in pancreatic cancer stem-like cells. PI3K/mTOR pathway is critical for pancreatic SP cells maintenance that can be selected as a new target for inhibiting cancer stem-like cells.

Aim: To investigate the persistence of side population (SP) cells in pancreatic cancer and their role and mechanism in the drug resistance., Methods: The presentation of side population cells in pancreatic cancer cell line PANC-1 and its proportion change when cultured with Gemcitabine, was detected by Hoechst 33342 staining and FACS analysis. The expression of ABCB1 and ABCG2 was detected by real-time PCR in either SP cells or non-SP cells., Results: SP cells do exist in PANC-1, with a median of 3.3% and a range of 2.1-8.7%. After cultured with Gemcitabine for 3 d, the proportion of SP cells increased significantly (3.8% +/- 1.9%, 10.7% +/- 3.7%, t = 4.616, P = 0.001 < 0.05). ABCB1 and ABCG2 expressed at higher concentrations in SP as compared with non-SP cells (ABCB1: 1.15 +/- 0.72, 5.82 +/- 1.16, t = 10.839, P = 0.000 < 0.05; ABCG2: 1.16 +/- 0.75, 5.48 +/- 0.94, t = 11.305, P = 0.000 < 0.05), which may contribute to the efflux of fluorescent staining and drug resistance., Conclusion: SP cells with inherently high resistance to chemotherapeutic agents do exist in pancreatic cancers, which may be candidate cancer stem cells contributing to the relapse of the tumor.

Aim: To observe whether pancreatic and duodenal homeobox factor-1 enhances the differentiation of pancreatic ductal epithelial cells into insulin-producing cells in vitro., Methods: Rat pancreatic tissue was submitted to digestion by collegenase, ductal epithelial cells were separated by density gradient centrifugation and then cultured in RPMI1640 medium with 10% fetal bovine serum. After 3-5 passages, the cells were incubated in a six-well plate for 24 h before transfection of recombination plasmid XlHbox8VP16. Lightcycler quantitative real-time RT-PCR was used to detect the expression of PDX-1 and insulin mRNA in pancreatic epithelial cells. The expression of PDX-1 and insulin protein was analyzed by Western blotting. Insulin secretion was detected by radioimmunoassay. Insulin-producing cells were detected by dithizone-staining., Results: XlHbox8 mRNA was expressed in pancreatic ductal epithelial cells. PDX-1 and insulin mRNA as well as PDX-1 and insulin protein were significantly increased in the transfected group. The production and insulin secretion of insulin-producing cells differentiated from pancreatic ductal epithelial cells were higher than those of the untransfected cells in vitro with a significant difference (1.32 +/- 0.43 vs 3.48 +/- 0.81, P < 0.01 at 5.6 mmol/L; 4.86 +/- 1.15 vs 10.25 +/- 1.32, P < 0.01 at 16.7 mmol/L)., Conclusion: PDX-1 can differentiate rat pancreatic ductal epithelial cells into insulin-producing cells in vitro. In vitro PDX-1 transfection is a valuable strategy for increasing the source of insulin-producing cells.

Background & Objective: Sonic hedgehog (SHH) signaling pathway is important for modulating cellular interaction in the development of mammalian embryo. Epidermal growth factor receptor (EGFR) has been involved in the regulation of cell proliferation and differentiation. Proliferating cell nuclear antigen (PCNA) is an indicator of cell proliferation. This study was to investigate the expression of SHH, EGFR and PCNA in pancreatic cancer, and explore their correlations to cell proliferation., Methods: The expression of SHH, EGFR, and PCNA in 49 specimens of pancreatic cancer and 49 specimens of normal pancreatic tissues adjacent to cancer was detected by immunohistochemistry. Their interrelations were analyzed., Results: The positive rates of SHH and EGFR were significantly higher in pancreatic cancer than in normal tissue adjacent to cancer (79.6% vs.14.3%, 73.5% vs.16.3%, P<0.05). The expression of SHH and EGFR in pancreatic cancer had no correlation to patientsoage, tumor size, pathologic type, and tumor site (P>0.05), but were correlated to lymph node metastasis and TNM stage (P<0.05). The strong positive rate of PCNA was significantly higher in pancreatic cancer than in normal tissues (83.7% vs. 20.4%, P<0.05). SHH expression was positively correlated to EGFR expression (r1=0.232, P<0.05). SHH and EGFR expression were positively correlated to PCNA expression(r2=0.412, P<0.05û r3=0.186, P<0.05)., Conclusion: SHH and EGFR signal pathways are active in pancreatic carcinoma, and are closely correlated to cancer cell proliferation.

Background: The pancreas has a strong regeneration potential in mammals. Previous studies suggested that pancreas regeneration is correlated with proliferation and differentiation of pancreatic stem cells, but the field of pancreatic stem cells is still in its infancy. This study was undertaken to detect the expression of pancreas/duodenal homeobox-1 (PDX-1) and proliferation of pancreatic duct epithelial cells in remnant pancreas during regeneration after partial pancreatectomy in rats, and characterize the source of pancreatic stem cells., Methods: Partial pancreatectomy (90%) was performed on four- to five-week-old Sprague-Dawley rats, and duct epithelial cells and acinar cells were detected by immunohistochemical staining and scored using the 5-bromo-2-deoxyuridine (BrdU) labelling index at various time points. Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR) were used to assess the expression of PDX-1 protein and mRNA, respectively., Results: At 24 hours after partial pancreatectomy, proliferation started in the main, large and small duct cells, and persisted in small duct cells to day 5. The experimental and control groups were significantly different (P<0.001). BrdU-positive acinar cells were greatly increased and reached a peak on day 5. PDX-1 protein was only faintly detectable in pancreatic ductal cells on day 1 after partial pancreatectomy. On days 2 and 3, a 2-3 fold increase in PDX-1 protein was observed, corresponding to the characteristic 42 kD protein in Western blotting. The operated and sham-operated groups also differed significantly (P<0.05). PDX-1 protein expression on days 5 and 7 after operation did not differ from that of the control group. RT-PCR revealed that PDX-1 mRNA expression did not significantly differ between the operated group and the sham-operated group at various time points., Conclusions: Pancreatic stem cells in pancreatic ductal epithelial cells are involved in the regeneration of remnant pancreas and the expression of PDX-1 in ductal cells is due to posttranscriptional regulation.

Aim: To study the correlations of Pancreas duodenal homeobox-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation., Methods: Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect PDX-1 mRNA expression in pancreatic cancer tissue and normal pancreatic tissue. The expression of PDX-1 protein was measured by Western blot and immunohistochemistry. Immunohistochemistry was also used to detect proliferative cell nuclear antigen (PCNA). Correlations of PDX-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation, were analyzed by using c2 test., Results: Immunohistochemistry showed that 41.1% of pancreatic cancers were positive for PDX-1 expression, but normal pancreatic tissue except islets showed no staining for PDX-1. In consistent with the result of imunohistochemistry, Western blot showed that 37.5% of pancreatic cancers were positive for PDX-1. RT-PCR showed that PDX-1 expression was significantly higher in pancreatic cancer tissues than normal pancreatic tissues (2(-3.56 +/- 0.35) vs 2(-8.76 +/- 0.14), P < 0.01). Lymph node metastasis (P < 0.01), TNM grading (P < 0.05), pathological grading (P < 0.05) and tumor cell proliferation (P < 0.01) were significantly correlated with PDX-1 expression levels., Conclusion: PDX-1 is re-expressed in pancreatic cancer, and PDX-1-positive pancreatic cancer cells show more malignant potential compared to PDX-1-negative cells. Therefore, PDX-1-positive cells may be tumor stem cells and PDX-1 may act as alternate surface marker of pancreatic cancer stem cells.

Objective: To analyze the indication and choice of operation technique for duodenum-preserving resection of pancreatic head., Methods: The Clinical material of the 22 patients who received duodenum-preserving resection of pancreatic head (DPPHR) from January 2001 to January 2006 was analyzed. Of the 22 cases, 8 cases presented with mucinous cystadenoma, 2 cases with mucinous cystadenocarcinoma, 4 cases with solid-pseudopapillary tumors, 2 cases with pancreatic endocrine tumors, 4 cases with chronic pancreatitis, 1 case with lymph epidermis cyst, 1 case with serous cystadenoma. The indication, choice of operation technique of DPPHR and the prevention and management of the post-operative complications were investigated., Results: No patient died of the operation. Three cases (13.6%) developed pancreatic fistula after the operation, 1 case (4.5%) developed biliary fistula, 1 case (4.5%) developed abdominal infection and 2 cases of duodenal fistula occurred (9.1%)., Conclusions: DPPHR retains the continuity of stomach, duodenum and biliary ducts. The operation is safe and it reduces wounds and excision scope. This procedure can be used in benign and low malignant lesions in the head and neck of the pancreas.

Objective: To explore the expression and clinical significance of MUC4 mRNA in peripheral blood mononuclear cells of pancreatic cancer patients., Methods: The expression of MUC4 mRNA in peripheral blood mononuclear cells of pancreatic cancer patients were detected with reverse transcription realtime PCR., Results: Expression of MUC4 mRNA was not detected in the peripheral blood mononuclear cells of chronic pancreatitis patients and normal healthy people, but was observed in those of pancreatic cancer patients. The positive expression rate of MUC4 mRNA in pancreatic cancer patients was 60%, which was significantly higher than those of chronic pancreatitis patients and normal healthy people (P < 0.01). The positive expression rate of MUC4 mRNA increased with the development of clinical stage, and the positive expression rate in stage of II - IV (TNM system) was 76.92%, which was significantly higher than that of I - II stage (P < 0.01)., Conclusions: Expression of MUC4 mRNA is highly correlated with the clinical stage in pancreatic cancer patients. Detecting the expression of MUC4 mRNA in peripheral blood mononuclear cells of pancreatic cancer patients may be helpful for the early diagnosis and differential diagnosis.

Aim: To investigate the effect of nutritional support therapy on severe acute pancreatitis (SAP)., Methods: A total of 96 patients with severe acute pancreatitis were divided randomly into control and treatment groups. The former group received total parenteral nutrition (TPN) via central venous infusion, while parenteral nutrition (PN) and enteral nutrition (EN) therapies were applied in different phases for the latter group. The nutrition status, acute phase responses, pancreas lesions, enteric mucosa penetrability and immune functions were monitored., Results: Body weight and prealbumin concentration were increased in treatment group, compared to those in the control group, but albumin concentration did not change significantly. Acute physiology and chronic health evaluation II (APACHE II) scores decreased after 7 d of treatment, whereas the scores of the control group decreased on the 11(th) day. Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukine-6 (IL-6) and serum C reactive protein (CRP) dropped earlier in the treatment group (on the 4(th) day) than that in the control group (on the 7(th) day). No difference was observed in pancreatic lesions between the control and treatment groups. Concentration of endotoxin and lactulose/manicol (L:M) ratio of urine did not change in treatment group, but those in the control group were elevated markedly. Compared with the treatment group, CD4:CD8 T cells ratio and immunoglobulin G (IgG) concentration in the control group decreased significantly., Conclusion: Compared to TPN, the combined therapy of EN and PN could improve the nutrition status and moderate the acute phase response obviously. Moreover, the integrity of enteric mucosa and immune function were protected more effectively in treatment group than in the control one. On the other hand, EN did not simulate the excretion of pancreas and avoid exaggerating the inflammation of pancreas. Thus, appropriate application of PN and EN appears to be more effective for patients with SAP.