【Abstract】ObjectiveTo develop a method of adult porcine pancreatic islet isolation.MethodsThe tails of adult porcine pancreas were perfused through the pancreatic duct with 0.1% cold collagenase(type Ⅺ) and incubated at 38.5 ℃.The digested tissue was dispersed in 4 ℃ Hanks balanced salt solution(HBSS).The tissue suspensions were filtered through a 600 μm mesh.The residual tissue was resuspended in cold HBSS,and put in the Ricordi’s chamber and shaken for 5 minutes,then filtered again.The isolated islets were divided into three groups: control group(n=14),Pefabloc(trypsin inhibitor,n=8) group and FOY(trypsin inhibitor,n=5) group.The collagenase solution of the Pefabloc and FOY group was supplemented with 1.0 mmol/L Pefabloc and FOY respectively. ResultsThe islet yields of the Pefabloc group and FOY group 〔(11 848±3 530) islet/g pancreas and (14 496±3 693) islet/g pancreas〕 were significantly higher than that of the control group 〔(8 505±3 349) islet/g pancreas〕,P＜0.05.The activity of pancreatic protein enzyme in digestive fluid after digestion in control group was higher than the activity of pancreatic duct before injection and Pefabloc group(P＜0.01),which the control group, pancreatic duct before injection and Pefabloc group were (114.7±50.0) BAEEU,(4.0±1.8) BAEEU and (5.5±2.7) BAEEU,respectively.The pancreatic duct before injection and Pefabloc group showed no significant difference in statistics. In control group,when the harvest of islet was more than 8 000/g,the activity of pancreatic protoin enzyme was less than that with the harvest of islet below 8 000/g 〔(78.3±26.7) BAEEU vs (137.5±48.4) BAEEU,P＜0.05〕.Islet after purification in control group,Pefabloc group and FOY group showed good insulin secretion ability for different concentration of glucose.ConclusionA higher porcine pancreatic islet yield can be obtained by this method of pancreatic islet isolation and prophylactic administration of trypsin inhibitors consistently produce excellent islet yields.
Objective To systematically review perioperative safety and middle-term and long-term complications of Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis after distal subtotal gastrectomy by a meta-analysis. Methods Literatures about Roux-en-Y and Billroth-Ⅰ anastomoses after distal subtotal gastrectomy in Embase, PubMed, MedLine, and the Cochrane Library databases were searched. Retrieval time was from December 1, 2015 to March 1, 2016. According to the inclusion and exclusion criteria, two reviewers independently screened literatures, extracted data, and evaluated the qualities of the included studies. Then meta-analysis was performed using Review Manager Version 5.1 software. Results Five randomized controlled trials (RCTs) were finally included involving 600 patients, of which 302 patients were underwent Roux-en-Y anasomosis, 298 patients were underwent Billroth-Ⅰ anasomosis. The results of meta-analysis showed that the Billroth-Ⅰ anastomosis operation had more advantages in the operative time 〔WMD: 38.95; 95%CI: (19.86, 58.04);P<0.000 1〕 and the intraoperative bleeding 〔WMD: 34.85; 95%CI: (2.13, 67.56);P=0.04〕. However, the Roux-en-Y anastomosis had more significant effects in the prevention of bile reflux 〔OR: 0.03; 95%CI: (0.01, 0.11);P<0.000 01〕 and the residual gastritis 〔OR: 0.37; 95%CI: (0.25, 0.54);P<0.000 01〕. There were no differences in the hospital stay 〔WMD: 2.96; 95%CI: (–0.00, 5.93);P=0.05〕, anastomotic leakage 〔OR: 0.43; 95%CI: (0.11, 1.68);P=0.23〕, anastomotic stricture 〔OR: 1.84; 95%CI: (0.61, 5.53);P=0.27〕, reflux esophagitis〔OR: 0.63; 95%CI: (0.28, 1.44);P=0.27〕, and delayed gastric emptying 〔OR: 1.24; 95%CI: (0.46, 3.30);P=0.67〕 between the Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis. Conclusions Billroth- I anastomosis and Roux-en-Y anastomosis have their own advantages and disadvantages, in term of safety of Billroth- I anastomosis is better, but it’s quality of life is worse as compared with Roux-en-Y anastomosis. However, more high-quality, well-designed, adequate RCTs data are needed to validate.