Clinical Diagnosis and Treatment of Autoimmune Pancreatitis and IgG4-related Sclerosing Cholangitis / 胃肠病学

Background: Autoimmune pancreatitis (AIP) is a chronic pancreatitis associated with immune factors. IgG4-related sclerosing cholangitis (IgG4-SC) is a common extrapancreatic manifestation of AIP, however, its optimal treatment still needs to be clarified. Aims: To summarize the experience in the clinical diagnosis and treatment of AIP, especially IgG4-SC. Methods: Twenty-five patients with AIP admitted from the First Affiliated Hospital of Nanchang University between January 2015 and May 2021 were recruited, and a retrospective analysis was conducted on the clinical symptoms, laboratory and imaging findings, pathological results, as well as the treatment regimens and clinical outcomes. Results: All the patients were diagnosed as type 1 AIP (84.0% male, mean age 63.5 years). Obstructive jaundice (56.0%) and epigastric pain (44.0%) were the main clinical symptoms. The main imaging findings were diffuse enlargement of the pancreas, capsule-like rim, and distal biliary stricture associated with intra- and extra-hepatic duct dilation. The serum IgG4 elevated significantly. In 14 patients with IgG4-SC, the total bilirubin was between 1-2 upper limit of normal (ULN) in 3 cases, between 2-5 ULN in 3 cases, and > 5×ULN in 8 cases. Fifteen (83.3%) patients obtained pathological diagnosis by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). Six IgG4-SC patients were treated with steroids alone, and 6 received biliary stenting with or without steroids, no differences in liver function tests were existed between the two groups prior to treatment (all P> 0.05). Liver function tests in most of these patients were normalized after treatment. Conclusions: AIP is a rare disease in clinical practice, and is more frequently seen in elderly male patients. Biliary involvement (IgG4-SC) is common and often presents initially as obstructive jaundice, which can be effectively managed with steroids alone, without the need for biliary stenting.

Analysis of risk factors for bleeding following endoscopic treatment of colorectal polyps and feature analysis for carcinogenesis of adenomatous polyps / 中国内镜杂志

Objective To investigate the clinical data, risk factors for bleeding following endoscopic treatment of colorectal polyps (diameter ≥ 1.0 cm) and feature analysis for carcinogenesis of adenomatous polyps. Method It was analyzed retrospectively that the clinical data, endoscopic characteristics, risk factors for bleeding and features for carcinogenesis of adenomatous polyps in 741 patients with a total of 884 colorectal polyps (diameter ≥ 1.0 cm) of our hospital from January 1, 2014 to January 1, 2016, which were resected under endoscope. Result Univariate analysis of colorectal polyps resected under endoscope on intraoperative and delayed bleeding, we found that gender (P = 0.017), location (P = 0.011), size (P = 0.004), lobulated or not (P = 0.010), resection methods under endoscope (P = 0.029) were statistically significant deviation between the two groups; taking the polyp as observation unit,multivariate Logistic regression analysis of their clinical data and endoscopic characteristics, we found gender (P = 0.012, OR

Contact pressure measurement of the computer mouse and wrist during mouse operations by TekScan / 医用生物力学

Objective To study the characteristics of mouse-desktop and wrist-desktop contact pressure distributions during different mouse operations, and investigate the influence of desktop on the mouse and wrist during mouse operations, so as to obtain biomechanical references for musculoskeletal disorders of the hand and wrist. Methods The laser scanner and TekScan pressure measurement system were employed to measure contact area and contact pressure of the mouse and wrist during different mouse operations. Results The contact pressure, contact area, and contact force varied with time, and the peak contact pressure of the mouse and wrist with desktop were obtained. The peak contact pressure of the mouse in single clicking of left, right key and scrolling of middle key was 62.87, 33.83, 74.66 kPa, respectively, and for the wrist, the minimum contact pressure appeared in key clicking, being 23.25, 11.02, 16.26 kPa, respectively. Conclusions During mouse operations, the thenar, hypothenar as well as the ulnar and radial sides of the wrist are persistently subjected to the continuous pressure, therefore, repetitive and continuous mouse operation can lead to the development of carpal tunnel syndrome of wrist or other MSDs.

Diagnostic value of endoscopic ultrasonography for staging of early gastric cancer / 中华消化内镜杂志

Objective To analyze the diagnostic value of endoscopic ultrasonography(EUS)for staging of early gastric cancer(EGC)and its influential factors. Methods Clinical information of 120 EGC patients admitted from February 2009 to January 2016 was reviewed. Diagnostic accuracy and the influencing factors of EUS for the invasive depth were analyzed by comparing the results of preoperative EUS and the pathology. Results Thirty-six patients were over-staged by EUS,and 10 patients were under-staged among 120 EGC patients. The accuracy, sensitivity, specificity of EUS for the submucosal invasion were 61.67%(74/120),58.33%(14/24),62.50%(60/96)respectively. The accuracy, sensitivity and specificity for protruded EGCs(Type I)diagnosis were 74.36%(29/39), 50.00%(6/12), 85.19%(23/27) respectively;these three variables were 59.02%(36/61),83.33%(5/6),56.36%(31/55)respectively for flat EGCs(Type Ⅱ), and 45.00%(9/20), 50.00%(3/6), 42.86%(6/14)respectively for excavated EGCs(Type Ⅲ). The univariate factor results showed that differentiated degree, location and endoscopic morphology of the tumor were possible influential factors for over-stage. Multivariate factor results showed that flat type(OR=3.667,95%CI:1.086-12.386,P<0.05)and excavated type(OR=6.552,95%CI:1.421-30.218,P<0.05)were independent risk factors. Gender,age and tumor maximum diameter were not factors influencing the diagnostic accuracy of EUS. Conclusion The EUS shows higher clinical value for diagnosing the invasive depth in EGC. Tumor differentiated degree, location and endoscopic morphology may be the influencing factors for diagnostic accuracy of EUS. Flat type and excavated type may lead to over-staging.

Contact pressure measurement of the computer mouse and wrist during mouse operations by TekScan / 医用生物力学

Objective To study the characteristics of mouse-desktop and wrist-desktop contact pressure distributions during different mouse operations,and investigate the influence of desktop on the mouse and wrist during mouse operations,so as to obtain biomechanical references for musculoskeletal disorders of the hand and wrist.Methods The laser scanner and TekScan pressure measurement system were employed to measure contact area and contact pressure of the mouse and wrist during different mouse operations.Results The contact pressure,contact area,and contact force varied with time,and the peak contact pressure of the mouse and wrist with desktop were obtained.The peak contact pressure of the mouse in single clicking of left,right key and scrolling of middle key was 62.87,33.83,74.66 kPa,respectively,and for the wrist,the minimum contact pressure appeared in key clicking,being 23.25,11.02,16.26 kPa,respectively.Conclusions During mouse operations,the thenar,hypothenar as well as the ulnar and radial sides of the wrist are persistently subjected to the continuous pressure,therefore,repetitive and continuous mouse operation can lead to the development of carpal tunnel syndrome of wrist or other MSDs.

Clinical characteristics of gastric Dieulafoy's lesion and risk factors for rebleeding of 111 patients / 中国内镜杂志

Objective Dieulafoy's lesion is a rare cause of upper gastrointestinal bleeding. The purpose of this study was to recognize the clinical characteristics of gastric Dieulafoy and to identify possible predictive factors of rebleeding. Methods Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion from January 2009 to June 2016. We analyzed the clinical data and endoscopic findings and the correlated with rebleeding risk factors with Dieulafoy's lesion. Results 111 patients were included in the study, 97 (87.4%) patients were male; the most common location of the bleeding lesions were Proximal stomach of 53 cases (47.7%); According to the Forrest type, 46.8% of the cases were arterial (spurting), 52.3% of the cases were arterial (oozing), there were 101 (91.0%) patients treated by endoscopic combined drug therapy. The success rate of Endoscopic hemostatic treatment was 84.2%, endoscopic hemostatic treatment success rate was as follows: single endoscopic, 85.0%; two endoscopic, 84.8%; three endoscopic, 75.0%. The hemostatic treatment success rate of 101 patients with endoscopic combined drug was as follows: Proximal stomach, 83.7%; mid-stomach, 82.1%; and distal stomach, 88.9%. Age (P = 0.002) and blood transfusion (P = 0.004) were risk factors for rebleeding in the study. Blood transfusion was associated with a higher recurrence rate for bleeding (P = 0.018, OR=37.77, 95% CI = 1.86~766.47) for 101 patients with endoscopic in combination with drug. Conclusion Endoscopic therapy is effective for treating Dieulafoy's lesion. The blood transfusion was associated with a high rate of bleeding recurrence. There were no significant differences between the rebleeding and non-rebleeding groups with respect to bleeding location or hemostatic methods.

In silico investigation of agonist activity of a structurally diverse set of drugs to hPXR using HM-BSM and HM-PNN / 华中科技大学学报（医学）（英德文版）

The human pregnane X receptor (hPXR) plays a critical role in the metabolism, transport and clearance of xenobiotics in the liver and intestine. The hPXR can be activated by a structurally diverse of drugs to initiate clinically relevant drug-drug interactions. In this article, in silico investigation was performed on a structurally diverse set of drugs to identify critical structural features greatly related to their agonist activity towards hPXR. Heuristic method (HM)-Best Subset Modeling (BSM) and HM-Polynomial Neural Networks (PNN) were utilized to develop the linear and non-linear quantitative structure-activity relationship models. The applicability domain (AD) of the models was assessed by Williams plot. Statistically reliable models with good predictive power and explain were achieved (for HM-BSM, r (2)=0.881, q LOO (2) =0.797, q EXT (2) =0.674; for HM-PNN, r (2)=0.882, q LOO (2) =0.856, q EXT (2) =0.655). The developed models indicated that molecular aromatic and electric property, molecular weight and complexity may govern agonist activity of a structurally diverse set of drugs to hPXR.

Evaluation of an enzyme-linked immunospot assay for the immunodiagnosis of atypical spinal tuberculosis (atypical clinical presentation/atypical radiographic presentation) in China

BACKGROUND: Atypical spinal tuberculosis (TB) usually presents in a slowly indolent manner with nonspecific clinical presentations making the diagnosis a great challenge for physicians. New technologies for the detection of atypical spinal TB are urgently needed. The aim of this study was to assess the diagnostic value of an enzyme-linked immunospot (ELISPOT) assay in clinically suspected cases of atypical spinal TB in China. METHODS: From March 2011 to September 2012, a total of 65 patients with suspected atypical spinal TB were enrolled. In addition to conventional tests for TB, we used ELISPOT assays to measure the IFN-I response to ESAT-γ and CFP-10 in T-cells in samples of peripheral blood mononuclear cells. Patients with suspected atypical spinal TB were classified by diagnostic category. Data on clinical characteristics of the patients and conventional laboratory results were collected. RESULTS: Out of 65 patients, 4 were excluded from the study. 18 (29.5%) subjects had cultureconfirmed TB, 11 (18.0%) subjects had probable TB, and the remaining 32 (52.5%) subjects did not have TB. Generally, the features of atypical spinal TB include the following aspects: (1) worm-eaten destruction of vertebral endplate; (2) destruction of centricity of the vertebral body or concentric collapse of vertebral body; (3) tuberculous abscess with no identifiable osseous lesion; (4) contiguous or skipped vertebral body destruction. 26 patients with atypical spinal TB had available biopsy or surgical specimens for histopathologic examination and 23 (88.5%) specimens had pathologic features consistent with TB infection. The sensitivities of the PPD skin test and ELISPOT assay for atypical spinal TB were 58.6% and 82.8%, and their specificities were 59.4% and 81.3%, respectively. Malnutrition and age were associated with ELISPOT positivity in atypical spinal TB patients. CONCLUSIONS: The ELISPOT assay is a useful adjunct to current tests for diagnosis of atypical spinal TB.

COX-2 inhibitor celecoxib can suppress the proliferation of FLT3-ITD positive acute myeloid leukemia cells with prominent down regulation of MEK/MCL-1 expression in vitro / 中国实验血液学杂志

The purpose of this study was to investigate the effects of Celecoxib on the proliferation of the FLT3-ITD positive and negative acute myeloid leukemia cells and its mechanism. The proliferation inhibition effect of Celecoxib with different doses on the FLT3-ITD positive cells MV4-11 and the FLT3-ITD negative K562 cells was detected by CCK-8 method, the cell apoptosis was determined by flow cytometry, and the MEK, Mcl-1, pAKT expression was tested by Western blot. The results showed that Celecoxib inhibited the proliferation of both MV4-11 and K562 cells, but the IC50 for MV4-11 was (29.14 ± 2.4) µmol/L, which was significantly lower than that of K562 cells (39.84 ± 1.0) µmol/L (P < 0.05); The induced apoptosis rate of Celecoxib at 20-80 µmol/L on MV4-11 was not observed, but there was apparent influence on K562 at the same concentration. Western blot showed that Celecoxib down-regulated the expression of MEK and Mcl-1 but did not change the expression of pAKT obviously on MV4-11 cells, while the expression of Mcl-1 was reduced a little, but no obvious change were found in the expression of MEK and pAKT on K562 cells. It is concluded that the Celecoxib can inhibit the proliferation of FLT3-ITD positive AML cells distinctly, and the potential mechanism may be related to the inhibition of the MEK/Mcl-1 signaling pathway.

Endoscopic variceal ligation plus sclerotherapy for esophageal variceal bleeding / 中华消化内镜杂志

Objective To observe the efficacy and safety of endoscopic variceal ligation (EVL) and esophageal variceal sclerotherapy (EVS) with different hardeners for esophageal variceal bleeding (EVB).Methods Clinical data of 314 patients with EVB were retrospectively reviewed.The patients were divided into 5 groups according to the endoscopic treatments they have received,i.e.,endoscopic variceal ligation (EVL) group (n =112),sodium morrhuate sclerotherapy (EVS1) group (n =48),lauromacrogol sclerotherapy (EVS2) group (n =40),EVL plus sodium morrhuate sclerotherapy (EVLS1) group (n =26) and EVL plus lauromacrogol sclerotherapy (EVLS2) group (n =88).The efficacy,variceal recurrence rate and complication rate were evaluated.Results There was no significant difference in efficacy of stop bleeding among 5 groups,which was 85.7％ (96/112) in EVL group,83.3％ (40/48) in EVS1 group,92.5％(37/40) in EVS2 group,92.3％ (24/26) in EVLS1 group and 94.3％ (83/88) in EVLS2 group (P ＞0.05).The complete cure rates in EVLS1 group (88.5％,23/26) and EVLS2 group (87.5％,77/88)were significantly higher than those in 3 other groups (P ＜ 0.05).Rebleeding rates in EVS1 group (18.8％,9/48) and EVL group (11.6％,13/112) were significantly higher than those in other 3 groups (P ＜0.05).The patients were followed up for 6-18 months,and the varices recurrence rate was highest in group EVL (23.2％,26/112) and lowest in EVLS2 (10.2％,9/88,P ＜0.05).The complication rate in group EVS1 (32.2％,49/152) was significantly higher than that in other 4 groups (P ＜0.05).Conclusion EVL plus EVS,either with sodium morrhuate or lauromacrogol EVS is safe and effective for EVB,especially EVL plus Lauromacrogol EVS,may become an optimal therapy to control esophageal variceal bleeding and rebleeding.

Early detection of MRD in peripheral blood after induction chemotherapy of newly diagnosed patients with AML and its correlation with curative effects / 中国实验血液学杂志

The purpose of this study was to detect the minimal residual disease (MRD) in peripheral blood of newly diagnosed patients with acute myeloid leukemia (AML) on day 8 of induction chemotherapy and analyze the correlation between day 8 MRD (D8RD) and therapeutic effectiveness. 29 adult patients (13 males and 16 females, aged 16 - 75 years, median 41 years) with AML diagnosed and treated in West China Hospital from September 2009 to June 2010 were analyzed and followed up in the study. The leukemia-associated aberrant immunophenotype (LAIP) of all the patients were detected by multiparameter flow cytometry (FCM) before therapy. The level of MRD in the peripheral blood at day 8 of induction chemotherapy was detected by FCM based on the LAIP. The overall survival curve was drawn by calculation using Kaplan-Meier method using, and the comparison between different groups was carried out by Log-rank test. The results indicated that after first course therapy, the levels of peripheral D8RD in 7 out of 29 AML cases were lower than 0.01% (negative group), and that in another 22 cases were higher than 0.01% (0.08% - 55%, positive group). The sex, age, WBC, LDH, percentage of bone marrow blasts at diagnosis in these groups were not statistically different. 6 cases achieved CR (86%) in D8RD negative group, and also 6 cases achieved CR (27%) in D8RD positive group, CR rate in D8RD negative group was higher than in D8RD positive group (86% vs 27%, P < 0.05). The median follow-up of 29 cases lasted for 15 months; the 1-year overall survival rate of D8RD negative and D8RD positive groups was 100% and 39.4%, respectively (P < 0.01). It is concluded that MRD level in peripheral blood at day 8 of induction chemotherapy is an early index to predict clinical efficacy of induction therapy in AML.

The impact of Helicobacter pylori eradication on reversing gastric mucosal atrophy and intestinal metaplasia: a prospective study / 中华消化杂志

Objective To investigate the effect of Helicobacter pylori (H. pylori) eradication on reversing gastric antrum atrophy and intestinal metaplasia (IM). Methods Biopsy specimens obtained from gastric antrum of patients who underwent gastroscopy were examined for pathology and the status of H. pylori infection. The H. pylori infected patients who had chronic gastritis with antrum atrophy or IM were recruited and were divided into either H. pylori eradicated group (n= 48)or control (non-eradicated) group (n=38). The gastroscopic follow-up was carried out at 1 year and 5years. The specimens examined for changes of histology and reverse of gastric antrum and IM were obtained at the same site. Results The reversing rate of gastric antrum atrophy in H. pylori eradicated group was significantly higher than that in control group (37.1% vs. 12.0%). In H. pylori eradicated group, the reversing rate of gastric antrum atrophy at 5-year was significantly higher than that at 1-year, and it was higher in patients aged below 45 years than those aged above 45 years.Whereas there was no association of reversing gastric antrum atrophy with follow-up time and age in control group. However there was no difference in reversing rate of IM between two groups in 1- or 5-year follow-up and H. pylori eradication. Conclusions H. pylori eradication can not reverse the IM of gastric antrum mucosa, but it can reverse the atrophy of gastric mucosa, which is associated with follow-up time and the age of patients. Therefore, H. pylori must he eradicated as early as possible in H. pylori infected patients with gastric antrum atrophy.

Clinical characteristics and the regularity of seasonal changes of peptic ulcer in Nanchang area / 中华消化杂志

Objectives To investigate the clinical characteristics and the regularity of seasonal changes that influence peptic ulcer (PU) in Nanehang area and to provide a theoretical basis for the treatment and prevention of PU.Methods Data collected from patients with PU diagnosed by clinic and gastroendoseopy between October 2003 to May 2008 were retrospectively analyzed.The PU was further divided into gastric ulcer,duodenal ulcer and complex ulcer.The lesion of gastric ulcer was calculated by five locations that were antral,angular,corporal,pyloric canal,fundic and cardia.The lesion of duodenal ulcer was calculated by five locations that were anterior wall of bulb,posterior wall,lesser curvature, greater curvature and postbulbar.The climate changes that influnced the incidence of PU disease were also observed.The detective rates of different types of PU were analyzed and its association with gender,age, lesion locations,seasons,Helicobacter pylori (Hp) infection and complications were also investigated. Results Among 83 888 patients who underwent endoscopy,PU was found in 21 308 patients (25.4%) including 66.33% duodenal ulcer,24.88% gastric ulcer and 8.79% complex ulcer.The male and femal ratio was 2.44 : 1 in PU,2.53 : 1 in duodenal ulcer,2.26 : 1 in gastric ulcer,and 2.33 : 1 in complex ulcer.The average age of patients with gastric ulcer was 48.0 years that was about 6.7 years higher than that of patients with duodenal ulcer.The prevalence of duodenal ulcer and gastric ulcer peaked in the 30- 39 years and 50-59 years,respectively.PU was more common from December to February (30.17%) and less common from June to August (22.54%) (P＜0.01) .The 57.43% of duodenal ulcer was found on anterior wall of bulb,18.26% on greater curvature,13.21% on lesser curvature,7.34% on posterior wall and 3.76% on postbulbar.The 45.69% of gastric ulcer was found on antral,20.54% on angular, 15.54% on corporal,9.36% on pyloric canal,and 8.87% on fundic and cardia.The 91.83% (12 318/ 13 414) of patients were positive for Hp infection.There was no significant difference of Hp infection among patients with different types of PU.The complications in patients with PU were bleeding (4.94%),pyloric obstruction (3.51%) and chronic perforation(0.04%).Conclusions The detective rate of PU in Nanchang area is 25.4%,which is higher than that in northern area of China.The incidence of PU is highly associated with sex,age,seasons and ulcer locations,with high Hp infections and a low incidence of complications.

Effect of TCM syndrome-typing based therapy combined with cyclosporin in treating myelodysplastic syndrome / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of TCM syndrome-typing based therapy (TCM-STBT) combined with cyclosporin on myelodysplastic syndrome (MDS) and investigate the correlation of efficacy with TCM syndrome type and MDS type.</p><p><b>METHODS</b>Fifty-eight MDS patients were classified into refractory anemia (RA) and RA with excess blast (RAEB) by FAB standard and randomly divided into the cyclosporin group (the treated group) and the alltransretinoic acid group (the control group), and both were subjected to STBT additionally. The therapeutic effect and changes of peripheral hemogram were observed and compared.</p><p><b>RESULTS</b>The total effective rate and the total remission rate was 73% and 33% in the treated group, higher than that in the control group (39% and 0) respectively. Hemoglobin level, white blood cell and blood platelet count increased significantly in the treated group after treatment (P < 0.05), while only hemoglobin level rose obviously in the control group (P < 0.05). The total effective rate and markedly effective rate in patients with qi-blood deficiency syndrome type were higher than those with other syndrome types.</p><p><b>CONCLUSION</b>TCM-STBT combined with cyclosporin has good efficacy in treating MDS and there is well correlation between the therapeutic efficacy and type of TCM syndrome or of MDS, indicating the STBT is necessory for TCM therapy.</p>