Objective To retrospectively evaluate the diagnostic accuracy of endoscopic ultrasonog raphy ( EUS) in pancreatic cancer, analyze the value of EUS in measurement of tumor diameters, TNM staging, and investigate the effectiveness of endoscopic ultrasonography-guided fine needle aspiration ( EUS-FNA). Methods All the data adopted from the patients underwent EUS in PUMC Hospital between 1997 and 2003. Eighty-eight patients with a final diagnosis of pancreatic cancer (56 is proven by surgical pathology, 10 by surgical findings and 22 by clinical diagnosis) and 47 patients with a final diagnosis of benign pancreatic disease were included and analyzed. Results The sensitivity, specificity, accuracy, positive and negative predictive values of EUS in the diagnosis of pancreatic cancer were 95. 5% , 59. 6% , 83. 0% , 81. 6% and 87. 5% respectively. Tumor diameters measured by EUS (2. 8?1. 0)cm were obviously smaller than those by surgical findings (6.5 ? 2. 9) cm. For TNM stage, compared with surgical findings, the accordance rates of EUS in T and N staging were 43. 1% and 61. 1% respectively. The accuracy of EUS-FNA in the diagnosis of pancreatic cancer was 76. 5% ( 13/17). Conclusions The sensitivity of EUS in pancreatic cancer is highest among all imaging procedures. Tumor diameters measured through EUS are smaller than those by surgery.

Endoscopic retrograde cholangiopancreatography(ERCP),as the main means of digestive endoscopy,plays an important role in the minimally invasive treatment of some pancreaticobiliary diseases,such as biliary drainage,external drainage,and pancreatic duct stent-ing for the decompression treatment of biliary stricture and pancreatic duct stricture and the treatment of pancreatic fistula. In recent years, with the progress in interventional endoscopic ultrasonography(EUS),EUS-guided puncture and stent implantation can be used to com-plete decompression of the bile duct and pancreatic duct when ERCP intubation is not successful or ERCP is unable to complete decompres-sion of the bile duct and pancreatic duct due to postoperative anatomical changes,which provides a new choice of treatment for biliary and pancreatic diseases and reflects the complementary role of EUS and ERCP in the treatment of biliary and pancreatic diseases.

Objective To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination.Methods A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted.Biopsy or surgical pathological findings served as the golden standard.The main outcome measure was the diagnostic accuracy of alarm features.Results Among 921 gastrointestinal outpatients,39 patients (4.2％) with malignancy were detected,including 13 (33.3％) with esophageal cancer,24 (61.5％) with gastric cancer and 2(5.1％) with duodenal ampulla cancer.36 patients (92.3％) were found with advanced cancer.In 137patients who had alarm features,21 (15.3％) were found to have malignancy and all were advanced.The sensitivity,specificity,positive predictive value and negative predictive value of alarm features were 53.8％(21/39),86.8％ (766/882),15.3％ (21/137) and 97.7％ (766/784),respectively.Conclusions Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy.Noninvasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload.

Objective To summarize the clinical features of different racial patients with celiac disease (CD) and analyze the disease prevalence,diagnosis and treatment in Chinese population.Methods All the patients were diagnosed as CD and enrolled in Beijing United Family Hospital between January 2005 and July 2015.Clinical data including nationality,age,symptoms,endoscopic and pathological findings,outcome were collected and compared in patients from different countries.Results A total of 87 patients were enrolled including 63 Caucasians,18 Asian patients and 6 Middle East patients.The peak age of disease onset was 40-60 years old.Patients with typical symptoms such as chronic diarrhea and weight loss only accounted for 20.7％ (18/87) and 9.2％ (8/87) respectively.Some patients presented with nonspecific symptoms such as abdominal pain and bloating [32.2％ (28/87)],even constipation [5.7％ (5/87)].13.8％ (12/87) patients were previously diagnosed as irritable bowel syndrome.The incidence of abdominal pain,bloating,diarrhea and constipation between Asians and Caucasians had no statistical significance (P ＞ 0.05);but the proportions of weight loss,growth retardation,iron deficiency anemia and dermatitis herpetiformis in Asian group were significantly higher than that in Caucasian group (P ＜ 0.05).IgA type of anti-gliadin antibody (AGA),endomysium antibody (EMA) and tissue transglutaminase antibody (tTGA) were dominant autoimmune antibodies in patients with CD,which accounted for 58.6％ (51/87),44.8％ (39/87) and 36.8％ (32/87) respectively.The endoscopy showed that the lesion of CD was mainly located in small intestine,with reducing severity from the proximal to the distal small intestine.The lesions of duodenal bulb and descending duodenum appeared more significant in Asian group.Accordingly pathological intestinal atrophy and the degree of intraepithelial lymphocytosis were more severe in Asian patients.All 87 cases took the gluten-free diet (GFD).Eighty-one cases received serological follow up and 8 with endoscopic intestinal biopsy.The celiac disease antibodies in 47 patients turned negative from 6-9 months after GFD treatment,while 34 patients turned negative from 12-18 months after GFD.All patients reported disease remission to some extent.After 1 year GFD treatment,the pathology of endoscopic intestinal biopsy in 8 patients showed significant improvement of villous atrophy and lymphocyte infiltration.Conclusions CD patients with typical clinical manifestations are not the majority.Serological celiac disease antibodies (AGA,EMA and tTGA) have a high diagnostic value.GFD treatment is effective on majority of celiac patients.Clinical manifestations,endoscopy,intestinal pathology,and response to GFD in Chinese patients are not the same as Caucasians.Clinicians need to pay attention to the differential diagnosis.

Objective To evaluate the value of intraduetal ultrasonography (IDUS) in diagnosing biliary and pancreatic disorders. Methods The findings by endoscopic retrograde cholangiopancreatography (ERCP) and IDUS from 19 patients with suspected biliary and pancreatic disorders from July 2006 to August 2007 in our hospital were analyzed retrospectively. Results Of the 19 patients, 17 had obstructive jaundice (including 6 eases of cholangiocarcinoma, 2 pancreatic adenocareinoma, 2 gallbladder carcinoma, 2 chole-docholithiasis with bile duct stricture, 2 autoimmune pancreatitis, 1 papillary adenocarcinoma, 1 papillary adenoma, and 1 sclerosing cholangitis) and 2 intraduetal papillary mueinous tumor (IPMT). The diagnosis was confirmed by surgery and pathological findings in 11 patients. The diagnostic accuracy of ERCP and IDUS was 73. 7% (14/19) and 84. 2% (16/19), respectively, and that of ERCP combined with IDUS was 89. 5% (17/19). The sensitivity and specificity of ERCP to differentiate benign bile duct strictures from ma-lignant ones were 100. 0% (11/11) and 83.3% (5/6), respectively; and those of IDUS were 100. 0%(11/11) and 100. 0% (6/6), respectively. The sensitivity and specificity of ERCP in diagnosing cholan-gioeareinoma were 83.3% (5/6) and 60% (3/5), respectively; and those of IDUS were 100. 0% (6/6) and 40. 0% (2/5), respectively. Conclusion Combination of ERCP with IDUS can improve the diagnostic accuracy of pancreaticobiliary disorders. Additionally, IDUS shows higher sensitivity and specificity in differ-entiation between benign and malignant bile duct strictures, but it is still difficult to identify the etiologic factors of malignant bile duet strictures by IDUS.

Objective To explore the long-term effect, prognosis and administration of corticosteroid treatment on autoimmune pancreatitis (AIP). Methods Clinical data were analyzed in 13 diagnosed and followed up AIP patients of Peking Union Medicine College Hospital during August 2004 to August 2008. Results Of 13 patients, 12 were males and 1 was female, with a mean age of 58.7 years old, and a mean follow-up of 30 months. Of 11 patients compliated with bile duct disease,biliary stents were placed in 9 patients and already taken out. Corticosteroid treatment was received by cured patients. The average corticosteroid therapeutic time was 9.2 months, 7.9 months in 6 biliary stent placed patients, 13.4 months in corticosteroid treated alone patients, the statistical difference was significant (P = 0. 023). Serum inflammatory parameters normalized range from 5. 3 to 8.8 weeks. After corticosteroid treatment, pancreas enlargement improved in all patients at the first imaging reexamination (1.0 to 11.3 weeks), pancreatic size normalized in 9 patients with an average of 16.6 weeks corticosteroid treatment. No relapsing sign was found with imaging examination during follow-up. Of 8 newly onset diabetes patients, glucose level normalized in 4 patients after corticosteroid treatment. Two patients complicated with autoimmune hepatitis developed early hepatic cirrhosis symptoms at the end of the follow-up. Swollen submandibular gland enlargement relapsed in one patient after corticosteroid withdrawn for six months. Conclsion AIP patients responsed well to corticosteroid treatment. Placement of biliary stent could shorten corticosteroid therapeutic time.Patients with bile duct complications and newly onset diabetes could partially relieve after the corticosteroid treatment, the prognosis of patients with autoimmune hepatitis complications was relatively poor.

Objective To assess pathological features of muscles as well as microvascular changes between muscle fibers in patients with dermatomyositis (DM),and to analyze pathological differences in muscles between DM and polymyositis (PM).Methods Specimens were obtained from involved muscles of 16 patients with DM,5 patients with PM,and from normal muscles of 9 patients with bone trauma (controls).Routine histopathological examination and immunohistochemical staining for CD34 and CD61 were conducted.Results Of the 16 patients with DM,6 (37.5％) had perifascicular atrophy,3 ( 18.8 ％) had an obvious inflammatory cell infiltration around microvessels between muscle fibers.Perifascicular atrophy was absent in muscle specimens from patients with PM or bone trauma.The number of CD34-positive microvessels between muscle fibers was reduced in patients with DM,but normal in those with PM.CD61 was positive in perifascicular area of 10 patients (5 moderately positive and 5 weakly positive) with DM,with an expression rate of 62.5％,however,only 1 case of PM was weakly positive for CD61,and all the controls were negative.Conclusions There is a decrease in the number of microvessels but an enhancement of neovascularization between muscle fibers in involved muscles of patients with DM,which may serve as a pathological marker to distinguish DM from PM.

Objective To evaluate the value of clinical data and various methods of diagnostic imaging in the patients with pancreatic cancer. Methods Two hundreds and fifty-six patients with pancreatic cancer admitted into Peking Union Medical College Hospital between 1996 and 2004 were included. The clinical symptom and the accuracy of various imaging methods (B-US, CT, ERCP, EUS, DSA and MRI) in assessing pancreatic carcinoma were analyzed. Results Weight lost was the most common symptom in 79% of patients with pancreatic carcinoma. Jaundice was mostly seen in patients with pancreatic head carcinoma. Upper abdominal pain was in 86% of patients with carcinoma in pancreatic body and tail. The diagnostic accuracies of B-US, CT, ERCP, EUS, DSA and MRI were 83% , 89% , 90% , 91% , 82% and 79% respectively. Conclusion B-US and CT scanning should be undergone in patients with abdominal pain, jaundice and weight lost who were suspected to have pancreatic carcinoma. Further imaging techniques such as EUS, ERCP and MRI should be advised in patients highly suspected to have pancreatic carcinoma, in spite of the results of B-US and CT were negative.

OBJECTIVE:To evaluate the effect of psychological intervention based on pharmaceutical care on the communi-ty patients with essential hypertension. METHODS:172 patients with essential hypertension in a community health service certer in Nanjing Gulou area in 2013 were divided into control group(n=87)and intervention group(n=85)by simple random meth-od. Control group received conventional antihypertensive drugs and management,intervention group additionally received pharma-ceutical care and psychological intervention,it lasted 6 months. Blood pressure controlling,drug compliance,mastery of drug knowledge and health status in 2 groups before and after treatment were compared. RESULTS:Before treatment,there were no significant differences in the systolic blood pressure(SBP)and diastolic blood pressure(DBP)between 2 groups(P>0.05);af-ter treatment, SBP and DBP in 2 groups were lower than before,SBP and DBP in intervention group were lower than control group,the decrease degree of SBP and DBP was bigger than control group,the differences were statistically significant (P<0.01). 1 month after the beginning of intervention,there was no significant difference in the proportion of drug compliance be-tween 2 groups (P>0.05);1 month after the end of the intervention,the proportion of drug compliance in intervention group was higher than 1 month after the beginning of intervention and control group,the differences were statistically significant(P<0.05). Before treatment,there was no significant difference in mastery of drug knowledge between 2 groups (P>0.05);after treatment,the proportion of patients showed good and excellent mastery of drug knowledge was higher than before and control group,the differences were statistically significant (P<0.05). Before treatment,there were no significant differences in scores of physical,mental,social health subscale and SRHMS between 2 groups(P>0.05);after treatment,scores of physical health subscale and SRHMS in control group,each subscale and to-tal scale scores in intervention group were higher than be-fore, and scores of mental, social health subscale and SRHMS in intervention group were higher than control group, the differences were statistically significant (P<0.05). CONCLUSIONS: The psychological intervention based on pharmaceutical care can effectively promote the con-trol of blood pressure,improve drug compliance,mastery of drug knowledge,health status and mental situation,which is worth of popularizing and applying in community health services.

Objective To enrich the knowledge in large gastric folds. Methods We investigated 45 cases of large gastric folds in ten years (1990 - 2001) retrospectively. All cases were examined endo-scopically and histologically. Some of them were examined by endoscopic ultrasonography and upper gastrointestinal barium. Results Of 45 cases with large gastric folds there were 30 cases with gastritis (66. 7% ) , seven with malignant tumors( 15. 6% ) (five with gastric carcinoma and two with malignant lymphoma) , four with Menetrier disease(8. 9% ) , two with systemic lupus erythematosus, one each with Billroth II anastomosis and gastric ulcer. The diseases including tumors, Menetrier disease and connective tissue diseases were located in gastric fundus and/or body . Conclusion The diseases located in upper stomach have more clinical significance. All of endoscopic ultrasonography, upper gastrointestinal barium and endoscopic mucosal resection are helpful in differential diagnosis of the large gastric folds.