Objective To explore the value of gastroendoscopy check-up early after non-surgical treatment of patients with gastroduodenal perfolation.Methods The patients suspected of perforated gastroduodenal ulcer on hospital admission underwent non-surgical treatment were enrolled.After cured clinically,performed gastroendoscopy at different time periods.Results Among 133 patients underwent gastrointestinal endoscopy,129 cases(97.0%)were diagnosed gastroduodenal ulcer,3 cases(2.3%)were diagnosed gastric carcinoma,1 case (0.8%)Was confirmed duodenal diverticulum,no compilcations occurred due to endoscopy.The 6 cases that had surgical indications had be implemented the early surgical treatment. Conclusions After non-surgical treatment of patient with gastroduodenal perforation,timely gsstroendoscopy can truly show pathologic changes with gastroduodenal perforation.So endoscopy is beneficial under condition appropriate time seleetion for confirmed the eliology of PGD,treatment promptly targeted etiology and understanding the mechanism healing the perforation as non-surgical treatment.

Objective To establish a big animal model of secondary infection of acute necrotizing pancreatitis (ANP). Methods Thirty young pigs were allocated to experiment group ( n = 20 ) or control group (n = 10). The ANP model was induced by retrograde injection of a mixture solution of 5% sodium taurocholate and 5% trypsin (0. 5 ml/kg body weight) into the main pancreatic duct and ligation of the proximal end of the main pancreatic duct, and then the second step was injecting 3 ～ 4 ml living Escherichia coli (E coli) suspension (108/ml) to the necrotic area of the pancreas by fine needle aspiration technique under CT guidance in the experiment group, and by injecting 3 ～ 4 ml inactivated E coli in the control group using the same method. Multi-slice spiral CT dynamic enhanced scan was performed in both groups 1 day and 2 or 3 days after ANP modeling and 5 days after bacterial injection to calculate the CTSI score. Serum amylase, blood WBC count and blood bacterial culture was performed in both groups. 5 days later, the animals were scarified to observe the infected or necrosis foci, and perform smear, bacterial culture and pathologic examinations of the tissue around the infected or necrosis foci. Results The ANP secondary infection model was successfully established in 16 of the 20 animals in the study group, with a success rate of the 80.0% (16/20). There were 17 foci where the positive rate of bacterial culture was 100% (17/17 foci), and the success rate of blood bacterial culture was 68.8%(11/16). In the control group, the ANP model was established successfully in 7 of 10 animals (70%), except for one case of contamination, only one foci was identified;the positive rate of bacterial culture and the success rate of b|ood bacterial culture was 14.3% (1/7). Serum amylase and white blood WBC count increased with similar trends, WBC count in the study group was significantly higher than that in the control group (P<0.01). The mean CT severity index(CTSI) was all ≥4 in beth groups, indicating the severity was moderate to severe. Conclusions A stable and reliable model of secondary infection of ANP in big could be established satisfactorily by injecting active E. coli into the pancreatic necrosis tissue under CT guidance, which helps further pathogenic mechanism studies and clinical studies, especially imaging studies.

Objective To determine the serum concentration of MCP-1 and the expression of MCP-1 protein in the pancreas in the piglet with chronic obstructive pancreatitis and to explore the role of MCP-1 protein in pancreatic fibrosisits.Methods The piglet model of chronic obstructive pancreatitis was established by incomplete ligation of the pancreatic duct.The piglets were sacrificed at 4, 6, 8 weeks after induction.Pathological changes of pancreas were examined.Pancreatic fibrosis was assessed by VG staining.Serum MCP-1 concentrations were detected by ELISA method.MCP-1 and α-SMA, PDGF, TGF-β1 and NF-κB protein expression were detected by immunohistochemistry.Results The induction was successful in 14 piglets ( 58.3% ).Mild atrophic changes, interstitial fibrosis, chronic inflammatory cell infiltration could be observed in the body and tail of pancreas from the 4th week in the experimental group.The most obvious changes occurred in the 8th week.Stage Ⅰ pancreatic fibrosis occurred in 5 piglets (35.7%), stage Ⅱ in 4 piglets (28.6%), stage Ⅲ in 5 rats ( 35.7% ).Seurm MCP-1 at 4, 6, 8 weeks was ( 102.44 ± 36.25 ) pg/ml,(97.84 ± 28.67) pg/ml, ( 94.32 ± 28.42 ) pg/ml, respectively, and was significantly higher than that in control group [ ( 10.42 ±5.86) pg/ml, (8.58 ±4.86) pg/ml, (8.22 ±4.58) pg/ml, P ＜0.01 ].There was no MCP-1 protein expression in the control group;MCP-1 protein was detected in the successful induction group, and MCP-1 expression was positively correlated with expressions of the PDGF, TGF-β1, α-SMA and NF-κB.Conclusions MCP-1 may play an important role in the course of pancreatic fibrosis in chronic obstructive pancreatitis.

ObjectiveTo investigate the role of lymphocyte apoptosis and endoplasmic reticulum stress (ERS) on the development of sepsis and their association with the prognosis of sepsis patients.Methods A prospective cohort study was conducted. Seventy septic patients admitted to intensive care unit (ICU) of Shanghai East Hospital of Tongji University were enrolled. Blood samples were collected on days 1, 3 and 7 to measure percentage of circulating apoptotic lymphocyte with flow cytometry analysis. The relative expressions of endoplasmic reticulum specific glucose regulated protein 78 (GRP78) mRNA and transcription factor CHOP mRNA were measured by real-time reverse transcription-polymerase chain reaction (RT-PCR). The correlation between CHOP mRNA expression and percentage of circulating apoptotic lymphocyte was analyzed by Spearman relative analysis. The patients were divided into death (n = 23) and survival subgroups (n = 47). Twenty healthy volunteers during the same period were selected as the healthy control group.Results① Rate of lymphocyte apoptosis: compared with healthy control group [(2.86±0.66)%], septic patients, either survival or death subgroup, exhibited higher rate of lymphocyte apoptosis on days 1, 3 and 7 [survival subgroup: (12.44±4.43)%, (8.57±3.38)%, (6.78±3.35)%; death subgroup: (14.42±2.01)%, (11.32±2.53)%, (8.87±3.62)%, allP< 0.01], and it was obvious on day 1, and the phenomenon became less marked gradually. The rate of circulating apoptotic lymphocytes did not differ between the death and survival subgroups on day 1, but there was a significant difference in the rate on day 3 and day 7 (bothP< 0.05).② The expression of CHOP mRNA (2-ΔΔCt):compared with that in healthy controls [(2.56±1.09)×10-3], CHOP mRNA expression was increased on days 1, 3 and 7 in septic patients [survival subgroup: (5.83±1.96)×10-3, (4.24±1.60)×10-3, (4.15±1.64)×10-3, death subgroup:(37.20±20.70)×10-3, (18.80±13.90)×10-3, (9.28±7.78)×10-3, allP< 0.01], and it was more obvious in the death subgroup, as it was increased by 6.38, 4.43, and 2.24 folds (P values was 0.000, 0.000, and 0.001), but it decreased rapidly in death subgroup.③ The expression of GRP78 mRNA (2-ΔΔCt): compared with healthy controls [(3.31±2.04 )×10-3], the expression of GRP78 mRNA in both survival and death subgroups increased in septic patients on day 1 [(5.83±2.00)×10-3, (11.30±6.48)×10-3, bothP< 0.01], and they decreased subsequently. The expression of GRP78 mRNA in the survival subgroup declined to the levels of the healthy control group on day 3 and day 7 [3 days: (3.99±1.60)×10-3, 7 days: (3.30±1.35)×10-3, bothP> 0.05], and GRP78 mRNA expression in the death subgroup was gradually lowered, but it was still higher than that in the healthy control group [3 days: (7.27± 3.64)×10-3, 7 days: (5.23±1.94)×10-3, bothP< 0.01].④ Spearman relative analysis showed that the expression of CHOP mRNA was positively correlated with the rate of lymphocyte apoptosis (r = 0.414,P = 0.000 ).Conclusion The increase in the rate of lymphocyte apoptosis and activation of ERS play an important role in the development of sepsis, and it is associated with worse outcome in the septic patients.

Objective To evaluate imaging features and clinical significance of anatomical variations of the dorsal pancreas.Methods CT and MR imaging data of 47 cases with variations of the dorsal pancreas were collected.Imaging characteristics of the dorsal pancreas were analysed.Results (1) Narrow dorsal pancreas:the agenesis of dorsal pancreas (7 cases) appeared as short pancreas,their length was (91.59 ± 22.39) mm.4 cases of pancreatic head volume increased,with tadpole-like retention of the pancreas,including 3 cases of annular pancreas.2 cases with polysplenia syndrome and congenital abscence of the hepatic segment of inferior vena cava.(2) Abnormaly enlarged dorsal pancreas:①the broadening of the pancreatic tail (n =18):the maximum diameter of pancreatic tail was (36.12 ± 6.59) mm,the pancreas was similar to the dumbbell-shaped.②Processes locally of pancreatic contour (n =13),which were local process at the ventral aspect of pancreas,the height was (15.72 ±2.65) mm,the width was (18.59 ± 3.64) mm,most often seen on the neck of the pancreas.(3) Dorsal pancreas related divisium:①Pancreas separated by fat spatium (n =7),the width was (3.51 ± 2.42),the deepness was (19.45 ± 5.84),it showed the crack-like fat density (signal) shadow,5 cases (5/7) located in the pancreatic body and tail,2 cases (2/7) located at the junction of ventral pancreas and dorsal pancreas.②The bifurcation of the pancereatic tail (n =3),limitations forked tail of the pancreas was dovetail-like performance.The maximum width diameter was (26.63 ± 1.75) mm,the bifurcation angle was (99.27 ± 30.73) degrees.Conclusions The developmental anomalies of dorsal pancreas can lead to a number of variations of pancreas,some of which can induce corresponding disease and be mistaken for neoplasm.

Objective To investigate the value of dual-phase 18F-FDG PET/CT for differentiating pancreatic cancer from pancreatitis.Methods Dual-phase 18F-FDG PET/CT scanning was prospectively performed on patients with suspicious pancreatic lesions.Patients with solid focal pancreatic lesions proved by histopathology or clinical follow-up were enrolled and divided into 3 groups according to the maximum diameter of the focus: ≤2.0 cm (group A), >2.0 cm and ≤ 4.0 cm (group B), >4.0 cm (group C).SUVmax at (60±10) min and (120±15) min after FDG injection was defined as early and delayed SUVmax (SUVearly and SUVdelayed), respectively, and retention index (RI) was calculated.The differences of SUVearly, SUVdelayed and RI between pancreatic cancer and pancreatitis were analyzed with Mann-Whitney u test.ROC curve was used to determine the optimal cutoff values of the above three parameters and corresponding diagnostic efficiencies were obtained.The AUC was compared with MedCalc software.Results A total of 196 patients (152 pancreatic cancers and 44 pancreatic inflammatory lesions) with solid focal pancreatic lesions were enrolled.The AUC of SUVdelayed was significantly larger than that of SUVearly (0.83 vs 0.79, z=3.64, P<0.01).Numbers of patients in group A, B and C were 45, 96 and 55 respectively.There was no significant difference of the maximum diameter between pancreatic cancers and pancreatitis lesions in all three groups (z values:-0.39,-1.52,-1.41, all P>0.05).The SUVearly, SUVdelayed and RI of pancreatic cancers were all higher than those of pancreatitis in group A and B (z values: from-4.59 to-3.00, all P<0.01).The diagnostic sensitivity and accuracy of SUVearly > 3.6 combined with RI > 0 for diagnosing pancreatic cancer were higher than those of SUVearly > 3.6: 96.4%(27/28) vs 75.0%(21/28), 95.6%(43/45) vs 82.2%(37/45).The AUC of SUVdelayed was significantly larger than that of SUVearly in group B (0.81 vs 0.77, z=2.06, P<0.05).The optimal cutoff value of SUVdelayed in group B was 5.3, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.4%(65/77), 13/19, 91.5%(65/71), 52.0%(13/25) and 81.2%(78/96), respectively.RI of pancreatic cancers was significantly higher than that of pancreatitis (25.0%(15.8%-35.7%) vs 14.4%(4.6%-18.7%), z=-2.39, P<0.05) in group C.The optimal cutoff value of RI in group C was 19.0%, with the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 68.1%(32/47), 7/8, 97.0%(32/33), 31.8%(7/22) and 70.9%(39/55).Conclusions The SUVdelayed and RI of dual-phase 18F-FDG PET/CT might be useful for diagnosis of pancreatic tumors.SUVearly > 3.6 combined with RI >0 could be helpful to improve the diagnostic sensitivity and accuracy in patients with the maximum diameter of lesions ≤2.0 cm.The diagnostic value of SUVdelayed might be better than that of SUVearly in patients with the maximum tumor diameter of >2.0 cm and ≤4.0 cm.Only RI could be used for diagnosing pancreatic tumors in patients with the maximum tumor diameter > 4.0 cm.

The hybrid PET/MR has been gradually applied in clinical practice.However,the hybrid PET/MR is a com plex advanced technique,and it brings to the new challenges,especially regarding the workflow and scan protocols.The guidelines for hybrid PET/MR in brain imaging include information related to the indications and contraindications,preparation before examination,procedures of examination (PET imaging,conventional MRI brain imaging and special MRI imaging for brain disease),application of radiopharmaceutical and MRI contrast-enhanced agent.The purpose of the guidelines is to offer a framework that would be practical and helpful for clinical PET/MR brain imaging.In PET tracers,the guidelines only limit to the 18 F-FDG.

Objective To evaluate the diagnostic value of the metabolic parameters for differentiating focal autoimmune pancreatitis (F-AIP) and pancreatic cancer (PC) by dual time 18F-FDG PET/CT scan.Methods Ten F-AIP patients and 20 PC patients in Changhai Hospital from May 2011 to November 2014 were enrolled in this study.All the AIP patients were histological confirmed or diagnosed by clinical follow up.The PC patients were histological confirmed and gender-and age-matched with F-AIP patients.50％ SUVmax was set as the threshold to fine-tune the boundary of interest.The extracted parameters included SUV SUV metabolic tumor volume (MTV),total lesion glycolysis (TLG),target-to-background ratio (TBR) and the retention indexes(RI) of all the parameters above.The PET/CT imaging features were also observed.Results The high metabolic lesions were observed in both F-AIP patients and PC patients.There were 6 F-AIP patients whose lesion was located in pancreas head,4 F-AIP patients whose lesion was located in pancreas body and tail.There were 12 PC patients whose lesion was located in pancreas head,8 PC patients whose lesion was located in pancreas body and tail.In F-AIP patients,2 cases had dilated pancreatic duct,6 had dilated biliary duct,8 had increased metabolism in mediastinal lymph node and 2 had abdominal lymphadenopathy,which were 8,5,5 and 14 cases in PC patients.The positive rate of mdeiastinal lymphadenopathy in F-AIP patients was statistically higher than that in PC patients,while the positivity rate of abdominal lymphadenopathy in AIP patients was lower than that in PC patients.The difference was statistically significant (both P ＜ 0.05).There were no statistical differences on the positivity rate of the dilated pancreatic duct,intra-and extra-hepatic bile duct between two groups.SUVmax,SUVmean and MTV in F-AIP were 5.37 ± 0.88,3.48 ± 0.66,21.79 ±15.60 in early stage and 6.45 ±1.51,4.23 ± 1.10,19.36 ± 14.63 in delayed stage,and those in PC were 8.31 ±3.08,5.41±1.95,9.26±8.35 in early stage,and 9.75±3.86,6.36±2.56,9.09±10.71 in delayed stage.SUVmax and SUVmean in F-AIP were lower than those in PC,whereas MTV were larger in F-AIP than that in PC.ROC curves for SUVmax,SUVmean and MTV were made.The AUC of SUV was the highest at 0.85,the cut-off value was 4.45,the corresponding sensitivity was 65％ and the specificity was 90％.TLG,TBR and RI of all the parameters were not statistically different in F-AIP and PC.Conclusions The 18F-FDG PET/CT metabolic parameters,such as SUVmax,SUVmean,MTV,could be of special diagnostic significance in discriminating F-AIP from PC.

Objective To investigate the diagnosis and differential diagnosis value of multisequences magnetic resonance imaging (MRI) in autoimmune pancreatitis (AIP).Methods The MRI data of twelve AIP patients were retrospectively analyzed.The sequences of MRI included T1 weighted imaging,T2-weighted imaging,magnetic resonance cholangiopancreatography (MRCP),diffusionweighted imaging (DWI) and dynamic enhancement images.The location and involving extent of lesions,signal,patterns of dynamic enhancement,changes of pancreatic and biliary duct,pseudo-capsule sign and other accompanying signs were observed.Twelve pancreatic cancer patients and twelve other patients with normal pancreas were set as controls.The imaging signs of AIP group and pancreatic cancer group were compared with Fisher's exact test.On the sequence of DWI,the apparent diffusion coefficient (ADC) values of pancreatic interested region of the three groups were tested and compared with least significant difference t test.At each period of enhanced MRI,the intensity ratios of pancreatic interested region to the left paraspinal muscle at the same level of the three groups were measured and compared with Pillai's Trace test.Results Among 12 patients with AIP,seven were diffused lesion,four were localized lesion,and one was multiple lesions.Among 12 pancreatic cancer patients,one was diffused lesion,and eleven were localized lesion.The difference of these two groups was statisfically significant (Fisher's exact test,P＜0.01).Among 12 AIP patients,on the T1-weighted image,intensity decreased in nine lesions,two cases without obvious intensity decreasing,and one case unevenly increased.On the T2 weighted image,intensity slightly increased in nine lesions,equal in one case,and slightly lowered in two cases.The ADC value of the lesions of AIP group ((1.011 ± 0.118) × 10 3 s/mm2) was lower than that of normal pancreas group ((1.489 ± 0.072) × 10 3 s/mm2) and pancreatic cancer group ((1.274 ± 0.120) × 10 3 s/mm2),and the differences were statistically significant (t=-11.793,-4.300; both P＜0.01).Among 12 AIP patients,the pancreatic duct of the lesions was irregular segmental sclerosis and stenosis in four patients.Pseudo-capsule sign around the lesions of pancreas was seen in seven patients.Among 12 pancreatic cancer patients,the pancreatic duct of the lesions was stenotic in two patients while the pseudo-capsule sign wasn't found.The differences of these two groups were statistically significant (Fisher's exact test,both P＜0.01).Dynamic enhanced MRI showed that enhancement patterns of the lesions of both AIP and pancreatic cancer presented progressive enhancement.However,during the balanced period,the signal intensity ratio of AIP group (3.34±1.40) was significantly higher than that of pancreatic cancer group (2.38 ± 0.18),and the difference was statistically significant (F =60.703,P ＜ 0.01).Conclusion Combination of a variety of sequences of MRI can help to fully reflect the pathological and biological characteristics of AIP and increase the accuracy of diagnosis.

Objective To evaluate the differential diagnostic value of 18F-FDG PET/CT between pancreatic lymphoma (PL) and pancreatic carcinoma (PC).Methods The 18 F-FDG PET-CT data of 16 patients who were pathological diagnosed with PL were retrospectively reviewed and compared with those of 32 consecutive pancreatic cancer patients who were pathologically diagnosed and randomly enrolled.The age,location,diameter and the maximum standard uptake values (SUVmax) of pancreatic lesions,pancreatic ductal dilatation,distal pancreatic atrophy,serum CA19-9 level and extrapancreatic organs involvement were analyzed.Results The 16 patients with PL included 8 men and 8 women,the mean age was (46 ± 17)year,and 11.1％ (1/9) patients had elevated CA19-9.The 32 patients with PC included 15 men and 17 women,the mean age was (61 ± 12)year,and 81.3％ patients had elevated CA19-9.There were no significant differences on gender between the two groups,while the mean age of PL patients was younger than that of PC,elevated CA19-9 was less common than that in PC,and the differences were statistically significant (all P＜0.05).There were 12 cases of diffusive large B cell lymphoma,2 cases of B lymphoblastic lymphoma/leukaemia,1 case of follicular lymphoma and 1 case of dysplastic large T cell lymphoma in 16 PL patients.There was no significant difference on the site of pancreatic lesions between the two groups,but long diameter of PL lesions was larger than that of PC [(6.6 ± 3.3) vs (4.3 ± 1.8) cm,P =0.038].Dilated pancreatic duct and distal parenchyma atrophy in PL were less than those in PC (3/16 vs 17/32,1/16 vs 13/32),and SUVmax of PL lesions was significantly higher than that of PC (12.0 ± 5.5 vs 8.6 ± 3.8),indicating that the differences were statistically significant (all P ＜ 0.05).The cut-off value of SUVmax was 9.95,and Youden's index was 0.406 with the sensitivity and specificity of 68.8％ and 71.9％ for differentiating PL from PC.The incidence of extrapancreatic lesions including bone marrow and kidney and spleen infiltration was significantly more frequent in patients with PL than that in patients with PC(56.3％ vs 6.25％,43.8％ vs 3.1％,50.0％ vs 6.3％),while the incidence of liver metastases was significantly lower than that in PC (12.5％ vs 5.0％),indicating that the differences were statistically significant (all P ＜0.01).There were no significant differences on the incidence of other extrapancreatic lesions.Conclusions PL should be considered in relatively younger patients and manifested as a bulky mass with significant FDG uptake and extrapancreatic involvement of bone,kidney and spleen but without distinct pancreatic ductal dilation or distal parenchymal atrophy or liver metastasis.