IgG4-related disease (IgG4-RD) has been proved to be associated with malignancy.The incidence and risk factors of malignancy development in IgG4-RD were not clear.Nine IgG4-RD patients with malignancies and 27 IgG4-RD control cases were analyzed for risk factors and clinical features.The incidence of malignancy in IgG4-RD was 3.3％,higher than age-controlled general population.Smoking history was significantly more common in patients with malignancies than in the control group (9/9 vs 16/27,P ＜ 0.05).A total of 6/9 malignancies occurred within the first year after the diagnosis of IgG4-RD.Colorectal,biliary and thyroid cancers were the leading types.Smoking history is a risk factor for IgG4-RD associated malignancy.Careful vigilance to monitor malignancy needs to be paid during follow-up.

Objective To investigate the clinicalmanifestation,monitoring and therapeutic measure of severe enterovirus 71 ( EV71 ) infection in children.MethodsForty-five cases of severe EV71 infectionwere admitted in our PICU from May 2010 to Sep 2011.The vital sign and arterial blood pressure,central venous pressure,mixed venous oxygen saturation,dynamic non-invasive heart function and urine volume were monitored.Forty-five cases were divided into 3 stages according to clinical manifestation:( 1 ) nervous system involvement stage; (2) respiratory system involvement stage; ( 3 ) circulatory system involvement stage ( compensation and decompensation).We adopted individualized remedy measure according to different stages.ResultsIn 45 cases,38 cases discharged from hospital,the cure rate was 84.4％.Among all the 38 cases,nervous system involvement was found in 19 cases,respiratory system involvement was found in 12 cases,circulatory system involvement was found in 7 cases.Seven cases died,who had circulation failure.ConclusionWe should identify severe EV71 infection early.Positive control of high fever,appropriate liquid treatment,control of high blood pressure,early respiratory support,preventment of circulation failure are the key measures for treatment.Individualized monitoring and treatment are effective in children with severe EV71 infection.

Objective To analyze the characteristics of EUS imaging in the patients with autoimmune pancreatitis(AIP).Methods Eleven cases of AIP were studied retrospectively,and features of EUS were analyzed.Results EUS revealed diffuse or focal enlargement of pancreas along with hypoechoic parenchyma and a wavy margin.In addition to dilation,the bile duct had a prominently thickened wall with homogenous mild hypoechoic image.Peripancreatic lymph nodes could be enlarged.No pancreatic duct dilation.calcification or cysts were found.No peripheral vessels were involved.Conclusion EUS could demonstrate specific images which is helpful in diagnosis of AIP.

Objective Mesenteric panniculitis is an idiopathic , uncommon disease involving the adipose tissue of mesentery .The etiology , diagnosis and treatment are still unnoticed .We thus reported a case series to improve the understanding of this rare disorder .Methods We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation , diagnosis, treatment and prognosis.Results We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis.The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12).Physical examination was unremarkable in the majority of patients (8/12).C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients.CT findings were of much diagnostic value .All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density .Pseudo-capsule sign ( 8/12 ) and fat halo sign (6/12) were common.Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis .Six cases all received prednisone , 2 with combined cyclophosphamide , 1 with azathioprine, 1 with tripterygium wilfordii .Short-term clinical response was achieved in all cases , but two patients relapsed .Conclusions Mesenteric panniculitis occurs predominantly in middle-aged and elderly . Abdominal pain is the leading symptom .Inflammatory markers are often normal while computed tomography is the most important diagnostic tool .Surgery combined with cortical steroid and immunosuppressant agents is effective.

Objective To evaluate magnifying endoscopy combined with narrow-band imaging ( ME-NBI) for diagnosis of early gastric cancer (EGC).Methods A total of 150 focal lesions from 143 patients over 35 years old identified by white light endoscopy (WLE) from March 2010 to December 2010 in our tertiary referential institution were recruited in the prospective study with written informed consent.Focal lesions were defined as any small local mucosa with abnormal shape or color based on an assessment of findings of WLE without any specified criteria, including superficial, depressed and elevated lesions.The patients with local advanced gastric cancer, submucosal lesions and history of gastrectomy were excluded from the study.All the patients received ME-NBI.Based on literature, national criteria of early diagnosis with ME-NBI were established.All the lesions underwent biopsy and pathological examination.Diagnostic accuracy of ME-NBI for EGC was assessed with reference to histopathology.Results In 150 focal lesions, 19 were pathologically diagnosed as EGC, 8 of which were treated by endoscopic resection and 11 were resected surgically.The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of conventional WLE for diagnosing EGC were 94.7%, 53.4%, 22.8%, 98.6% and 58.7%, respectively.The counterparts of ME-NBI for diagnosing EGC were 73.7%, 99.2%, 93.3%, 96.3% and 96.0%, respectively.The diagnostic accuracy of ME-NBI was significantly better than that of conventional WLE (96.0% vs.58.7%, P＜0.05).With regard to the findings of EGC on ME-NBI, irregular or absent microsurface pattern and microvascular pattern were characteristic features of EGC.Conclusion Conventional WLE is still an important and mandatory screening modality, which is significant for further procedures of suspected lesions, preferably accompanied with biopsy.ME-NBI achieved superior accuracy in the differential diagnosis of focal lesions detected with conventional WLE, but needs further verification.

A 56-year-old female was admitted to Department of Gastroenterology at Peking Union Medical College Hospital with diarrhea for seven months, and abnormal liver function for six months. She had a history of type 1 diabetes. The main clinical manifestations were recurrent fatty diarrhea and abnormal liver function, accompanied by abdominal and retroperitoneal lymphadenopathy, elevated CA19-9 and CEA. Progressive impairment of hepatic synthetic function and shrinkage of liver developed in a short period of time. The pathology of liver biopsy suggested that nodular regeneration of hepatocytes was followed by hyperplasia of thin bile ducts after submassive necrosis. Intestinal mucosa biopsies were performed twice. The pathology showed that the intestinal villi were completely blunt, accompanied with crypt hyperplasia. Goblet cells disappeared with reduced mucin. Paneth cells were barely seen without intraepithelial infiltration of lymphocytes. Rifaximin was not effective, while glucocorticoids improved clinical situation. The diagnosis of autoimmune enteropathy was finally confirmed by multidisciplinary team including departments of gastroenterology, pathology, endocrinology, hematology, infectious diseases, and rheumatology. With the administration of glucocorticoid and sirolimus, diarrhea relieved and liver function returned to normal.

Objective To investigate the mechanism of matrix metalloproteinase(MMP)-9 involved in epithelial mesenchymal transformation(EMT)in chronic sinusitis(CRS).Methods The expression of MMP-9 from polypoid middle turbinate tissue was detected by immunohistochemical staining qPCR and Western blot assay in 42 patients with CRS and 8 patients underwent septoplasty.Primary human nasal epithelial cells HNEpc were cultured in vitro and divided into the control group,the TGF-β1 group(5 μg/L TGF-β1 intervention)and the TGF-β1+si-MMP-9 group(transfected with si-MMP-9 and 5 μg/L TGF-β1 intervention).The expression of MMP-9 was detected by cell immunofluorescence staining.Expression levels of TGF-β1,MMP-9 and EMT-related proteins E-cadherin,vimentin and α-SMA were detected by Western blot assay.Results(1)The positive expression rate of MMP-9 was significantly higher in the nasal mucosa of CRS with nasal polyps(CRSwNP)group(54.5%,12/22)than that of the CRS without polyps(25.0%,5/20)group and the control group(12.8%,1/8).The relative expression levels of MMP-9 mRNA and protein in nasal mucosa were higher in the CRSwNP group than those in the CRSsNP group and the control group(P＜0.05).(2)Compared with the control group,the expressions levels of TGF-β1,MMP-9,vimentin and α-SMA were increased in the TGF-β1 group,while the expression of E-cadherin was decreased(P＜0.05).Compared with the TGF-β1 group,expression levels of TGF-β1,MMP-9,vimentin and α-SMA were decreased in the TGF-β1+si-MMP-9 group,and the expression of E-cadherin was increased(P＜0.05).Conclusion The expression of MMP-9 is increased in CRS patients,which may be involved in the development of CRS through the regulation of EMT.

Objective To compare the Rosemont criteria with conventional criteria for diagnosis of patients with chronic pancreatitis(CP)by endoscopic ultrasonography(EUS). Methods The data of patients with CP confirmed in Peking Union Medical College Hospital from January 2001 to September 2011 were retrospectively analyzed. Pancreatic parenchymal and ductal features were evaluated by conventional criteria and Rosemont criteria using EUS,respectively. The diagnostic value of the two kinds of criteria were compared. Results Among the 45 CP patients with mean age of 48.8 years, 34 were male, and 11 were female. Nineteen cases were in clinical phase 1, 8 in clinical phase 2, and 18 in clinical phase 3. The diagnostic yield of conventional criteria with at least 3 imaging features was higher than that of Rosemont criteria(51.1% VS 31.1%, P=0.004), but there was no significant difference between conventional criteria with at least 5 imaging features and Rosemont criteria(26.7% VS 31.1%,P>0.05).In CP patients of clinical phase 1,the diagnostic yield of conventional criteria with at least 3 imaging features was higher than that of Rosemont criteria(47.4% VS 21.1%, P=0.033), but there was no significant difference in phase 2 and 3. Conclusion Conventional criteria shows higher diagnostic yield than Rosemont criteria. It will be more valuable to apply conventional criteria with at least 3 imaging features of EUS in early suggestive chronic pancreatitis.

Objective: To study clinical characteristics and treatment after colonscopic perforation, and to determine risk factors for postoperative complications. Methods: Cases diagnosed as colonoscopic perforation within 7 days after colonoscopy in Peking Union Medical College Hospital between January 2010 and January 2017 were reviewed. Data regarding demography (age, sex), clinical information (comorbidities, medication history of glucocorticoid, length of hospital stay), colonoscopy (whether endoscopic therapy or anesthesia was performed, intestinal cleanliness), perforation (region, diagnosing time) and operation (laparotomy or laparoscopic operation, procedure, post-operational complications) were collected. Single factor analysis and Spearman correlation analysis were employed to determine the risk factors of postoperative complications. Results: A total of 14 colonoscopic perforation cases were identified and included in this study, and the overall perforation rate was 0.03%. Most perforations occurred in rectum (2 cases) and sigmoid colon (8 cases). Twelve perforation patients received operational treatment, of who 6 developed postoperative complications, including 3 cases of incision infection, 2 cases of peritoneal infection, 1 case of catheter-related infection and 1 case of pulmonary embolism. Spearman correlation analysis showed that preoperative medication of glucocorticoid and non-rectosigmoid perforation were positively related to postoperative complications (both correlation coefficients were 0.707, P=0.01), while perforation diagnosed immediately and satisfying intestinal cleanliness were negatively related to it (both correlation coefficients were -0.667, P<0.05). Conclusion Perforations are rare but severe complications of colonoscopy, and surgical interventions are necessary in most cases. Postoperative complications were significantly related to perforation sites, preoperative medication of glucocorticoid, perforation diagnosis time and intestinal cleanliness.

Objective:To investigate the role of endoscopic ultrasonography (EUS) in differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC).Methods:Data of 133 patients with AIP and 113 patients with PC who underwent EUS because of obstructive jaundice at Peking Union Medical College Hospital from January 2013 to December 2018 were retrospectively analyzed in the study, and were randomly divided into either a derivation sample or a validation sample using 1∶1 allocation according to the random number. In the derivation sample, 10 EUS characteristics were used to construct a prediction model to distinguish between AIP and PC, in which predictors were identified by multivariate stepwise logistic regression analysis and predictive efficacy was evaluated by receiver operating characteristics (ROC) curve analysis. The predictive efficacy was assessed in the validation sample. In view of the subjectivity in the judgment of diffuse/focal hypoechogenicity, 2 prediction models were designed in order to avoid bias.Results:By multivariate stepwise logistic regression analysis, diffuse hypoechogenicity ( OR=591.0, 95% CI: 98.8->999.9, P<0.001) and vessel involvement ( OR=11.9, 95% CI: 1.4-260.2, P=0.023) were identified as statistically significant predictors for distinguishing AIP from PC. EUS characteristics excluding diffuse/focal hypoechogenicity were stepped by logistic regression, which showed that hyperechoic foci/strands ( OR=177.3, 95% CI: 18.7->999.9, P<0.001), pancreatic duct dilation ( OR=60.5, 95% CI: 6.2->999.9, P=0.004), bile duct wall thickening ( OR=35.4, 95% CI: 3.7->999.9, P=0.009), lymphadenopathy ( OR=16.8, 95% CI: 1.7-475.2, P=0.038) and vessel involvement ( OR=22.7, 95% CI: 2.0-725.7, P=0.028) were statistically significant predictors to distinguish the two diseases. Both prediction models were built in the derivation sample, with area under the ROC curve of 0.995 and 0.979 respectively. In the validation sample, sensitivity, specificity, accuracy, positive predictive value and negative predictive value of both prediction models were all >90% by using the optimal cutoff value. Even for discrimination between focal AIP and PC, sensitivity and accuracy of both models were >90%, and specificity, positive predictive value and negative predictive value were all >85%. Conclusion:The 2 prediction models have good differential predictive value, and EUS is a useful tool to differentiate between AIP and PC.