Objective Diagnosis of contrast-enhanced ultrasound ( CEUS) for small focal liver lesions under the background of hepatocirrhosis has been a difficult problem in clinical practice .CEUS has significantly improved the accuracy of liver cancer diagno-sis, but little research has been done in minimal lesions .The article was to investigate the diagnostic value of CEUS in liver cirrhosis with small focal liver lesions (≤2 cm) . Methods 70 patients with cirrhosis and 76 small focal hepatic lesions who were admitted in our hospital from March 2015 to August 2015 were examined by conventional ultrasound and CEUS .Comparative analysis was made be-tween the results of tests and pathology to calculate the sensitivity , specificity and accuracy of CEUS and conventional ultrasound . Results The sensitivity , specificity and accuracy in diagnosing small hepatic cancer lesions complicated with cirrhosis by CEUS and conventional ultrasound were 47.6%、79.4%、61.8%and97.6%、97.1%、97.4%,respectively.CEUS was in high consistence with the results of pathology ( Kappa 0.947) and significantly higher than those of conventional ultrasound (Kappa 0.259). Conclusion CEUS has high application value in the differential diagnosis of small focal he-patic lesions complicated with cirrhosis .

ObjectiveTo investigate the clinicopathologic features,therapy,and prognosis of primary small cell carcinoma of the pancreas.MethodsDatabases including Chinese Journal Full-text Database,VIP Database for Chinese Technical Periodicals,Medline/Pubmed,and OVID were searched electronically up to April 2012.A systematic review was performed together with one case in our hospital.ResultsTwenty-eight articles fulfilling the criteria consisting of 46 patients with pathologically confirmed diagnosis of primary small cell carcinoma of the pancreas were studied,together with 1 patient in our Drum Tower Hospital,finally 47patients were included.The results of this systematic review showed:( 1 ) Primary small cell carcinoma of the pancreas was more common in men with a median age of 62.The most common clinical presentations were abdominal pain,jaundice and weight loss.Para-neoplastic syndrome was rarely observed.(2)Most cases were found to have abnormally elevated serum levels of neuron-specific enolase.CT displayed heterogeneous,and marked enhancing masses in most cases.The conclusive diagnosis depended on histological confirmation.(3)63.8％ of the cases were found to be associated with metastasis at the time of diagnosis.The overall median survival time was 28 weeks.(4) There was no consensus on the treatment of primary small cell carcinoma of the pancreas. Chemotherapy was currently considered as the treatment of choice among the systematic management for these patients.ConclusionsPrimary small cell carcinoma of the pancreas was a rare and aggressive neuroendocrine tumor with a poor prognosis.

Objective To study the expression and interactions of DNA methyltransferase 1 (DNMT1),enhancer of zeste homolog 2 (EZH2) and histone deacetylase 1 (HDAC1) in gastric cancer cell lines and tissue specimens.Methods The expression of DNMT1,EZH2 and HDAC1 was detected at mRNA and protein level in gastric cancer lines MKN28,SGC7901,BGC823,AGS,normal gastric epithelium cell line GES-1 and 10 pairs of fresh gastric cancer tissues and corresponding normal gastric tissues by real-time polymerase chain reaction and Western blot.Whether DNMT1,EZH2 and HDAC1 forming complex or not was detected by co-immunoprecipitation (Co-IP) in well-differentiated gastric cancer cell line MKN28,medium-differentiated gastric cancer cell line SGC7901,lowdifferentiated gastric cancer cell line BCG823,normal gastric epithelium cell line GES-1,mediumdifferentiated,medium to low-differentiated,low-differentiated gastric cancer tissues and corresponding normal gastric tissues.Results Compared with that of normal gastric epithelium cell and gastric tissue,the expression of DNMT1,EZH2 and HDAC1 in gastric cancer cell lines and gastric tissue was higher.The results of Co-IP indicated that DNMT1,EZH2 and HDAC1 formed complex in the high,medium,and poor differentiated gastric cancer cells and the medium,mediumlow,poor differentiated gastric cancer tissues,but not in normal gastric epithelium cell and tissue.Conclusion DNMT1,EZH2 and HDAC1 highly expressed in gastric cancer and there was interaction effects among them,which might be an important mechanism in the correlation between DNA methylation and histone modifications in gastric cancer.

Objective To assess the safety and the efficacy of endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic pseudocysts (PPC).Methods A total of 17 patients with PPC who underwent EUS to detect the optimal site and depth of puncture.The needle was punctured into the PPC cavity through endoscopic biopsy hole,cyst fluid was drained with a syringe.The guide wire was inserted along the pinhole under X-ray,and then the needle-knife was sent along the guide wire to cut the gastric wall and pseudocysts wall,followed by balloon dilation.The way of drainage was selected according to the cyst fluid properties.The technical success rate,treatment success rate,complication occurring rate and the skills were evaluated.Results Four patients were with nasalcystic catheter drainage,9 patients with double pigtail stents internal drainage,and 4 patients with nasal-cystic catheter and double pigtail stents combination drainage.The treatment success rates were 3/4,7/9,and 4/4 respectively.Only 1 patient subsequently developed bleeding from puncture site after stent successively placed,and was turned to surgery because of ineffective endoscopic treatment.Infection occurred in 4 patients during drainage,two of those were switched to surgical resection due to poor medical treatment response,and the other 2 were cured with intravenous infusion of antibiotics sensitive to cyst fluid bacteria and metronidazole rinse PPC.The median follow-up duration was 28.5months,and there was none of recurrence.Conclusions EUS-guided transmural drainage of PPC is safe.Stent placement and nasal-cystic catheter play an important role in PPC treatment.

Objective To analyze the etiology and clinical features of isolated gastric varices.Methods A retrospectives analysis was carried out in 31 patients with isolated gastric varices between January 2003 and January 2008.The patients records including data of etiology,clinical presentation,imaging studies and therapeutic modalities were reviewed.Results Those who had isolated gastric varices were accounted for 7.38 0A (31/420)of all patients with gastroesophageal varices.The etiologies were left-sided portal hypertension(14 cases,45.2%),liver cirrhosis(8 cases,25.8%),unknown origin(6 eases,19.4%),hepatocellular carcinoma(2 cases,6.5%),portal cavernous transformation(1 case,3.2%).Twenty-one patients(67.7%)had variceal hemorrhage.Splenomegaly was present in 21 cases(67.7%),among which 10 cases(32.3%)had concomitant hypersplenism.Venous involvement was identified in 18 patients(splenic vein obstruction in 9 cases and portal vein involvement in 9 cases).Surgical therapy was performed in 8 cases,selerotherapy in 3 cases,and medical therapy in 20 cases.Conclusions Left-side portal hypertension is responsible for most of the isolated gastric varices,and some of which are also caused by liver cirrhosis.Surgery is the appropriate procedure of choice in management of hemorrhage and recurrence.

BACKGROUND: The hot environmental condition of the isolated severe acute respiratory syndrome (SARS) ward makes the protein transformation of the medical personnel accelerated. The dietary protein should make up the special consumption and improve the immunity in addition to guaranteeing the normal metabolism for the purpose to promote the organic endurance and resist the communicable disease.OBJECTIVE: To study the scientific mode of quality and quantity of protein supply for the medical staff working in the SARS ward.DESIGN: A cross section analysis.SETTING: Trophological Department, General Hospital of Chinese People's Armed Police Forces.PARTICIPANTS: The 64 healthy doctors and nurses, 22 males and 42females, aged 29 averagely, worked in the SARS ward from May 1st to 20th 2003, were the volunteers to join the observation.METHODS: The weighing method was applied to measure the quantity of various food supplied by recipe and actually taken and the nutrition software was used to analyze the quantity of protein and amino acid contained in the food. The quantity of protein supply (taking male as standard) calculated according to the heavy consumption, 1.5 g/kg.d, in the hot environment was compared with the estimated consumption, male (108.00±12.63) g and female (85.21±9.55) g, and with the actual intake analyzed by computer. The corrected scoring of digestibility was employed to evaluate the reasonability of intake of various essential amino acids. The quantity of essential amino acids contained in every gram of protein of recipe/the amino acids contained in Reference Mode of Chinese Food × 93% being higher than 1.0 was said to be the quality protein meeting the need of human body.MAIN OUTCOME MEASURES:① The quantity and composition of protein supplied by the recipe. ② The quantity and composition of protein actually taken by the working staff.RESULTS: All of the 64 medical working staff entered the result analysis.① The protein supply of recipe (daily average) could totally meet the need of estimated consumption of male and female staff [(157.36±10.43) g,(108.00±12.63) g, (85.21±9.55) g, t=9.344, 18.278, P ＜ 0.01] and the need of actual intake [(157.70±58.14) g, (111.02±31.77) g, t= -0.015, 3.795, P＞ 0.05, P ＜ 0.01]. ② The corrected scores of 9 amino acids of digestibility, (1.9-3.1), were all higher than 1.0 and the percentage of amino acids was in accordance with the food mode of Chinese people.CONCLUSION: The protein quantity and quality of recipe can meet the special need of medical staff working in the hot environment with the heavy physical consumption in the SARS ward and can produce the best biological effect, being scientific.

ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for precancerous lesions and early cancer at gastroesophageal junction (GEJ) by comparing endoscopic mucosal resection (EMR) with ESD.MethodsData of patients with GEJ precancerous lesions or early cancer,who received EMR ( n =51 ) or ESD ( n =28) were reviewed to compared the en bloc resection rate,R0 resection rate,operation time,complication and recurrence rate between 2 methods.ResultsEn blcc resection and R0 resection rates of ESD group (92.9％,78.6％ respectively) were significantly higher than those of EMR group (45.1％,43.1％ respectively).Local recurrence rate in ESD group (3.6％,1/28) was significantly lower than that of EMR group ( 19.6％ ).Complications including perforation,delayed hemorrhage,stricture were not significantly different between EMR and ESD groups.Mean operation time of ESD group (64.3 ±27.1 min) was significantly longer than that of EMR group (27.6 ± 14.1 min)(P ＜0.05).ConclusionESD,with a higher cure rate and en bloc rate and a lower local recurrence rate,is superior to EMR for precancerous lesions and early cancer at GEJ.

Objective To investigate the therapeutic efficacy and safety of endoscopic resection of giant gastric stromal tumors without explicit evidence of metastases.Methods A total of 12 giant gastric stromal tumors with no evidence of metastases diagnosed by endoscopic ultrasound (EUS) and computed tomography (CT) scan were managed by endoscopic resection.Operation time,blood loss and the incidence rate of perforation were recorded respectively.The diagnoses of tissue specimens were made by pathological examination and immunohistochemistry.In order to assess local recurrence and distant metastases,endoscopy and endoscopic ultrasound follow-up examinations were performed routinely at 2,6 and 12 months,and the whole abdominal CT scan was also performed at 12 months after operation.Results Endoscopic resections were successfully performed in 10 of 12 cases (83.3％),among which,6 underwent endoscopic submucosal excavation (ESE) without unexpected perforation and 4 endoscopic full-thickness resection (EFR)with intentional perforation.The rate of intentional perforation was 33.3％ (4/12),and all the perforations could be sealed by endoscopic methods.The blood losses were all more than 100 ml,which could be controlled by argon plasma coagulation,electrocoagulation or hemostatic clips.In the 10 encapsulated tumors,8 could be smoothly removed from esophagus,whose long diameter of the minimum cross section was less than 3.5 cm,however,2 tumors whose diameters were larger than 3.5 cm were taken out after segmentation.In the 10 tissue samples,9 were confirmed as low risk GIST,1 larger than 5 cm was pathologically confirmed as high risk GIST.During 1-year follow-up,no local recurrence or peritoneal metastasis was found.2 tumors,larger than 5.0 cm,could not be removed by endoscopic methods due to uncontrolled bleeding.The rate of uncontrolled bleeding was 16.7％ (2/12).The patients were transferred to surgery,and pathologically confirmed as having high risk GIST.Conclusion For low-risk giant gastric stromal tumors whose diameters were less than 5cm without evidence of metastases,endoscopic resection is considered as a safe and effective procedure.Tumors with long diameter of the minimum cross section less than 3.5 cm are more suitable for endoscopic resection,which can be smoothly taken out through cardia.However,for high-risk GIST larger than 5.0 cm,the rate of uncontrolled bleeding is high,so endoscopic resection should be adopted with discretion.

Objective To analyze the possible risk factors of esophageal stenosis after endoscopic mucosal resection (EMR). Methods From January 2008 to December 2009, a total of 219 procedures of esophageal EMR were performed to resect early esophageal squamous carcinoma and its precancerous lesions,and esophageal stenosis was observed in 9 cases. Data of these 9 patients ( stenosis group) were collected and compared with those of patients without stenosis ( control group, n = 202, 8 patients were excluded because of being diagnosed as squamous carcinoma with submucosal infiltration after EMR and being transfered to surgery). Results There was no significant difference between two groups in regard of gender, age, location of the lesion, length of the lesion or pathological diagnosis after EMR, while the rate of patients with mucosal defect larger than 3/4 circumference in stenosis group ( 8/9, 88.9% ) was significantly higher than that in control group (9/202, 4. 5%, P ＜ 0. 01 ). Conclusion In EMR for early esophageal squamous carcinoma and its precancerous lesions, post-EMR mucosal defect larger than 3/4 circumference is a risk factor for esophageal stenosis.

Objective To investigate the clinical,pathologic and endoscopic ultrasound characteristics of pancreatic neuroendocrine tumors (PNETs).Methods Clinical data of 24 consecutive patients of PNETs who were admitted between January 2002 and January 2011 were reviewed.Results Among these 24 patients,19 were diagnosed to have insulinomas,1 was malignant insulinoma,2 were gastrinomas,and 2 were glucagonomas.Eighteen (75％) cases of PNETs were functional PNETs,and 6 (25％) were nonfunctional PNETs.The mean age of the patients was (42 ± 14) years old ranging from 19 ～ 64 years old,and the percentage of male patient was 33.3％.The main symptoms of insulinomas were intermittent abdominal pain or discomfort,and the main manifestations of glucagonomas were weight loss,skin migratory erythema; and the main symptoms of gastrinomas were diarrhea,vomiting with large amounts of water-like liquid.The detection rate of CT was 86.7％ (13/15),and the detection rate of EUS was 100％ (15/15),but PET-CT detected only 40％ of tumors (2/5).The endoscopic ultrasound characteristics of PNETs were circular or oval hypoechoic mass,and the volume was small with clear boundary and homogeneous echo.There was no enlarged lymph node,and liquid was detected in big tumor.Twenty-two patients received operation and 2 patients did not.PNETs expressed CgA and Syn protein.All patients of PNETs were alive with 7 to 80 months follow-up.Conclusions The clinical characteristics of PNETs were unique.EUS has a high accuracy for detecting and localizing PNETs.The surgical method is similar to that of pancreatic cancer,and the prognosis is relatively good.