The principle of Endoscopic Ultrasonography (EUS) is similar to abdominal ultrasonography. The difference between them is the installment of a high-frequency ultrasound miniature probe at the tip of the endoscope for real-time ultrasound scanning. The pancreas is a retroperitoneal organ. The insertion of the ultrasonic endoscope into the stomach and duodenum can clearly demonstrate the structure of the pancreas on ultrasound scanning. With the extensive application of EUS and development of endoscopic accessories, EUS is becoming more important and it plays an important role in the minimally invasive treatment of pancreatic diseases. EUS-FNA and injection technique, EUS-CPN,EUS-guided radiation seed implantation, endoscopic ultrasound-guided puncture and drainage of pancreatic pseudocyst broaden the application of EUS techniques. EUS will become another important minimally invasive endoscopic treatment for pancreatic diseases following ERCP.

Objective: To investigate the diagnostic value and clinical significance of trans-splenic portal scintigraphy in cirrhotic portal hypertension and compensatory circulation. Methods: Transsplenic portal scintigraphy, ultrasound, and gastroscopy were performed on 50 patients with cirrhotic portal hypertension and on 10 controls. According to the Child-Pugh classification, 15 patients with cirrhosis were Child A, 19 cases were Child B, and 16 cases were Child C. Results: In the control group, the splenoportal vein was shaped like the letter S, and the portosystemic shunt index was 0.19?0.07. Portal hypertension portosystemic shunts were of 3 types: intrahepatic (13 patients; index, 0.52?0.19), compensatory(31 patients; index, 0.64?0.28)and completely extrahepatic (6 patients; index, 0.91?0.03). Collateral vessels were uphill, downhill, or complex. The portosystemic shunt index increased as cirrhosis and esophageal varices increased. There was statistical significance among groups(P

Y0, then the diagnosis of hypertension with liver cirrhosis obtained. The positive rate of diagnosis is 95% and the specificity is 96% and 91% respectively, much better than those in type B ultrasonography or gastric endoscopy, 78% or 75% respectively (P

Objective To evaluate safety and efficacy of EUS-FNA for occupying pancreatic lesions.Methods Data of 62 patients with occupying pancreatic lesions,who underwent EUS-FNA between June 2011 and June 2014,were analyzed for completion and complications,with surgery and clinical follow-up as the golden standard.Accuracy,sensitivity and specificity of EUS-FNA were calculated.Results A total of 62 patients with pancreatic lesions successfully underwent EUS-FNA and median puncture number was 4.2(3 to 8).Success rate of puncture was 100％ and sampling satisfaction rate was 90.3％ (56/62).No complications such as fever,infection,bleeding,perforation,severe pancreatitis or death were found.With the final diagnosis as the golden standard(39 malignant lesions and 23 benign lesions),overall diagnostic accuracy of EUS-FNA was 88.7％(55/62).The cytology diagnostic accuracy was 69.4％ (43/62),significantly higher than that of the tissue pathology of 30.6％ (19/62,P＜0.01).Sensitivity and specificity of the procedure were 87.2％(34/39) and 91.3％(21/23) respectively.Conclusion EUS-FNA is an effective and safe procedure in diagnosis of occupying pancreatic lesions.

Objective To analysis the clinical effects of biliary-pancreatic double stents in pancreatic cancer patients with obstructive jaundice.Methods From July 2008 to October 2011,a total of 60 patients with advanced pancreatic cancer were randomly divided into two groups to receive biliary-pancreatic double stents (n =28) or biliary stent only (n =32) according to the odd and even numbers of their admission date.Changes in liver function,abdominal pain,quality of life scores (QOL) were compared between two groups.Results The stents were placed successfully in 54 patients (90.0％),in which symptoms were relieved or gradually disappeared in all patients after the procedure.One week after stents placement,the serum total bilirubin decreased significantly from 164.32 ±45.16 μmol/L before ERCP to 63.25 ±27.06 μmol/L (P ＜ 0.05),other parameters including ALT,AST,AKP and r-GT were also decreased significantly compared with those of pre-ERCP (P ＜ 0.01),but there was no significant difference between the two groups (P ＞ 0.05).25 cases in double-stents group and 29 cases in single-stent group had varying degrees of pain relief at 7d after ERCP,but the overall pain relief rate and complete pain relief rate in double-stent group were significantly higher than those in single-stent group (92.0％ vs.55.2％; 64.0％ vs.34.5％,P＜0.05).At 7d and 14d after ERCP,Karnofsky QOL score were improved significantly in double-stent group (P ＜ 0.05).It was significantly better than single-stent group at 14d after ERCP (P ＜0.05).No death or other severe ERCP-related complications were observed.Conclusion Biliary-pancreatic stent placement for pancreatic cancer could significantly improve liver function and relieve obstructive pain.In the ways of alleviating pain and improving quality of life scores,it was better than ERCP biliary stent placement,especially for patients with pancreatic cancer combined obstructive pain.It indicated that biliary-pancreatic stent placement was better than simple biliary stent placement for advanced pancreatic head cancer patients with obstructive pain.

ObjectiveTo determine the Golgi protein-73 (GP73) level and platelet (PLT) count in the peripheral blood of patients with hepatitis B virus (HBV)-related liver diseases and to investigate their values in diagnosing different stages of HBV-related liver diseases. MethodsPeripheral blood samples were collected from 215 patients treated in Beijing Youan Hospital, including 36 patients with chronic hepatitis B (CHB), 32 patients with liver cirrhosis (LC), and 147 patients with hepatocellular carcinoma (HCC). The level of GP73 was measured by ELISA and the PLT count was determined using the Automatic Hematology Analyzer. Comparison of continuous variables was performed using one-way ANOVA, and comparison of categorical variables using chi-square test. The correlation between different variables was assessed by liner regression analysis. ResultsGP73 level (ng/ml) and PLT count (×109/L) displayed similar changes between patients with CHB, LC, pro-early HCC, early HCC, progressive HCC, and advanced HCC. The GP73 level and PLT count were significantly lower in patients with pro-early HCC(80.5±49.8; 84.4±40.0) than in those with CHB(135.5±95.8; 174.4±49.9), progressive HCC(133.8±71.1; 122.0±70.50), and advanced HCC(192.2±98.1; 176.2±86.3) (all P＜0.01). ConclusionGP73 level and PLT count change in patients with different stages of HBV-related diseases. The dynamic monitoring of GP73 level and PLT count is useful in the early diagnosis of HCC and the prognostic judgment of HCC patients.

OBJECTIVETo understand the influence of HIV infection on hepatitis C progress in patients co-infected with HIV and hepatitis C virus (HCV) and related immune mechanism.

METHODSTwenty eight patients co-infected with HIV/HCV and 12 patients with simplex HCV infection were enrolled. The liver function and hepatic fibrosis progress were evaluated by detecting peripheral blood and with Fibro-Scan. The viral load of HCV was detected by using real time quantitative PCR. And the percentage of Treg/CD4⁺ T lymphocyte cell was tested by using flow cytometry.

RESULTSThe levels of ALT and ALP in HIV/HCV co-infection group were (76.16 ± 81.248) U/L, (24.507 1 ± 8.194) g/L respectively, higher than those of simplex HCV infection group [(27.475 0 ± 13.985) U/L, (16.966 7 ± 7.189) g/L], the differences were statistical significant. P value was 0.012 and 0.009 respectively. The liver fibrosis index in HIV/HCV co-infection group was 5.950 0-5.825 0 Kpa, higher than that in simplex HIV infection group (5.150 0-1.050 0 Kpa), and the difference was nearly statistical significant (P = 0.077). The HCV viral load in HIV/HCV co-infection group was (6.476 8-5.343 4) lg copy/ml, higher than that in simplex HCV infection group [(1.699 0-2.681 5) lg copy/ml], and the rate of HCV clearance in HIV/HCV co-infection group was 32.14%, lower than that in simplex HCV infection group (75.00%). P value was 0.012 and 0.032 respectively. The percentage of Treg/CD4⁺ T lymphocyte cell in HIV/HCV co-infection group was (7.460 0%-2.287 5%), higher than that in simplex HCV infection group (5.965 0%-2.105 0%), and the difference was significant (P = 0.032). The percentage of Treg/CD4⁺ T lymphocyte cell was significantly related with HCV viral load (ρ = 0.350, P = 0.027), and HCV viral load was significantly related with the liver fibrosis index (ρ = 0.487, P = 0.001).

CONCLUSIONHIV infection could accelerate the progress of hepatitis C, and Treg cells were involved in this progress.

CD4-Positive T-Lymphocytes ; Coinfection ; Disease Progression ; HIV Infections ; complications ; Hepacivirus ; Hepatitis C ; complications ; virology ; Humans ; Liver Cirrhosis ; virology ; Viral Load

Objective To investigate the influence of intrahepatic cholestasis of pregnancy (ICP) on adverse pregnancy outcomes of hepatitis B virus (HBV)-infected pregnant women. Methods A retrospective analysis was performed for 232 pregnant women with chronic HBV infection who were admitted to Beijing YouAn Hospital, Capital Medical University, from March 2018 to March 2021. According to the presence or absence of ICP, the patients were divided into HBV infection group with 100 patients and HBV+ICP group with 132 patients; according to the severity of ICP, the patients in the HBV+ICP group were further divided into HBV+mild ICP group with 86 patients and HBV+severe ICP group with 46 patients. The above groups were compared in terms of the incidence rates of maternal complications during pregnancy, such as premature delivery, premature rupture of membranes, gestational diabetes mellitus, hypertensive disorder complicating pregnancy, and postpartum hemorrhage (PPH), as well as the adverse outcomes of fetus/neonate, such as intrauterine fetal death, neonatal asphyxia, amniotic fluid pollution degree Ⅲ(AFⅢ), neonatal respiratory distress syndrome, small-for-gestational-age (SGA), admission to the neonatal intensive care unit, pneumonia, and mother-to-child transmission (MTCT) of HBV. A one-way analysis of variance was used for comparison between multiple groups; the chi-square test, the chi-square test with continuity correction or the Fisher's exact test was used for comparison of categorical data between multiple groups. Results Compared with the HBV infection group in terms of maternal complications in late pregnancy, the HBV+ICP group had significantly higher incidence rates of premature delivery and PPH ( χ 2 =4.169 and 5.448, P =0.041 and 0.020), and in terms of the adverse outcomes of neonates, the HBV+ICP group had significantly higher incidence rates of neonatal asphyxia, AFⅢ, and SGA than the HBV infection group ( χ 2 =5.448, 16.567, and 11.053, P =0.020, P < 0.001, and P =0.002). In terms of the adverse outcomes of neonates, the HBV+severe ICP group had significantly higher incidence rates of AFⅢ and SGA than the HBV+mild ICP group ( χ 2 =4.200 and 4.511, P =0.040 and 0.034). Conclusion Compared with the pregnant women with HBV infection alone, the pregnant women with HBV infection and ICP have significantly higher incidence rates of adverse pregnancy outcomes in mothers and neonates, and the incidence rate of adverse outcomes in neonates increases with the increase in the severity of ICP. However, ICP has no influence on HBV MTCT.

ObjectiveTo investigate the causes of hypoglycemia and the features of clinical indices in patients with liver cirrhosis and diabetes mellitus. MethodsA total of 50 patients with liver cirrhosis and diabetes mellitus who were admitted to Beijing YouAn Hospital, Capital Medical University, from January 2017 to June 2019 were enrolled as subjects, among whom 25 patients with one hypoglycemic event were enrolled as experimental group and 25 patients without hypoglycemia were enrolled as control group. Hepatic and renal function, fasting blood glucose, glycosylated hemoglobin, and Child-Pugh class were evaluated for both groups, and the time period and possible causes of hypoglycemia were analyzed. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the control group, the experimental group had significantly lower levels of fasting blood glucose ［6.10(3.45~8.96) mmol/L vs 8.12(6.18~12.59)mmol/L, Z=-2.687, P=0.007］, cholinesterase ［3009.00(1788.50~4439.50)U/L vs 4936.00(4051.00~6740.50)U/L, Z=-3.095, P=0.002), albumin (32.02±7.07 g/L vs 35.89±5.49 g/L, t=2.161, P=0.036), and glycosylated hemoglobin (6.97±1.64 mmol/L vs 8.04±1.78 mmol/L, t=2.047, P=0.047). Among the patients in the experimental group, 36% had Child-Pugh class B cirrhosis and 36% had Child-Pugh class C cirrhosis, and among the patients in the control group, 56% had Child-Pugh class A cirrhosis and 40% had Child-Pugh class B cirrhosis; there was a significant difference in Child-Pugh class between the two groups (χ2=8.786, P=0.012). Most of the patients with liver cirrhosis and diabetes mellitus experienced hypoglycemia in the fasting state in the morning and in the daytime, with the main causes of excessive insulin (44%) and insufficient food intake or calorie supplementation (40%), and some patients experienced fasting asymptomatic hypoglycemia (16%). ConclusionBlood glucose monitoring and management should be taken seriously for patients with liver cirrhosis and diabetes mellitus in clinical practice, in order to reduce the occurrence of hypoglycemia.