Objective To explore the value of multislice spiral computed tomography ( MSCT ) in predicting the resectability of pancreatic cancer ( PC) .Methods The MSCT images of 102 PC patients ( 62 men, mean age, 61 ±9 years;40 women, mean age, 60 ±9 years) confirmed by postoperative pathology were analyzed retrospectively .The images were analyzed and evaluated by 2 senior radiologists who were double blinded.The relationship between tumor and vessels was investigated based on consensus statement on the radiological diagnosis of PC of the Society of Abdominal Radiology and the American Pancreatic Association in 2014 .The diagnostic criterion on the resectability of PC was based on the 2015 NCCN Clinical Practice Guidelines on PC . Image analysis included the lesion location , size and density , the characteristics of pancreatic and bile ducts , relationship of tumor and adjacent vessels , the extrapancreatic findings as well as T staging and resectability.Results The locations of PC were found in the pancreatic head (n=71,69.6%), body (n=23, 22.5%) and tail (n=8, 7.8%).The long-and short-axis diameter were (28.9 ±8.8)mm and (23.8 ±8.0)mm in head, and respectively, (31.2 ±11.0)mm and (23.8 ±6.3)mm in body and tail, respectively.The imaging findings included hypo-(n=98, 96.1%) and iso-density masses (n=4, 3.9%) on pancreatic phase, intra-and extrahepatic bile duct dilation (n=63, 61.8%), main pancreatic duct cut-off with dilation (n=46, 45.1%), the pseudocyst (n=4), acute pancreatitis (n=1) and chronic pancreatitis (n=2).T staging evaluation by MSCT observed T1 (n=3), T2 (n=7), T3 (n=78) and T4 (n=14), respectively.MSCT assessment for T staging was correct in 98 (96.1%), but wrong in 4 (3.9%), which was quite consistent with pathological T staging (K=0.88, P<0.05).MSCT assessment for the resectability was correct in 98 (96.1%), but wrong in 4 (3.9%).Sensitivity, specificity, positive and negative predictive values, and area under curve of MSCT in the assessment of the resectability were 96.8%, 87.5%, 98.9%, 70.0%and 92.2%, respectively.Conclusions MSCT could improve the diagnostic accuracy for T Staging and resectability of PC .

Objective To explore the imaging findings of branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods A total of 45 BD-IPMNs were confirmed by pathology after surgery.The clinical data and imaging findings were retrospec-tively reviewed.Image analysis included characteristics and the nature of the lesions.Finally,an ROC curve was performed to evaluate the differential diagnostic efficacy between benign and malignant lesions using the imaging findings.Results There were statistically significant differences for differential diagnosis of malignant and benign BD-IPMNs in the maximum diameter of the lesions and the MPD,walls,wall nodules,shape,and the atrophy of pancreatic parenchyma (P < 0.05 ).The diagnostic sensitivity,specificity, AUC and Kappa value of benign and malignant BD-IPMNs were 94.3%,90%,92.1% and 0.81 (P =0.000 1)respectively.Conclu-sion The imaging technology is valuable in diagnosing and differentiating malignant from benign BD-IPMNs.

OBJECTIVETo investigate the effect of Xianxiong decoction on the mice with acute lung injury induced by lipopolysaccharide.

METHODEighty female ICR mice were randomly divided into 8 groups: model group, Xianxiong decoction group, Daxianxiong decoction group, Xianxiong decoction group without Kansui Radix group, Xianxiong decoction group without Glycyrrhizae Radix et Rhizoma group, Glycyrrhizae Radix et Rhizoma and Kansui Radix group, normal group and control group. Animals of each group, except normal group, were undertaken intraperitoneal injection and intranasal inhalation of lipopolysaccharide (LPS) on day 1, 2, 3 to establish acute lung injury (ALI) model. 30 min after modeling, 0.2 mL corresponding drugs were administrated to each mice, dexam ethasone and normal saline were given to the mice of control group and normal group respectively. White blood cell in blood, neutrophil percentage of blood and bronchoalveolar lavage fluid (BALF) supernatant, the ratio of wet and dry lung tissue ( W/D), histopathological changes of lung tissue were estimated. Sixty ICR mice were randomly divided into normal, model, control, high, middle and low dose Xianxiong decoction groups and were modeled in the same way. ELISA was applied to detect the level of NF-kappaB, TNF-alpha and IL-6 in BALF, PCR for NF-kappaB and TNF-alpha mRNA in lung tissue, and Western blot for NF-kappaB and TNF-alpha. Half of 20 ICR mice were administrated with Xianxiong decoction of its maximum tolerant normal saline.

RESULTCompared with model group, the number of WBC in blood of Xianxiong decoction group mice decreased (P < 0.01), percentage of neutrophils in both blood and BALF decreased as well (P < 0.01, P < 0.05); it also significantly reduced the ratio of W/D (P < 0.01); and found the alveolar wall, the number of inflammatory cells infiltrating improved, compared with model group. Xianxiong decoction reduced the level of NF-kappaB, TNF-alpha and IL-6 in BALF (P < 0.01, P < 0.01, P < 0.05); its high and low dose groups only found TNF-alpha level declined. Five mice died 24 h after administration of Xianxiong decoction which indicated its toxicity when other influential factors were considered.

CONCLUSIONXianxiong decoction is effective on the ALI mice induced by LPS, but it is of toxicity at 3 g x mL(-1).

Acute Lung Injury ; drug therapy ; genetics ; metabolism ; pathology ; Animals ; Bronchoalveolar Lavage Fluid ; chemistry ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Interleukin-6 ; genetics ; metabolism ; Lipopolysaccharides ; adverse effects ; Lung ; drug effects ; metabolism ; pathology ; Mice ; Mice, Inbred ICR ; NF-kappa B ; genetics ; metabolism ; Tumor Necrosis Factor-alpha ; genetics ; metabolism

Objective To discuss the MSCT imaging characteristics of metastatic lymph nodes in pancreatic cancer.Methods The MSCT images of 30 pancreatic cancer patients with metastatic lymph node confirmed by pathology were selected and all the patients underwent enhanced MSCT before surgery.The location, maximum short axis diameter ( MSAD) , sizes, density, enhancement, necrosis and fusion of the metastatic lymph nodes were analyzed using the 5th edition of TNM stage of Japan Pancreatic Society in 2002 as the standard.Results Sixty-three metastatic lymph nodes was pathologically diagnosed , while 53were diagnosed by MSCT.The metastatic lymph nodes most commonly occurred in group 13 and 17in pancreatic head cancer, while group 18 lymph node metastasis was more common in pancreatic body and tail cancer.The MSAD of metastatic lymph nodes was 2~17 mm with the average of (7.2 ±4.0)mm.All of metastatic lymph nodes were divided into MSAD <5 mm group, 5 mm~<10 mm group and ≥10 mm group based on their size.The number of metastatic lymph nodes of the three groups were 10, 18 and 25, respectively.The number of enhanced metastatic lymph nodes was decreased as the size increased, while the number of necrotic and fused lymph nodes was increased, which were statistically different (all P<0.05).Comparison between the two groups showed that the number of enhancement metastatic lymph nodes in MSAD <5 mm group and 5 mm~<10 mm group were more than that in ≥10 mm group ( 7/10 and 11/18 vs 2/25 ) .The number of fused lymph nodes in MSAD <5 mm group and 5 mm~<10 mm group were less than that in≥10 mm group (0 and 2/18 vs 22/25 ) .Clear edge metastatic lymph nodes were more in MSAD <5 mm group than that in≥10 mm group (6/10 vs 5/25).The number of necrotic metastatic lymph nodes in MSAD <5 mm group was less than that in ≥10 mm group(2 /10 vs 18/25).All the differences above were statistically significant ( all P<0.05), but no other significant differences were found between two groups.Conclusions The main imaging findings of metastatic lymph nodes in pancreatic cancer were unobvious enhancement, intratumoral necrosis and fusion.Heterogeneous density and unclear edge could benefit the diagnosis of metastatic lymph node.

Objective To evaluate the value of imaging studies in diagnosis and differentiating malignant from benign main duct intraductal papillary mucinous neoplasms (MD-IPMNs).Methods The imaging studies of a total of 31 patients with MD-IPMNs confirmed by pathology after surgery was retrospectively reviewed.All patients underwent either CT,MR or MRCP.Two radiologists observed the lesions' imaging feature,and then the lesions was scored,and the differentiation between malignant and benign was made.The Bland Altman method was used for evaluation of inter-observer agreement.The score of the lesions was compared with the pathological results.Finally,a ROC curve was used to calculate AUC,and to evaluate the role of the maximum diameter of the main pancreatic duct (MPD) obtained by imaging studies in differentiation of malignant and benign IPMNs,and to determine the best cut-off point,and sensitivity,specificity.Results Histological analysis revealed low grade dysplasia in 13 patients,middle grade dysplasia in 6 and high grade dysplasia in 5,and adenocarcinoma in 7.Imaging studies suggested benign lesions in 16,malignant lesions in 10 patients and disdiagnosis in 5.The inter-observer agreement on major imaging features was good.The maximum diameter of the MPD was clinically meaningful for distinguishing malignant from benign lesions,and the AUC was 83.8％,and the best cut-off value was 14.8 mm,the sensitivity and specificity was 66.7％ and 100％.The presence of wall nodules could be an imaging feature for distinguishing malignant from benign lesions,but the size of nodules,location of nodules within pancreatic duct,the atrophy of pancreatic parenchyma,and dilated bile duct was not useful for differentiation.Conclusions The imaging studies are sensitive for diagnosis and differentiation between malignant and benign MD-IPMNs,and it is of clinical value for preoperative diagnosis and follow up.

To study the mechanisms of total flavonoid from Glycyrrhizae Radix et Rhizoma (TFGR) and its ingredient isoliquiritigenin (ISL) on their regulation of M2 phenotype polarization of macrophages. IL-4 (60 μg x L(-1)) induced RAW264.7 cells for 6 h to establish the M2 macrophage model. TFGR and ISL restrained breast cancer cells migration with the aid of M2 macrophages in vitro. TFGR and ISL inhibited gene and protein expression of Arg-1, up-regulated gene of HO-1 and protein expression of iNOS, enhanced the expression of microRNA 155 and its target gene SHIP1, meanwhile down-regulated.the phosphorylation of STAT3 and STAT6. So TFGR and ISL were the bioactive fraction and ingredient in Glycyrrhizae Radix et Rhizoma to reverse M2 phenotype macrophages polarization. TFGR and ISL inhibited the promotion of M2 macrophages to breast cancer cells migration in vitro, STAT signal pathways and miR155 were partly involved.
Animals ; Cell Line, Tumor ; Cell Movement ; drug effects ; Cell Polarity ; drug effects ; Chalcones ; pharmacology ; Flavonoids ; pharmacology ; Glycyrrhiza ; chemistry ; Interleukin-4 ; genetics ; metabolism ; Macrophages ; cytology ; drug effects ; metabolism ; Mice ; RAW 264.7 Cells ; Rhizome ; chemistry

Objective To investigate effect of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) on visualization improvement of main and branch pancreatic duct and its diagnostic value of grading chronic pancreatitis (CP) .Methods The 3 .0 T magnetic resonance (MR) imaging data of 88 subjects (23 health volunteers and 65 CP patients) were prospectively analyzed .All the subjects received coronal T2-weighted sequences scan ,thick slab 2-dimensional MRCP sequences scan , routine pancreas plain scan and enhanced scan before and after 0 .1 mL/kg secretin intravenous injection . Sixty-five CP patients were grouped according to Cambridge classification and also according to normal and abnormal of duodenal filling (DF) .The images of main pancreatic duct (MPD) ,branch pancreatic duct (BPD) and DF were compared before and after secretin injection .The result was compared with that of endoscopic retrograde cholangio pancreatography (ERCP) which was the gold standard .One-way analysis of variance test was performed for comparison between healthy control group and CP group .Chi-square test was used for comparison between normal DF group and abnormal DF group .The consistence between the diagnostic results of MRCP ,S-MRCP and the results of ERCP were analyzed by Kappa test .Results Compare with MRCP ,after secretin injection the indexes of MPD ,the sensitivity ,specificity ,positive predictive value and negative predictive value of BPD were all improved ,and the rates of misdiagnosis and missed diagnosis all decreased .Using ERCP as gold standard of CP grade diagnosis ,the consistence of S-MRCP in CP grade diagnosis increased more significantly (Kappa=0 .77 ,P=0 .000 1) compared with that of MRCP (Kappa=0 .55 ,P=0 .000 1) .Among 43 normal DF cases ,the number of MPD dilatation , filling defect and branch duct in pancreatic head was 28 ,23 and 30 ,respectively ;among 22 abnormal DF cases which was 20 ,19 and 21 ,respectively ,and the differences were statistically significant (χ2=5 .01 , 3 .91 ,6 .88 and 4 .26 ,all P<0 .05) .Taking 4 min as the cutoff value of peak time ,the sensitivity and specificity of which in CP diagnosis were 86 .0% and 100 .0% , respectively . Conclusion S-MRCP improves the visualization of MPD and BPD ,and also increases the accuracy of CP grade diagnosis .

Objective To discuss the value of combining secretin-enhanced MR cholangiopancreatography (MRCP) and conventional MRI in the evaluation of chronic pancreatitis (CP).Methods Seventeen normal volunteers,and 36 patients with CP were enrolled in this study.Thick slab two dimension MRCP sequence,coronal T2 weighted sequence and conventional MRI were performed on all subjects.The changes of pancreatic ducts were observed before and after the injection of secretin.The exocrine function of the pancreas was evaluated using duodenal filling (DF) grades.Pancreatic parenchyma was reflected by signal intensity ratio (SIR) between the pancreas and the left psoas muscle on MR plain scan,and the ratio between the pancreatic substance phase and portal phase (A/V) of MR enhanced scan.All subjects were classified based on Cambridge classification and DF grades.The SIR and A/V were compared between all groups of Cambridge classification using the one-way ANOVA test,and between two groups of DF grades using Student's t test.Correlations between Cambridge classifications,DF grades and SIR,A/V were tested using Spearman rank correlation coefficients.Results After secretin injection,the visualization of all portions of the main pancreatic ducts and branch ducts were significantly improved in all subjects.Ten minutes after secretin injection,17 volunteers showed grade 3.Grade 3,2 and 1 were seen in 23,8,5 patients,respectively.Mild,moderate and severe CP by Cambridge classification showed in 11,12,13 patients,respectively.The mean SIR values of the volunteers and the three groups were 1.21 ± 0.19,1.07 ±0.21,0.98 ± 0.21 and 0.85 ± 0.18,respectively; the mean A/V values:1.15 ± 0.11,1.23 ± 0.34,0.97 ± 0.16 and 0.91 ± 0.12.There was statistically significant difference of SIR and A/V (F =8.72 and 7.72,P ＜0.01) between volunteers and CP.Normal and abnormal DF were seen in 40 and 13 patients.The mean SIR values of the two groups were 1.09 ± 0.20 and 0.88 ± 0.27 ; the mean A/V values:1.15 ± 0.11 and 0.94 ± 0.30.There was statistically significant difference of SIR and A/V (t =3.10 and -2.40,P ＜ 0.01) between two groups.There were correlations between Cambridge classification,DF grades and SIR (r =0.60 and 0.41,P＜0.01),A/V (r =0.60 and 0.52,P＜0.01).Conclusion Secretin-enhanced MRCP combined with conventional MRI can be used to evaluate CP regarding changes of morphology and function,which can provide a useful reference for the clinical diagnosis.

Objective To understand the status quo of the illness situation and the implementation of prevention and control measures on Kashin-Beck disease( KBD ) in Shandong Province , and provide a scientific basis for assessment and acceptance of the work on eliminating KBD. Methods In accordance with the requirements of the national “Implementation Scheme for Endemic Disease Control in 2012” and the “Shandong Provincial Technical Scheme for KBD Control in 2012”. In four towns of Qingzhou, three epidemic villages were selected as the surveying villages in each town in order to understand the implementation of measures for prevention and control of KBD; information such as population of investigating villages, per capita income, farming, food and the implementation of control measures,etc were included. In each investigating village, 7 - 12 years old children were selected to receive clinical and X-ray examination. When fewer than 50 people in a investigating village , one additional endemic village was included near the investigating village , and all children aged 7 to 12 of the village were checked. The number of cases of clinical degree Ⅰ, Ⅱ, Ⅲand the detection rates, X-ray positive detection rate, the number of cases of metaphysis, epiphysis, distal end of phalanx, carpal bone, triad and the detection rates were calculated, respectively. Clinical and X-ray diagnosis were based on “The Diagnostic Criteria of Kaschin-Beck disease”(WS/T 207-2010). Results A total of 14 epidemic villages were selected to survey in four towns of Qingzhou. In the recent three years in the epidemic areas, measures of supplying Se had not been implemented;measures of resettlement and off-site education had not been implemented either. In the epidemic areas , the main crops were wheat and corn; the staple food was flour which accounted for more than 80%, and the foreign food bought accounted for only 11%. The areas of returning farmland to forest (grass) accounted for 0.32%(36/11 151) of the original arable land, and the areas of replanting economic crops accounted for 1.17%(131/11 151) of the original farmland. A total of 536 children aged 7 to 12 were examined by clinical and X-rays. Patient of KBD was not detected clinically. Six positive patients with metaphyseal changes of KBD were detected by X-rays, and the average X-ray detection rate was 1.12%(6/536). Patients with abnormal epiphysis, distal end of phalanx and carpal bone were not detected by X-rays. Conclusions KBD in Shandong Province has been effectively controlled. Since the cause of KBD is still unknown, it is necessary to build a sustainable long-term control mechanism of KBD;further improve the monitoring system and dynamic monitoring work still need to be strengthened.

Objective To analyze the imaging findings and misdiagnosis of intraductal papillary mucinous neoplasm (IPMN),to improve diagnosis level and decrease misdiagnosis rate.Methods The images of 130 patients were suspicion or diagnosis of IPMN, and the other pancreatic lesions but confirmed IPMN by pathology.Two radiologists collected materials, analyzed the reasons of misdiagnosis, and found out countermeasures.Results A total of 130 patients confirmed by pathology were available for analysis, in which there were 105 (80.7%) of IPMN, and 25 (19.2%) of other pancreatic lesions.The most misdiagnosed patients were between IPMN and chronic pancreatitis(CP),serous cystadenoma(SCN).All patients were divided into mild to moderate group and severe to infiltrating carcinoma group based on pathologic grades.There was significant difference between two groups in cystic diameter, wall nodule, separation and dilation, the diameter of main duct, and intra-or extrahepatic biliary tract(P<0.05).The most common causes of misdiagnosis included that the radiologists didn't combined with the patient's clinical features,and didn't reconstruct images or perform MRCP scan when the relationship between the lesions and the pancreatic duct was unclear.Conclusion It is important that the radiologists need to combine with the patient's clinical features, clear the relationship between the lesions and the pancreatic duct, and fully master imaging findings.The recurrent pancreatitis maybe result from IPMN, and IPMN for a long time would lead to CP.