Objective To observe MSCT features of partially or completely low enhancement of pancreas neuroendocrine tumors (PNENs).Methods The clinical data and MSCT features before pancreatectomy in 44 patients with confirmed PNENs were retrospectively reviewed.The MSCT findings were evaluated including tumor size, location, margin, density, intratumoral structure, bile duct and pancreatic ductal dilation and distant metastasis.Tumors were classified into complete enhancement type, partially or completely low enhancement type for further comparative analysis based on MSCT enhancement during pancreatic stage.Results A total of 56 PNENs in 44 patients were found, and there were 31 partially or completely low enhanced PNENs and 25 completely enhanced PNENs.The former were larger than the latter [mean tumor size, (3.3±2.2)cm vs (1.4±0.9) cm], and irregular shape and cystic components within tumors were more often observed (all P<0.05).There were no significant differences between the two types of PNENs in terms of gender, the presence of functional tumor, tumor location, clear tumor margin, intratumoral calcification, bile and pancreatic duct dilation and metastasis.76.0%(19/25) of completely enhanced PNENs reached peak enhancement in arterial phase, and 71.0%(22/31) of low enhancement PNENs reached peak in pancreatic phase.Enhanced intratumoral blood vessels in the arterial phase were more frequent in low enhancement PNENs, and the difference was statistically significant (P<0.05).There were significant differences on pathological grade between the two types of PNENs (G1=21,G2=4,G3=0 vs G1=18,G2=5, G3=8), and the difference was statistically significant (P<0.05).Conclusions Compared with complete enhancement PNENs, partially or completely low enhancement PNENs had bigger size, irregular shape, and cystic component.Intratumoral blood vessels in the arterial phase were observed, peak enhancement arrived later and the pathological grade was higher.

Objective To observe the regulatory role of long non-coding RNA HIF1A-AS1 on the autophagy of pancreatic cancer PANC1 cells induced by hypoxia.Methods The pancreatic cancer PANC1 cells were cultured in a three-gas incubator filled with hypoxic gas mixture (94% N2,5% CO2,1% O2) for 3, 6, 12, 24, 36 and 48 h.HIF1A-AS1 overexpression and low expression PANC1 cells were obtained by the infection of recombinant adenovirus carrying HIF1A-AS1 and the transfection of HIF1A-AS1 targeting siRNA by liposome, and routinely cultured PANC1 cells served as control.The expression of HIF1A-AS1 of PANC1 cells was detected by real-time quantitative PCR after being cultured in hypoxia-induced condition for 24 h.The apoptosis rate was detected by flow cytometry.The autophagy related proteins Beclin 1 were detected by western blot.Results The expression of HIF1A-AS1 in hypoxic cells was increased as the hypoxic time increased since 6 h and peaked at 36 h, which was significantly higher than that in control group (P<0.01).HIF1A-AS1 relative expression in HIF1A-AS1 overexpression and low expression PANC1 cells was 4.49±0.53 and 0.49±0.07, which were normalized to that of control group with the relative expression of 1.Control group had lower HIF1A-AS1 expression than HIF1A-AS1 overexpression PANC1 cells but higher HIF1A-AS1 in HIF1A-AS1 low expression PANC1 cells, and the differences were statistically significant (P<0.01).The cell apoptosis rate of control, HIF1A-AS1 overexpression and low expression PANC1 cells was (8.27±1.28)%, (6.56±1.49)% and (19.9±2.34)% after 24 h hypoxic culture.Control group had higher HIF1A-AS1 expression than HIF1A-AS1 overexpression PANC1 cells but lower HIF1A-AS1 in HIF1A-AS1 low expression PANC1 cells, and the differences were statistically significant (P<0.01).The expression of Beclin 1 protein was protein 1.05±0.11, 1.29±0.19 and 0.38±0.18, respectively.Control group had lower Beclin 1 expression than HIF1A-AS1 overexpression PANC1 cells but higher Beclin 1 in HIF1A-AS1 low expression PANC1 cells, and the differences were statistically significant (P<0.01).Conclusions HIF1A-AS1 can promote autophagy of pancreatic cancer PANC1 cells induced by hypoxia and participate in the pathogenesis and metastasis of pancreatic cancer.

Objective To investigate the effects of ARHI transfection on the chemokines and receptors related gene expression profile of PANC1 cells.Methods Plasmids expressing ARHI and empty plasmid were transfected into PANC1 cells, and the stably expressed cell lines were established by using G418.mRNA expression of chemokines and receptors related genes was detected by PCR Array.Real-time PCR was used to detect mRNA expression of the genes related vascular growth.Results In cells transfected with ARHI gene, the expression levels of mRNA of 36 genes were down-regulated, and 9 were up-regulated.Among the genes related to tumor metastasis and invasion CXCL12 and CXCR4 were significantly down-regulated (<-6 folds), and MMP-2 was slightly down-regulated (<-2 folds).Among the genes related to tumor angiogenesis, pro-angiogenesis genes including CCL2, CXCL1, CXCL2, CXCL8, CXCL12 and CXCR4 were significantly down-regulated, and pro-angiogenesis genes including CXCL3, CCR1 and CCR2 was slightly down-regulated.Anti-angiogenesis genes including CXCL9, CXCL10, CXCL11 and CXCR3 were significantly up-regulated (>6 folds).Among the genes related to the localization of distant organ infiltration and latency, CXCL12, CXCR4 and CCR7 were significantly down-regulated,and CXCR5 was slightly down-regulated.Among the gene with tumor immunity,CXCL8,CXCR1 and CCR7 were significantly down-regulated.Gene expression of CXCL1,CXCL8,CXCR4 and CXCR3 detected by Real-time PCR were consistent with PCR array.Conclusions ARHI gene inhibits the expression of chemokines and receptors related to tumor metastasis,angiogenesis and tumor immunity.

Objective To assess the effect of Chinese Rhubarb in assisting the treatment of severe acute pancreatitis (SAP) by nasojejunal tube (NJ) and nasogastric tube (NG).Methods Cochrane Library, PubMed, Embase, Science Citation Index Expanded-SCIE, EBSCO-CINAHL Complete, SinoMed, VIP network and Wan Fang net were retrieved systematically and randomized controlled trails (RCT) that involved in Chinese rhubarb assisting the treatment of SAP by NJ and NG were searched.According to eligibility and extraction standards, 2 researchers independently selected relevant literature and extracted the relevant data.The quality of literature was evaluated using criteria published by Australian Evidence-Based Health Care Center (2008).RevMan5.3 software was employed for Meta analysis.Results Eleven RCTs were enrolled and the quality of all the 11 papers was B grade.Compared with NG, NJ had lower score of APACHE-Ⅱ, shorter time of decreased CRP, amylase activity, IL-6 and IL-1, and shorter recovery time of bowel function and abdominal pain, and the differences were statistically significant (P<0.01).However, there were no significant differences between two groups on complication rate, mortality, the rate of bowel function failure, the rate of surgical operation and recovery rate.Conclusions Chinese Rhubarb by NJ irrigation in assisting the treatment of SAP can rapidly alleviate abdominal pain, promote bowel function recovery and reduce inflammatory reaction, which had better efficacy than NG.

Objective To investigate the correlativity between elasticity modulus and pathological severity in chronic pancreatitis (CP).Methods Twenty-one pigs were divided randomly into experimental group (n=18) and control group (n=3) using random number method.The main pancreatic duct (MPD) was incompletely ligated to establish the CP model.In control group, MPD was not ligated.The animals were killed in batches at 4th, 8th and 12th week after surgery.The pancreatic tissue was taken for elasticity modulus test and pathological examination, and the pigs were classified into control, mild, moderate and severe groups based on the severity of fibrosis.Cell density, fat infiltration and extracellular edema were observed and classified into mild and severe.The difference of elasticity modulus among different groups were compared by Variance analysis, the correlation between pancreatic fibrosis and elastic modulus was analyzed with Spearman correlation analysis, and ROC curve was used to evaluate its efficacy of diagnosing CP.Results Sixteen CP models were established successfully expected for 2 deaths (mild, n=7;moderate, n=2 and severe, n=7).All of the control group (n=3) showed normal pancreas.The elasticity modulus of control, mild and moderate to severe group were 0.4268±0.0566, 0.3203±0.0518 and 0.2235±0.0685, respectively.The difference between the groups was statistically significant (F=13.658,P<0.01), and the elastic modulus and pathological grade had a negative correlation (r=0.969, P<0.01).AUC of elasticity modulus for differentiating normal and mild CP was 1.000, the best critical value was 0.3807, and both the sensitivity and specificity of the diagnosis were 100%.AUC for differentiating mild and moderate to severe CP was 0.8730, the best critical value was 0.2646, and the sensitivity and specificity of the diagnosis were 85.7% and 77.8%, respectively.The pancreatic elasticity modulus of low parenchymal cell density group and high parenchymal cell density group were 0.1931±0.0373 and 0.3485±0.0655, respectively, which in the high cell density group was significantly higher than that in the low cell density group (t=-5.719, P<0.01).The elasticity modulus of negative infiltration or slight fatty infiltration group and severe fatty infiltration group were 0.3401±0.0697 and 0.1855±0.0344, respectively, which in the negative infiltration or slight infiltration group was significantly higher than that in severe infiltration group (t=5.102, P<0.01).The elasticity modulus of negative or mild cell edema group and moderate to severe cell edema group were 0.2760±0.0825 and 0.3024±0.1056, respectively;there was no statistically significant(t=-0.586, P >0.05).Conclusions The elasticity modulus can be used to detect the pathological changes of CP, and evaluate the CP pathologic grades.

Objective To investigate the expression variation of aquaporin in colon tissues in acute necrotizing pancreatitis (ANP).Methods ANP rat model was induced by the retrograde injection of sodium taurocholate into the biliopancreatic duct.The rats were killed at 4 h, 8 h, 12 h and 24 h after modeling with 6 rats for each time point.The pancreas and colon tissues were harvested for pathological examination.The levels of IL-6, TNF-α mRNA expression and AQR (aquaporin-3, aquaporin-4, aquaporin-8) mRNA expression in proximal and distant colon were detected by RT-PCR.The levels of aquaporin protein in colon were examined by immunohistochemistry.Results After the establishment of ANP SD rat model, the integrity of colonic mucosa was continuously damaged, the structure of epithelial cells was unclear and the colonic villus were broken and destroyed, and inflammatory cell infiltration in submucosa was observed.The pathological score increased with the time of modeling.In 4 h, except that the mRNA levels of AQP-4 in distal colon was not obviously changed, mRNA levels of IL-6 and TNF-α, mRNA and protein expression of AQP-3 and AQP-8 in the proximal and distal colon of ANP rats were significantly elevated compared with shame group (P<0.05).AQP-3 and AQP-8 mRNA in proximal colon of ANP rats reached its peak in 8 h after the establishment and AQP-4 mRNA peaked at 24 h.AQP-3 and AQP-4 mRNA in distant colon of ANP rats reached its peak in 8 h after the establishment and AQP-8 mRNA peaked at 24 h.Protein expression of AQP-3, AQP-4 and AQP-8 in proximal and distant colon was strongest in 12 h and 24 h after the establishment.Conclusions With the progression of the ANP, the expression levels of AQP-3, AQP-4 and AQP-8 in both proximal and distal colons were elevated in various degrees, indicating that the aquaporins may participate in water metabolism of colon during ANP.

Objective To investigate the clinical features, diagnosis and management of pancreatic lesions in patients with von Hippel-Lindau (VHL) disease, and improve the current understanding on pancreatic lesions in VHL disease.Methods The clinical data of three VHL disease patients with pancreatic lesions were analyzed retrospectively, including clinical features, laboratory findings, imaging, pathological features, operation method and follow-up.Results Two patients had a family history of hemangioblastoma in central neural system, and 1 patient had retinal multiple angioma and angioma in central neural system, who were diagnosed as VHL.One patient with pancreatic portal hypertension had splenectomy and biopsy of left renal tumor.During the surgery, pancreatic cystic lesions were observed and the transparent cysts were diffusively distributed on the surface.The other 2 patients were diagnosed as pancreatic multiple cysts and non functional pNETs, and pancreatic multiple cysts, respectively, based on the imaging.All the three patients had stable disease status, and followed up by outpatient visits.Conclusions VHL disease can manifest as simple pancreatic cyst, pancreatic serous cystadenoma and pNETs.The optimal individualized treatment should be determined by Multidisciplinary team (MDT) according to the general condition of patient.

Objective To determine the prevalence and clinical features of peripancreatic vascular abnormalities in patients with pancreatitis.Methods The clinical data of 102 pancreatitis patients between January 2013 to December 2014 in the General Hospital of Shenyang Military Command who underwent contrast enhanced CT or contrast enhanced MRI scans were retrospectively analyzed.The radiological features of peripancreatic vascular abnormalities in such patients were examined, and the clinical features of pancreatitis patients with or without peripancreatic vascular abnormalities were investigated.Results Peripancreatic vascular abnormalities were found in 18 patients(17.6%), and vascular abnormalities were relatively common in portal vessels.No significant differences were observed on the age at onset, gender ratio, smoking status, alcohol consumption and length of stay between patients with and without peripancreatic vascular abnormalities.Compared with those without peripancreatic vascular abnormalities, patients with peripancreatic vascular abnormalities had a significantly higher incidence of peripancreatic fluid collection, pancreatic pseudocyst and gastric varices, and the differences were statistically significant(all P<0.05).Conclusions Peripancreatic vascular abnormalities can be complicated with pancreatitis.Enhanced CT or enhanced MRI were valuable in the diagnosis.Pancreatic pseudocyst, peripancreatic fluid collection and gastric varices were more common in pancreatitis complicated with peripancreatic vascular abnormalities.

Objective To establish a MRI grading diagnostic model for chronic pancreatitis (CP) to acquire better combination for CP diagnosis and improve the diagnostic ability of CP grading.Methods To collecte the data of 68 CP patients who were clinically diagnosed and 23 health volunteers from Dec 2012 to Oct 2014.There were 23 mild CP, 14 moderate CP and 31 severe CP according to Cambridge classification.3.0 T MRI data were analyzed, and 14 features were extracted to compare the MRI features among groups.The single ordinal regression analysis was conducted on the variables with significant difference between groups, and the collinearity was diagnosed.The factor analysis was used for multicollinearity.The multiple ordinal logistic regression was finally conducted to establish the regression model.Results There was no significant difference between control groups and CP groups on pancreas divisum (X14), but significant differences were found in other 13 features (P<0.05).Single ordinal regression analysis of 13 features showed that all features except pancreatic parenchymal bubble (X12) were significantly correlated with CP grading diagnosis(P<0.05).The effect of multicollinearity was validated among 9 continuous variables.Three common factors were identified, including F1(X3、X4、X5、X9、X8), F2(X7、X6) and F3 (X1、X2) which represented the exocrine function, the features of main pancreatic ducts and pancreatic parenchyma, respectively.Six features were implemented into the multi Logistic regression model, which included F1, F2, F3, X10 (the visualizations of branch pancreatic duct after secretin stimulation), X11 (pancreatic shape) and X13 (the filling defects of main pancreatic duct).Finally, the most appropriate regression model was gotten, which was the scale model of the probit link function.The model′s diagnostic accuracy for normal, mild CP, moderate CP, severe CP and total CP was 96.65%,100%, 71.42%,100% and 94.50%, respectively.Conclusions The ordinal logistic regression model proposed in this study may accurately predict the CP grades and can offer valuable references for clinic diagnosis and therapy of CP.

Objective To provide objective parameters for differentiating pancreatic cystic tumors via using computed tomography texture analysis (CTTA) to quantify the special imaging features of pancreatic cystadenomas.Methods Enhanced CT images of pancreas from patients who were admitted in Department of Radiology in First Hospital affiliated with Zhejiang University and First People's Hospital of Hangzhou City and pathologically diagnosed as pancreatic serous cystadenomas (n =48) and mucinous cystadenomas (n =34) from January 2009 to December 2016 were retrospectively analyzed.Regions of interest were drawn on the parenchymal phase CT images in 5 slices according to the border of the tumors.Mean grey level intensity (M),variance (V),entropy (E),skewness (Ske) and kurtosis (Kur) were obtained from fine texture (σ =1.0) to coarse texture (σ =2.5).Receiver operating characteristic (ROC) curve for texture parameters with statistically difference was drawn,and the area under curve (AUC),diagnostic sensitivity and specificity were calculated.The diagnostic accuracy of senior and junior doctors was compared with the traditional CT analysis method.Results Reliability coefficient of the two radiologists was 0.809 ～ 0.997 with high consistency.Compared with mucinous cystic tumors,serous cystadenomas had a significantly different V (5.93 ± 9.02 vs 1.29±0.62),E (2.39±0.61 vs2.02±0.39) and Kur(30.18 ±42.55 vs 8.80-±4.34) in Ske0 of 2.5 (P ＜0.05),and there were no statistically significant differences on other parameters.The AUC of differential parameters for diagnosing two kinds of cystic tumors ranged from 0.56 to 0.84.The diagnostic accuracy of the traditional CT analysis method by junior doctor and senior radiologist was 60％ and 71％,respectively.Conclusions CTTA can not only effectively quantify the heterogeneity of pancreatic cystadenomas,but also is effective in the differentiation.