Microcirculation disturbance and ischemia of the pancreas are important pathophysiological changes in the onset of acute pancrea-titis,and organ hypoperfusion is a risk factor for poor prognosis.During the first 12 to 24 hours after admission,fluid resuscitation is the most important medical treatment for the early stage of acute pancreatitis,and timely and rational fluid infusion helps to improve prognosis. However,there lacks high -quality clinical evidence for type of fluid,infusion speed,and monitoring methods,and more randomized con-trolled trials are needed.

Drug-induced pancreatitis (DIP)belongs to gastrointestinal drug-induced diseases.With the wide use of drugs,the number of drugs that may induce DIP is increasing.Since there are not specific clinical indicators for detecting DIP or a complete diagnostic and thera-peutic process for DIP,its diagnosis is often missed.The epidemiology and pathogenesis of DIP,as well as drugs inducing DIP and their classifications,are reviewed.It is stressed that careful collection of medication history of DIP patients and timely discontinuation of suspected pharmacological agents are the key to diagnosis and treatment of this disease,and the patients should be informed of the related drugs that in-duce DIP to prevent its recurrence.

Inflammatory bowel disease (IBD) is a group of diseases characterized by recurrent episodes of chronic intestinal inflammation including ulcerative colitis (UC) and Crohn's disease (CD).The prevalence of IBD has shown a rapid growth in China.Malnutrition is often seen in IBD patients,especially in those with CD.Appropriate diets and supplementation of trace elements,calcium,vitamin D,and probiotics are beneficial for disease remission and control.Nutrition support therapy can improve the nutritional status and meanwhile may facilitate the induction and maintenance of remission in CD patients.

Objective To evaluate the feasibility of testing the high methylation of ppENK gene in stool with methylation-specific polymerase chain reaction (MSP) assay in pancreatic cancer diagnosis.Methods Twenty-four fresh stool samples of pancreatic cancer patients and six healthy control samples were collected.The methylation status of ppENK gene in all the stool samples was detected by MSP assay.The positive rate of wild-type ppENK gene in all the stool samples was determined by polymerase chain reaction (PCR).And 10 non wild-type ppENK gene negative pancreatic cancer samples were collected,and K-ras gene mutation was detected by PCR-restriction fragment length polymorphism (RFLP).The single cell suspension of pancreatic cancer PC3 cell line was added into stool sample from the same healthy individual,the positive rate of ppENK gene methylation was detected by MSP assay.The minimum number of pancreatic cancer cell was calculated when methylation was positive.Results The rate of methylation detection in 30 samples was 0 (0/30); and the rate of non-methylation detection was 10％ (3/30).The rate of wild-type ppENK detection was 6.7％ (2/30).By PCR-RFLP assay,eight were successfully amplified and seven had mutation in 12th code of K-ras gene in 10 selected wild-type ppENK gene negative pancreatic cancer samples.The minimum number of pancreatic cancer cells needed for ppENK methylation band positive detected by MSP was 50 cell/ml.Conclusion Detecting ppENK gene methylation status in stool samples of pancreatic cancer patients by MSP assay has not yet become the method of pancreatic cancer screening and diagnosis.

Objective To analyze the clinical characteristics of liver metastases of neuroendocrine tumors (NET) and its treatment outcome,so as to further cognition of NET.Methods The clinical data of patients with liver metastases of NET diagnosed by Peking Union Medical College Hospital during January 1996 to July 2010 were analyzed retrospectively.Results The ratio of male to female was 1∶1.15 (20∶ 23).The median age at onset of the patients with liver metastases of NET was 47.5 (26-70) years.The median duration from onset to diagnosis was 4 (0-120) months.The liver metastases were the first manifestation in 69.8％ (30/43) cases.The detection rate of primary lesions with routine abdominal imaging (B-type ultrasonography,CT,MRI) was 65.1％ (28/43),while increased to 90.7％ (39/43) when combined the following one or more special examinations including somatostatin receptor scintigraphy ( SRS),PET-CT,endoscopic ultrasound (EUS) (P =0.004).The definite diagnosis methods mainly depended on surgical specimens (69.8％,30/43).The ratio of nonfunctional to functional NET with liver metastases was 1.87∶1(28∶ 15).The primary tumors were most commonly located in pancreas [39.3％ (11/28) and 73.3％( 11/15 ) ],followed by stomach [ 21.4％ (6/28) and 13.3％ ( 2/15 ) ].Totally 88.4％ ( 38/43 ) patients received operation,and 9.3％ (4/43) patients had reoperation due to missed diagnosis of the primary tumors on earlier operation.Non-surgical treatments included octreotide acetate long-acting release,interventional therapy,chemotherapy and radiotherapy,which were difficult to be evaluated due to less follow-uped cases.Conclusions Liver metastases of NET are common and even the first manifestated symptom.Primary NET with liver metastases is the most commonly nonfunctional and located in digestive system.The detection rates of primary lesions are increased by special examinations including SRS,PET-CT and EUS. Surgical specimens are helpful to the final diagnosis,but it is necessary to improve the preoperative diagnostic rate of primary tumors to avoid repeat surgeries.

Objective To identify the main clinical characteristics helpful for diagnosis and differential diagnosis of Crohn s disease (CD) from primary intestinal lymphoma (PIL). Methods Ninety cases of CD and 46 cases of PIL during 1983-2004 in Peking Union Medical College Hospital were investigated retrospectively. Results The average age of PIL was nearly 10 years elder than that of CD (45. 0?16. 2 vs. 36. 7?15. 7, P

Aiming for improving the understanding of enteral nutrition(EN)in active and remittent Crohn’s disease (CD),this paper reviewed the history of EN,clarified the mechanisms of nutritional treatment,with emphasis on the effectiveness and key points of EN in the treatment of active and remittent CD.

Objective This meta-analysis assessed the value of interferon-γ release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD).Methods Systematic search without language restriction was conducted in the main computerized databases until June 2015.Studies that have evaluated the performance of IGRAs (QuantiFERON-TB Gold or T-SPOT.TB) in distinguishing ITB from CD were eligible.Main outcome measures included sensitivity and specificity.Area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was used to evaluate the accuracy of IGRAs.Results Twelve studies (all from Asia) were finally included.The pooled sensitivity and specificity of IGRAs for the differential diagnosis of ITB from CD were 82.8％ (95％CI 78.4％-86.6％) and 86.7％ (95％ CI 83.2％-89.6％) respectively.The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.870 (95％ CI 5.345-8.830) and 0.171 (95％ CI 0.105-0.279).The diagnostic odds ratio was 44.030 (95％ CI 27.964-69.325).And the AUC of sROC was 0.939.Conclusions IGRAs have a high sensitivity and specificity for the diagnosis of ITB,and specificity is consistent from study to study.IGRAs may be considered as a supplementary method in the differential diagnosis of ITB from CD.

Objective To investigate the effects of Astragalus polysaccarides (APS) on 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis in rats. Methods Forty male Sprague-Dawley rats were randomly divided into five groups (n = 8 ): control group, TNBS group, low-dose APS group, high-dose APS group, and prednisone group. Experimental colitis was induced in rats by enema administration of TNBS. Rats in APS and sions and histological damages were determined, and the activity of myeloperoxidase (MPO) was measured in the excised colonic tissues. Cytokine levels including interleukin (IL)-4 and IL-10 were determined by enzyme-linked immunosorbent assay. Results Both macroscopic lesions and histological colonic damages induced by TNBS were reduced by low-dose APS treatment. These were accompanied by significantly attenuated colonic MPO activity (P = 0. 03) and the increase of IL-4 and IL-10 levels. The macroscopic lesions and MPO activities of high-dose APS group were higher than TNBS group, histological damage and level of IL-4 were lower, and level of IL-10 was higher, but all without statistical significance. Levels of IL-4 and IL-10 were lower than those of TNBS group, but there was no significant difference between prednisone group and TNBS group. Levels of IL-4 and IL-10 were significantly lower in prednisone group than in control group ( P = 0. 049, P = 0. 001 ). Conclusions Different doses of APS have different effects on TNBS-induced colitis. Lower dose of APS has the therapeutic potential inexperimental colitis, while higher dose of APS may aggravate the disease.

Objective To comprehend the clinical characteristics and treatment of primary hepatic amyloidosis.Methods A total of 10 cases of primary hepatic amyloidosis included. 4 cases from Peking Union Medical College Hospital and 6 cases from other hospitals.reported in the literature in recent 20 years were reviewed,Results (1)The frequent clinical symptoms related to primary hepatic amyloidosis presented as hepatomegaly(90%),abdominal distension(80%),shifting dullness(60%),anorexia(50%),fatigue(40%),edema(40%),weight loss(40%) and abdominal pain(30%).(2)Laboratory tests revealed elevated serum alkaline phosphatase which was (558.3?517.2)U/L,and other liver function involvement were rare:six patients(85.7%)had either a serum or urine monoclonal protein.(3)Liver biopsy is golden standard.The amyloid deposition was mainly located at sinusoida(4 casese,57.1%),and only 2 cases was at vascular(28.6%).Complication of bleeding after liver biopsy was reported(1 case).(4)The classical therapy scheme was melphalan and prednisone,four cases died from liver function failure and infection.Conclusion The clues to the diagnosis of primary hepatic amyloidosis include elevated monoclonal protein,hepatomegaly and an unexplained elevated serum alkaline phosphatase level which is not parallel with other liver functions.Live biopsy is golden standard.The treatment scheme include melphalan and prednisone,but its prognosis is poor.