Objective To evaluate the clinical value of the three-category classification of severe acute pancreatitis (SAP).Methods Clinical data of 337 traditional SAP patients,who were admitted to Peking Union Medical College Hospital (PUMCH)from January 2001 to December 2012,were retrospectively studied.These patients were classified into moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) according to the latest 2013 Atlanta Classification.SAP patients were further categorized as critical acute pancreatitis (CAP) and non-CAP.Disease severity,therapy and prognosis among three groups were compared.Results Among the total 337 traditional SAP patients,253 were classified as MSAP and 84 as SAP.In the group of SAP,40 patients were categorized as CAP and 44 as non-CAP.Compared with non-CAP patients,CAP patients had significantly higher mortality rate which was 70％ (28/40).Other results were all significantly higher in CAP group rather than non-CAP group,including ICU admission rate 77.5％(31/40),length of ICU stay (15.5 ± 20.6) days,Ranson,APACHE Ⅱ,BISAP,MCTSI,modified Marshall scores 4.6 ± 1.4,16.8 ± 5.8,3.0 ± 1.0,8.6 ± 1.7,and 7.4 ± 2.9,respectively (P ＜ 0.01 in each endpoint).These parameters of SAP group were also significantly higher than those of MSAP group (P ＜0.01).Conclusions Using the new three-category classification to distinguish traditional severe acute pancreatitis,namely MSAP,SAP,and CAP,can better reflect the severity of disease,predict outcome and guide clinical management.

Objective To assess the fecal immunochemical test (FIT) followed by colonoscopy in opportunistic screenings for colorectal neoplasm.Methods Total 6 193 patients, who underwent opportunistic colorectal cancer (CRC) screening, were classified into four groups: 3 812 patients underwent direct colonoscopy (group 1), 1 244 patients received one FIT followed by colonoscopy (group 2), 341 patients received two FITs followed by colonoscopy (group 3), and 796 patients received three FITs followed by colonoscopy (group 4).Results Total 97 (1.6%) patients with CRC and 1 038 (16.8%) with colorectal adenoma were detected.The positive predictive value of 1, 2 and 3 positive tests out of three FITs for CRC were 4.53%, 5.62% and 8.94%, respectively, which was higher than that of direct colonoscopy (1.52%).One or more positive tests out of three FIT had the largest area under receiver operating characteristic curve (0.743).For colorectal adenoma, detection rate of direct colonoscopy (17 581.25/105) was higher than all FIT strategies (3 732.30/105-13 127.41/105).Conclusions Single or repeated FIT and colonoscopy have different screening utility.One or more positive tests out of three FIT followed by colonoscopy is preferred to screen CRC, and direct colonoscopy is better for detection of colorectal adenoma.

Objective To evaluate the significance of detecting plasma methylated Septin9 (SEPT9) alone and combined with fecal immunochemical test (FIT) in screening colorectal cancer (CRC) and adenoma.Methods From October 2014 to April 2015,outpatients received CRC and adenoma screening were enrolled.Colonscopy examination and pathological diagnosis were taken as gold standard.The sensitivity and specificity of plasma methylated SEPT9 and FIT in CRC and adenoma were calculated.The diagnostic value of combined examination was evaluated.Receiver operating characteristic (ROC) curve of SEPT9 in CRC diagnosis was drawn.Results A total of 300 outpatients were enrolled.Among them,CRC was detected in 45 patients (15.0％) and adenoma was detected in 68(22.7％) patients,including 37(12.3％) cases of advanced adenomas.The sensitivity of SEPT9 and FIT for CRC diagnosis was 80.0％ and 88.9％,and the specificity was 95.3 ％ and 54.1％,respectively.The area under concentration curve (AUC) of methylated SEPT9 in CRC diagnosis was 0.923.The sensitivity of SEPT9 and FIT in advanced adenoma diagnosis were 10.8％ and 62.2％,and the specificity were 83.3％ and 49.0％,respectively.The sensitivity of combined examination in CRC diagnosis was 97.8％ and the specificity was 52.9％;the sensitivity in advanced adenoma diagnosis was 67.6％ and the specificity was 47.4％.Conclusions Plasma methylated SEPT9 is helpful in CRC screening,moreover,when combined with FIT,it can increase detection rate of colorectal adenoma.

ObjectiveTo evaluate the application of immunochemical fecal occult blood test for colorectal cancer screening in a gastroenterology clinic. MethodsTotal 512 outpatients received immunochemical fecal occult blood tests and colonoscopy for screening of colorectal cancer from January 2009 to October 2010 in Gastroenterology Clinic of Peking Union Hospital.The application of occult blood test was retrospectively evaluated using colonoscopy and pathological examination as the gold standard. Results Among 512 patients,203 were found positive for immunochemical fecal occult blood. According to the colonoscopy and histological study,115 patients had polyps,9 with high-grade dysplasia and 21 with colorectal cancer.The sensitivity,specificity,positive likelihood ratio and negative likelihood ratio of fecal occult blood to detect colorectal adenomatous polyps was 42.8％,60.9％,1.09 and 0.93,respectively.And those for detection of colorectal cancer and high-grade dysplasia were 76.6％,62.5％,2.05 and 0.37,respectively.ConclusionsImmunochemical fecal occult blood test was useful in the screening for colorectal tumors among gastroenterology clinic patients.More large-scale prospective studies are needed to establish a screening model for colorectal tumors.

Objective To evaluate the performance of split-dosed polyethylene(PEG) for colonoscopy preparation.Methods Split-dose means that 1-3 L of PEG is taken in the afternoon or evening before examination and the remains in the next morning.And single-dose refers to all PEG is taken in the evening before ex-amination.A meta-analysis was conducted to compare bowel preparation quality,adenoma detection rate and patients' acceptance between groups.Results Ten randomized controlled trials were included into this study with 3 222 participants(1 481 in split-dose group and 1 741 in single-dose group).Split-dose group had higher rate of satisfactory bowel preparation(OR=3.37,95％CI:2.37-4.79),and so did the subgroup of 2～ 3 L PEG (OR =3.88,95％ CI:2.39-6.29).Split-dose group did not improve adenoma detection rate significantly (OR =0.94,95％ CI:0.71-1.24),but reported less adverse events such as nausea (OR =0.56,95％ CI:0.42-0.74)and vomiting(OR=0.51,95％CI:0.30-0.88).Conclusion Split-dosed PEG provides better colon cleansing with higher patient compliance,but does not improve detection rate of adenoma.

Objective To study the diagnostic value of magnifying chromoendoscopy combined with narrow band imaging (NBI) for screening inflammatory bowel disease (IBD) and colorectal cancer(CRC).Methods In colonoscopic examinations of long-term IBD patients,magnifying colonoscopy was used to make the consecutive observation with white light,NBI,and indigo carmine spraying.Targeted biopsies or endoscopic resections were performed for histological diagnosis as the golden standard of this study.Results Sixteen cases (17 lesions) with dysplasia or colorectal cancer in 45 long-term IBD patients were detected,including 12 (26.7％) cases of low-grade dysplasia (LGD),4 (8.9％) cases of high-grade dysplasia (HGD),and 1 (2.2％) case of CRC.Targeted biopsy yielded a positive rate of 13.2％ (17/129).Detection rates of NICE and Kudo classification were 81.3％ (13/16) and 75.0％ (12/16),respectively,and were 100.0％ when combined together.Age (P =0.027) and prolonged disease course (P =0.013)were associated with advanced histology in those with dysplasia or CRC.Lesions of HGD and CRC have larger diameters (2.5 ± 1.4 cm) than LGD (0.6 ± 0.4 cm) (P =0.003).Conclusion Magnifying chromoendoscopy with NBI is effective to detect and differentiate colitis-related neoplastic lesions,thus allowing rational therapeutic plans.

Objective To investigate the expression of inducible co-stimulator (ICOS) and inducible co-stimulator ligand (ICOSL) on PBMCs,and the plasma concentrations of soluble forms of ICOSL and their clinical relationship with systemic lupus erythematosus (SLE) patients.Methods Peripheral blood samples were collected from 45 SLE patients and 39 healthy subjects (HC).The expressions of ICOS and ICOSL on peripheral blood mononuclear cells (PBMCs) were detected by flow cytometry.The concentrations of soluble ICOSL were assessed by measured by enzyme linked immunosorbent assay (ELISA).And the relationship between their expression levels and patients' clinical manifestations were analyzed.Levene F test was used for statistical analysis,the comparison between groups was conducted using t test,and the correlation between two variables were tested by Pearson correlation analysis.Results The expression of ICOS on CD4+ and CD8+ T cells were significantly higher than that of the HC [(19.1±1.7)％ vs (14.0±1.5)％,t=2.156,P=0.035],[(10.0± 1.0)％ vs (6.4±1.0)％,t=2.587,P=0.012].The expression of ICOSL on CD14+ mononuclear cells in SLE patients was significantly higher than that in the HC group [(2.94±0.88)％ vs (0.89 ±0.21)％,t=2.152,P=0.04].Plasma ICOSL concentrations in patients with active SLE were significantly higher than those of patients with inactive SLE [(362±25) ng/ml vs (278±15) ng/ml,t=2.356,P=0.025].We also found a significant negative correlation between the soluble ICOSL expression and the surface ICOSL expression on both mononuclear cells and B cells (r=-0.4243,P=0.022;r=-0.4099,P=0.025).MMPI induced an evident reduction in sICOSL levels released from the cells,which was statistically significant in comparison with untreated cells (P＜0.05).Conclusion The up-regulated expressions of ICOS and ICOSL on peripheral lymphocytes and the high levels of plasma concentration of soluble ICOSL are closely correlated with the severity of the disease,suggesting that ICOS/ICOSL pathway may play a critical role in the pathogenesis of SLE.

Objective To summarize the clinical features of the third portion of duodenum (PATD) for improving the understanding of PATD.Methods Sixteen cases with PATD in Peking Union Medical College Hospital(PUMCH) were retrospectively analyzed.Results The most common symptoms of PATD were upper abdominal pain(12/16),vomiting (9/16) and distention (7/16).On average,the disease had progressed 5.5 months (including 2.5 months of diagnostic workup) before the diagnosis was established.Patients with pathologically poorly differentiated PATD had shorter course of disease (6.5 vs 16.6 months,P =0.56) and lower chance of cancer-directed surgery (1/8 vs 6/8,P =0.04) than those with well differentiated PATD.The diagnostic rate was 11/14 by CT scan while only 2/7 by upper gastrointestinal radiography.Three cases were misdiagnosed as superior mesenteric artery syndrome by barium examination.Conclusions PATD should be considered in patients presenting upper abdominal symptoms with negative gastmendoscopy and barium examination.Overall,CT scan plays a pivotal role in diagnosing PATD.Making a correct diagnosis timely can improve the outcome of PATD patients,particularly,in those with poorly differentiated pathology.

ObjectiveTo explore the significance of colonoscopy examination in healthy subjects.MethodsA total of 537 health examination cases who underwent colonoscopy from January 2010 to June 2011 in Peking Union Medical College Hospital (PUMCH) health examination center were enrolled,in which 529 cases underwent total colonoscopy.Detection of colorectal lesion,polyp types and pathology were recorded and the correlation between detection rate of polyps,lesion sites and ages as well as gender were analyzed.ResultsThere were 315 male and 214 female,with a mean age of 48.3 ± 9.3 years.A total of 158 colorectal polyps were detected in 104 cases ( 19.7％ ),including 84 ( 15.9％ ) adenomas,17 (3.2％ ) advanced polyps and 1 (0.2％ ) rectal cancer.Other abnormalities were hemorrhoids in 61 cases ( 11.5％ )and inflammation in 22 (4.2％ ).Colorectal polyps were more frequent in men (P ＜0.001 ).Adults older than 50 had higher rates of colorectal polyps (P ＜0.001 ) and advanced polyps ( P ＜0.05).The proportion of patients with proximal polyps increased with age,whereas that of patients with distal polyps decreased with age ( P ＜0.05).ConclusionColonoscopy is an effective screening modality for colorectal lesions and the importance of colonoscopy on health examination population to prevent colorectal cancer should be stressed.

Objective Mesenteric panniculitis is an idiopathic , uncommon disease involving the adipose tissue of mesentery .The etiology , diagnosis and treatment are still unnoticed .We thus reported a case series to improve the understanding of this rare disorder .Methods We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation , diagnosis, treatment and prognosis.Results We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis.The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12).Physical examination was unremarkable in the majority of patients (8/12).C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients.CT findings were of much diagnostic value .All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density .Pseudo-capsule sign ( 8/12 ) and fat halo sign (6/12) were common.Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis .Six cases all received prednisone , 2 with combined cyclophosphamide , 1 with azathioprine, 1 with tripterygium wilfordii .Short-term clinical response was achieved in all cases , but two patients relapsed .Conclusions Mesenteric panniculitis occurs predominantly in middle-aged and elderly . Abdominal pain is the leading symptom .Inflammatory markers are often normal while computed tomography is the most important diagnostic tool .Surgery combined with cortical steroid and immunosuppressant agents is effective.