Objective To analyze CT findings of insulinoma,and to summarize the causes of missed diagnosis of nontypical insuli-noma.Methods Clinical and CT manifestations of 18 patients with 18 insulinomas were analyzed retrospectively which were proved by surgery and pathology,and the causes of the missed diagnosis of nontypical insulinoma were also summarized.Results 10 patients with 10 insulinoma underwent CT plain scan with isodensity in 9 and slightly lower density in 1 with thread-like capsule.Other 18 patients underwent enhanced CT scan,10 of whom showed obvious enhancement in arterial phase with isodentisy in 6 and slightly higher density in 4 in portal phase,and isodensity in 10 in delayed phase.4 lesions showed mild-to-moderate enhancement in arterial phase with slightly higher density than normal pancreas in 2 and isodentisy in 2 in portal phase,and slightly higher density than nor-mal pancreas in 1 and similar density to pancreas in 3 in delayed phase.In portal phase,the enhanced degree in 8 was similar to the pancreas,and that in 6 was slightly higher or higher than that of pancreas.In delayed phase,13 were similar to the pancreas and other 1 was higher than that.3 of 18 lesions were easily missed,and 4 lesions with missed diagnosis showed isodensity on plain CT and en-hanced CT,and were further detected by other imaging methods.Conclusion Multiphase enhancement CT scanning can be used as the first choice for the insulinoma.

Objective To explore the application value of monoexponential, biexponential models multiple b values diffusion weighted imaging(DWI) in distinguishing pancreatic cancer from non-tumorous pancreas.Methods Subjects comprised 37 pancreatic cancers confirmed by clinical or surgery.Pancreas multiple b values DWI was performed using 3.0T scanner.Standard apparent diffusion coefficient (ADCstandard) was calculated using monoexponential diffusion model.Pure diffusion coefficient (ADCslow), pseudodiffusion coefficient (ADCfast) and perfusion fraction (f) were calculated using intravoxel incoherent motion(IVIM) diffusion model.Parameters of pancreatic cancers and non-tumorous pancreas were compared using independent samples t test.Results Mean ADCslow value of pancreatic cancer was higher than that of non-tumorous pancreas (0.611×10-3 mm2/s vs 0.521×10-3 mm2/s,P=0.037).Mean ADCfast and f values of pancreatic cancer were lower than that of non-tumorous pancreas (5.066×10-3 mm2/s vs 7.188×10-3 mm2/s,P=0.035;55.8% vs 64.0%,P=0.016;respectively).ADCslow of pancreatic cancer was positively correlated to ADCstandard (r=0.824,P=0.000).ADCfast of pancreatic cancer was negatively correlated to f(r=-0.558,P=0.000).Conclusion ADCslow, ADCfast and f derived from IVIM-DWI model can distinguish pancreatic cancer from non-tumorous pancreas.IVIM-DWI may be a promising and non-invasive tool for early diagnosing and differentiating pancreatic carcinoma from non-tumorous pancreas.

Objective To explore the role of Entecavir in CD4 * T cells and CD4 + CD25 + Foxp3 + regulatory T cells of patients with chronic hepatitis B.Methods Patients with chronic active hepatitis B (CAH,n =50) were divided into Entecavir treatment group (n =30) and controls (n =20).The entecavir treatment group and the controls were followed up for 12 months.The frequency and phenotype of peripheral CD4 + and CD4 + CD25 + Foxp3 + T cells were detected by flow cytometry.Results Patients with CHB receiving entecavir treatment for 3 months,6 months and 12months exhibited significantly higher frequency of CD4 + T cells and CD4/CD8 ratio as opposed to those of baseline levels(P ＜0.05).The frequency of CD4 +CD25 + Foxp3 + T cells from the patients receiving entecavir treatment for 3 months,6 months and 12 months was significantly decreased compared with that of basline level(P ＜ 0.05).However,the frequency of CD4 T cells and CD4 + CD25 + Foxp3 + T cells,as well as CD4/CD8 ratio of the control group following up for 12 months displayed no significant differences compared with its baseline levels.The serum HBV DNA level from the baseline to Entecavir treatment for 12 months was correlated with the frequency of CD4 + CD25 +Foxp3 * T cells from the baseline to Entecavir treatment for 12 months.Conclusions Entecavir not only can effectively suppress HBV replication,but also simultaneously improve the cellular immune function of chronic hepatitis B.

ObjectiveTo compare the contents and relative molecular weight distributions of proteins and polypeptides in Naoxuekang dropping pills， Huoxue Tongmai capsules and Maixuekang capsules of Hirudo single medicinal preparations， to evaluate the in vitro anticoagulant， antiplatelet and fibrinolytic activities of the three preparations， and to investigate the effects of temperature， pH and digestive enzymes on the anticoagulant activities of the three preparations. MethodsThe contents of soluble proteins and polypeptides in the three preparations were determined by bicinchoninic acid assay（BCA） and Bradford method， and the relative molecular weight distributions of the three preparations were determined by electrophoresis combined with gel chromatography. The antithrombin activity of the three preparations was evaluated by fibrinogen-thrombin time（Fibg-TT） method， and their anticoagulant activities were further assessed by the elongations of activated partial thromboplastin time（APTT）， prothrombin time（PT） and thrombin time（TT）. The antiplatelet aggregation activities of the three preparations were measured by turbidimetry and the fibrinolytic activities were measured by fibrin plate method. Relative TT was used as index to investigate the effects of temperature， pH and digestive enzyme buffer on anticoagulant activities of the three preparations. ResultsAt the lowest single dosage， the contents of proteins and polypeptides were in the order of Maixuekang capsules>Huoxue Tongmai capsules>Naoxuekang dropping pills. Both Huoxue Tongmai capsules and Maixuekang capsules had 11 electrophoretic bands between 4.0 kDa and 90 kDa， the bands of Maixuekang capsules were more clear in the range of >25 kDa， and there was 1 obvious band at 14 kDa for the two capsules. Huoxue Tongmai capsules had one specific band at 9.0 kDa and Maixuekang capsules had one specific band at 48.0 kDa. Naoxuekang dropping pills only had 2 electrophoretic bands at 6.5 kDa and 8.5 kDa， primarily containing peptides below 2 kDa， most of which were oligopeptides. The anticoagulant activity concentrations of the three preparations exhibited a certain dose-dependent effect. At the lowest single dosage， The anticoagulant activity concentrations were ranked as Naoxuekang dropping pills>Huoxue Tongmai capsules>Maixuekang capsules. The prolongation effect of the three preparations on coagulation time was dose-dependent. At the same concentration， the prolongation effect of Naoxuekang dropping pills and Huoxue Tongmai capsules was APTT prolongation rate>TT prolongation rate>PT prolongation rate， whereas for Maixuekang capsules， the sequence was TT prolongation rate>APTT prolongation rate>PT lengthening rate. At the single minimum dosage， the order of APTT prolongation rate was Maixuekang capsules>Huoxue Tongmai capsules≈Naoxuekang dropping pills， the order of PT prolongation rate was Naoxuekang dropping pills≈Maixuekang capsules>Huoxue Tongmai capsules， and the order of TT prolongation rate was Maixuekang capsules>Huoxue Tongmai capsules>Naoxuekang dropping pills. The three preparations showed dose-dependent effects on platelet aggregation induced by adenosine diphosphate（ADP） and arachidonic acid（AA）， and the effect induced by ADP was stronger than that induced by AA. The anti-platelet aggregation effect of Naoxuekang dropping pills was significantly stronger than that of Maixuekang capsules（P<0.01）， whereas Huoxue Tongmai capsules had the effect of promoting platelet aggregation. None of the three preparations had the ability to dissolve fibrin. The anticoagulant activity of Naoxuekang dropping pills was least affected by heating， while the activities of the two capsules decreased significantly within 5 min above 80 ℃， and continued to decrease within 2 h. Compared with pure water， the anticoagulant activities of the three preparations could be increased by 1-3 times under strong acidity（pH 1-3）. In the pepsin buffer， the anticoagulant activity of Naoxuekang dropping pills could be increased by 1-3 times， while the anticoagulant activities of Huoxue Tongmai capsules and Maxuekang capsules were significantly decreased， the lowest levels were about 60% and 20%， respectively. In trypsin buffer， the anticoagulant activities of Naoxuekang dropping pills， Huoxue Tongmai capsules and Maixuekang capsules decreased significantly， and the lowest levels decreased to about 41%， 41% and 35%， respectively. ConclusionThe contents of proteins and polypeptides and relative molecular weights of the preparations derived from lyophilized fresh Hirudo powder， dried Hirudo powder and reflux extract of Hirudo decrease sequentially， and the anticoagulant activity decrease gradually， but the anticoagulant pathway is different. And the anti-platelet aggregation activity of the reflux extract is significantly enhanced. The heat resistance and gastrointestinal stability of the three preparations increase successively， and the first two are suitable for enteric-soluble preparations， while the latter is suitable for routine oral administration. The above results can provide data reference for the rationality of different preparation methods， active substances， pharmacodynamics and mechanism of Hirudo preparations.