Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis which is closely related with abnormal autoimmune.To some extent,it is too difficult to identify the diagnosis between AIP and pancreatic cancer.The treatment includes hormone therapy and surgery.In this article,based on accumulating the experience in the diagnosis and treatment of AIP cases for many years and reviewing the related literatures,we evaluate its type,the etiology and the clinical presentations,as well as summarize the typical characteristics of pathology,radiology and serology.

Acute pancreatitis (AP) is an inflammatory disease of the pancreas. Its pathogenesis is not only related to abnormal activation of trypsinogen, but also related to calcium overload, mitochondrial dysfunction, impaired autophagy and endoplasmic reticulum stress. However, the mechanism has not been fully elucidated and needs to be further studied. Currently, there is no effective treatment for AP. It is difficult to prevent the loss of pancreatic function. An in-depth understanding of the pathophysiological mechanisms of AP may help to identify the potential therapeutic targets. Therefore, the purpose of this study is to review recent advances in the mechanism of AP in order to provide more research direction for treatment.

Exosomes are small membrane bound vesicles typically 30 ～ 150 nm in size which are widely distributed in the body fluids.The cytosol is rich in proteins and nucleic acids which mediates communication between different cells and transporting substances.Exosomes are involved in pancreatic cancer initiation and progression by promoting the formation of tumor microenvironment,enhancing gemcitabine resistance.GPC1 + circulating exosomes and high exosome levels of microRNA-10b serve as potertial non-invasive diagnostic tools to detect pancreatic cancer in the early stage.Meanwhile,exosomes could successfully deliver genetic drugs,anticancer drugs to target cells.In this article,we provide a review on the recent advances on exosomes in the diagnosis and treatment of pancreatic cancer.

Malignant tumors usually have no obvious clinical symptoms in the early stage. Most patients are already in the advanced stage when they are diagnosed. Some patients have lost the opportunity for operation, resulting in poor prognosis. Therefore, how to find the best therapeutic target for such patients and improve the prognosis of patients has gradually become the focus of scholar′s attention. Recently, Kruppel-like factor (KLF) is a transcriptional regulator that can bind to the target DNA, and its family plays an important role in the occurrence and development of malignant tumors. It has also been confirmed that the KLF family affects the proliferation, differentiation and migration of tumor cells, but the specific mechanism is still not fully elucidate. Consequently, in order to further explored the effect of the KLF family on tumors, this study intends to briefly review the roles and regulatory mechanisms of the KLF family in the cell proliferation, differentiation and migration of malignant tumors, hoping to provide new target for the biological treatment of tumors.

Exosomes are extracellular vesicles containing DNA, RNA and protein. They participate in intercellular communication and play an important role in tumor growth and metastasis. Exosomes exist in a variety of body fluids. Blood, urine and cerebrospinal fluid can be separated and extracted. Exosomes derived from tumor cells have the characteristics of tumor cells. Studies have shown that exosomes are involved in many processes of tumorigenesis and development, including information transmission between tumor cells, invasion and metastasis of tumor cells. Exosomes can also be used as carriers to deliver drugs to target cells, which has the potential of targeted therapy. In the process of tumor treatment, drugs can be designed based on the targeted recognition characteristics of exosomes, so as to improve the bioavailability of anti-tumor drugs, reduce adverse reactions and enhance the therapeutic effect. The research and application of exosomes are very challenging. There is a huge heterogeneity in the types, sizes and sources of exosomes, and the production mechanism is also very complex. This paper reviews the extraction and identification methods of exosomes, and reviews the clinical application of tumor derived exosomes.

Objective: To investigate IMRT planning process using the combined application of failure modes and effects analysis (FMEA) and fault tree analysis (FTA) by reference to the report of Task Group 100 of the AAPM, and stablish and optimize the quality. Methods: A multidisciplinary team detailed the process mapping of IMRT planning using Eclipse TPS. The team evaluated the potential failure modes (FMs) of every process step. The evaluation was divided into two groups according to whether quality management (QM) was considered. For every FM, occurrence (O), severity (S) and detectability (D) by consensus were evaluated, and the product of O, S and D yielded the risk priority number (RPN), which permitted the ranking of the FMs. Finally, FTA was used to determine the root factors contributing to the riskiest failure modes. Results: The IMRT plan process consisted of 10 major sub-processes and 33 steps, which amounted to 47 failure modes. For the group without quality management, the RPN of FMs was between 13.2-271.8, 27 of which had RPN≥80, and 18 FMs had S≥8. For the group with quality management, the RPN of FMs was between 11.2-158.4, 11 of which had RPN≥80. The difference of RPN between the two groups was statistically significant (RPN of the group without QM=101.17±66.34, RPN of the group with QM=59.54±35.64, t=8.501, P<0.05). Finally, FTA was used to determine the root factors contributing to the FMs, i. e., prescription dose definition and importing images. Conclusions The FMEA and FTA methods are operable and practical, which can systematically and comprehensively analyze the potential failures and risks existing in the process of IMRT plan. And the FMEA and FTA can contribute to establish and optimize the quality management program in radiotherapy.

Objective:To analyze the effects of infectious complications [infected pancreatic necrosis (IPN) and extra-pancreatic infection (EPI)] on the outcomes of patients with severe acute pancreatitis (SAP), and evaluate the differences in infection time, infection site and infecting species between SAP patients with infections complications.Methods:The clinical data of 66 SAP patients with combined infectious complications admitted to Xuanwu Hospital, Capital Medical University from January 2014 to December 2020 were retrospectively analyzed, and SAP patients were divided into IPN group ( n=7), EPI group ( n=14) and co-infection (EPI+ IPN) group ( n=45) according to the type of infection. Whether the study data conformed to a normal distribution was assessed by the Shapiro-Wilk test, normally distributed measures were expressed as mean ± standard deviation ( ± s), and ANOVA was used for comparison between groups; skewed measures were expressed as median (interquartile range) [ M ( Q1, Q3)], and the rank-sum test was used for comparison between groups. Bonferroni correction was used for multiple group comparisons ( P value significance level reduced to 0.017). Quantitative data were compared between groups using the χ2 test or Fisher's exact probability method. Results:There were no statistical differences between the three groups in terms of baseline data at admission (gender, age, etiology, modified CTSI score, degree of pancreatic necrosis, and number of organ failure) ( P>0.05), patients in the EPI group were referred earlier than the other two groups ( P<0.05). In clinical treatment, patients in the IPN group and co-infection group required multiple minimally invasive interventions compared with those in the EPI group ( P<0.05), and the number of patients requiring combined nutritional support, length of intensive care unit stay, and total length of hospital stay were higher in the co-infection group than in the other two groups ( P<0.05). In addition, 360 strains of pathogenic bacteria were cultured in this study, with Gram-negative bacteria being the most common, and patients with SAP were more likely to have EPI in the early stage of disease onset, with bacteremia and respiratory tract infections in the early stage (≤14 d), and bacteremia, urinary tract infections, and catheter-associated infections in the late stage (>14 d). Conclusions:Among patients with SAP, patients in the co-infection group had higher surgical intervention, nutritional support and length of hospital stay than those in the single infection group. It is advisable to prioritize EPI in SAP patients with suspected infections, and the common infectious strains in SAP patients are still predominantly Gram-negative bacteria, and clinicians need to adjust the treatment plan in a timely manner according to the changes in patients′ conditions.

Objective:To determine the accuracy and clinical application of donor HLA quartile genotyping based upon transplanted kidney biopsy.Methods:The clinical and follow-up data are retrospectively reviewed for 38 recipients of kidney transplantation(KT)at First Affiliated Hospital of Xi'an Jiaotong University from 2019 to 2022.They are suspected of rejection.HLA quartile genotyping of donor kidney is performed through puncture and DNA analysis by LABType SSO method.Known HLA genotypes of recipients are compared for predicting HLA genotypes of donors.Donor-specific antibody(DSA)is detected by Labscreen Single kit.And SPSS18.0 statistical software is employed for processing baseline data, donor/recipient HLA typing data, recipient DSA antibody data and transplant nephropathy parameters.Results:Among them, 12(31.58%)belonged to HLA-A, B, C, DR and DQ.Four loci are detected in 14 cases(36.84%). Three sites are detected in 10 cases(26.32%). Two sites are detected in 2 cases(5.26%)and a negative correlation exists between detected sites and transplantation time( rs=-0.707, P=0.001). The detection rate of HLA loci is 78.94%(30 cases). B: 65.78%(25 cases); C: 84.21%(32 cases); DR: 57.89%(22 cases); DQ: 100% (38 cases); HLA sites detected in puncture tissue are 89.47% consistent with the results of donor whole blood test, among which HLA-C and HLA-DQ sites are 100% consistent and HLA-A and HLA-B sites 87.50% and 90% consistent and HLA-DR sites 66.7% consistent( P<0.01). Spearman's rank correlation analysis indicated that pathological diagnosis of interstitial inflammation( rs=-0.432, P=0.017), renal tubule atrophy( rs=-0.587, P=0.001)and interstitial fibrosis( rs=-0.560, P=0.001)are correlated negatively with HLA detected sites in transplanted kidney puncture tissue.DSA is detected in 42.1% of recipients and 68.75% of recipients belonged to HLA-DQ. Conclusions:HLA typing results of puncture tissue are consistent with those of whole blood test.Time after transplantation, infiltration of transplanted nephritis cells and degree of fibrosis may influence the detection of HLA loci.Donor HLA quartile genotyping using transplanted kidney biopsy has some diagnostic values for detecting the presence of DSA.

Objective:To investigate the computed tomography (CT) features and diagnosis and treatment of emphysema pancreatitis (EP).Methods:The retrospective and descriptive study was conducted. The clinical and imaging data of 12 patients with EP who were admitted to Xuanwu Hospital of Capital Medical University from January 2017 to June 2020 were collected. There were 10 males and 2 females, aged from 25 to 71 years, with a median age of 42 years. All patients received CT examination. Step-up treatment or one-step surgical treatment was performed on patients according to their conditions. Observation indicators: (1) CT features; (2) bacteriological characteristics; (3) treatment and follow-up. Follow-up using outpatient examination was conducted at postoperative 1, 3, 6 months to detect survival of patients up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) CT features: 1 of the 12 patients underwent abdominal+pelvic CT plain scan, and 11 cases underwent abdominal+pelvic CT plain scan and enhanced scan of arterial and portal venous phase. CT examination of 12 patients showed diffuse enlargement of the pancreas, unclear borders and a large amount of exudation around the pancreas. Pancreatic necrotic tissues accounted for >30% of the total pancreatic volume; the Balthazar CT score was 10 (range, 8-10). Of the 12 patients, 5 cases showed that the exudation or necrosis involved bilateral prerenal fascia, 7 cases only involved the left prerenal fascia; the necrotic infection area of 11 patients formed obvious wraps. The distribution of pancreatic, peripancreatic infection and gas in 12 patients: 6 cases had pancreatic, peripancreatic infection and gas located in Ⅰ+Ⅱa area, 3 cases located in Ⅰ+Ⅱa+Ⅲ area, 2 cases located in Ⅰ+Ⅲ area, and 1 case located in Ⅰ area. There was gas in the pancreatic parenchyma in 12 patients, with fluid in the abdominal cavity and pelvic cavity. (2) Bacteriological characteristics: the culture results of peripancreatic necrotic issues in 12 patients were all positive for the pathogenic specimens, and 27 strains were cultured. Klebsiella pneumoniae was the most common in the culture of necrosis from 12 patients, followed by Escherichia coli and Enterococcus bacteria. Fungus was found in the culture of necrosis from 1 patient. Of the 12 patients, 5 had negative blood cultures and 7 had positive blood cultures. A total of 14 strains were cultured, with Klebsiella pneumoniae being the most common; fungus was found in the blood culture from 4 patients. (3) Treatment and follow-up: 1 patient underwent percutaneous catheter drainage, 7 underwent step-up surgical treatment, 4 underwent one-step surgical treatment; 11 patients undergoing surgical treatment received laparoscopic-assisted removal of pancreatic necrotic tissue, including 1 case with exploratory laparotomy due to abdominal hemorrhage. Of the 11 patients undergoing surgical treatment, 7 cases received the left retroperitoneal approach surgery (including 1 case combined with the upper abdominal median approach), 2 cases received the upper abdominal median transomental sac approach surgery, 1 case received the right retroperitoneal approach surgery, and 1 case received the left rectus abdominis approach surgery. The number of operations of all the 11 patients were (3.1±0.9)times, the number of step-up treatments was (3.6±0.8)times, and the number of one-step surgery was (2.3±0.5)times. Nine of 12 patients had organ dysfunction that lasted for more than 48 hours during the treatment, which received surgical treatment after organ support and anti-infection therapy. All the 12 patients were followed up for 6 months after operation, of which 9 cases were cured after treatment and 3 cases died including 1 case dying of bleeding and 2 cases dying of septic shock combined with multiple organ failure.Conclusions:Emphysema pancreatitis is complicated by pancreatic necrosis, which is characterized by pancreatic and peripancreatic gas accumulation on CT. Most patients with EP have organ failure. Surgery is an important treatment for EP.

Objective To review the research of self-management intervention in patients with hematopoietic stem cell transplantation,clarify the intervention elements,so as to provide references for clinical practice and future related research.Methods According to the scoping review framework,a literature search was performed in the PubMed,Embase,CINAHL,Web of Science,Cochrane Library,CNKI,Wan fang Database,VIP,CBMdisc for all the studies on self-management intervention of patients with hematopoietic stem cell transplantation.The retrieval time was from the establishment of the database to December,2022.There were 2 researchers who extracted and analyzed the data of the included literature.Results A total of 12 articles were included,including 3 randomized controlled trials,8 quasi-experimental studies,and 1 mixed study.6 studies were conducted with interventions based on the theoretical basis or nursing model such as self-management oriented 5A nursing model,continuous nursing model,problem-based learning theory.The intervention methods of 12 studies included nurse-led self-management guidance,mobile applications,multidisciplinary collaboration,and graphic cards.The intervention time was mostly 1～3 months.The outcome indicators included feasibility evaluation indicators such as operability,ease of use,and user satisfaction of the application,and effect evaluation indicators such as self-management ability,quality of life,and medication compliance of patients.The results showed that self-management interventions could improve patient self-management ability,quality of life,medication compliance,and improve their psychological and nutritional status.Conclusion The research on self-management intervention in patients with hematopoietic stem cell transplantation is still in the development stage,and its positive effect has been preliminarily verified.Medical staff should strengthen the self-management evaluation of patients with hematopoietic stem cell transplantation,play the role of multidisciplinary team,use electronic health intervention methods,and formulate multi-level,scientific and effective self-management intervention programs.