Objective:To summarize the computed tomography (CT) and magnetic resonance imaging (MRI) features of acinar cell carcinoma of the pancreas (ACCP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 patients with ACCP who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2015 to December 2019 were collected. There were 5 males and 16 females, aged (57±9)years, with a range from 41 to 74 years. Patients underwent CT and MRI examinations. Observation indicators: (1) imaging examination; (2) imaging features on CT; (3) imaging features on MRI; (4) pathological examination and immunohistochemistry staining; (5) treatment and follow-up. Follow-up using outpatient examination and telephone interview was conducted at 1, 3, 6 months after discharge and once every 6 months thereafter to detect survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers. Results:(1) Imaging examination. Of the 21 patients, 7 underwent single CT examination, 11 underwent MRI examination, and 3 underwent both CT and MRI examinations. ① Tumor shape: all the 21 patients had single tumor, including 17 showing round or quasi-round shape, and 4 showing irregular clumps. ② Tumor location: of the 21 patients, 6 had tumor located at pancreatic head, 2 had tumor located at pancreatic head and body, 2 had tumor located at pancreatic body, 4 had tumor located at pancreatic body and tail, 4 had tumor located at pancreatic tail, and 3 had had tumor located at ampulla. ③ The maximum tumor diameter was (43±29)mm, with a range from 11 to 129 mm. ④ Adjacent organ invasion: 10 of the 21 patients had invasion of adjacent organ, including 2 with invasion of stomach, spleen and left adrenal gland invasion, 4 with invasion of duodenum, 3 with invasion of duodenum and common bile duct, 1 with invasion of spleen. ⑤ Vascular invasion: 12 patients had invasion of splenic artery or splenic vein, including 1 combined with invasion of both common hepatic artery and superior mesenteric vein, 1 combined with invasion of celiac root. ⑥ Pancreatic and bile duct invasion: 8 patients had pancreatic and bile duct dilation, including 4 with bile duct and upper pancreatic duct dilation, and 4 with pancreatic duct dilation. ⑦ Lymph node metastasis: 2 patients had perineoplastic lymph node enlargement. ⑧ Other conditions: 7 patients had tumor center with cystic necrosis. Four patients had atrophy pancreatic parenchyma. Two patients had splenic vein tumor thrombosis. Two patients had cysts. One patient had multiple liver metastases. (2) Imaging features on CT. ① The solid part was dominant in the main body of the 10 patients undergoing CT examination, demostrating equal density, of which 3 cases had clear boundaries, 2 cases had pseudocapsule around the lesion, and 5 cases had low-density necrotic area in the center of lesion. ② In arterial phase of CT examination, the solid part of tumor had a lower enhancement compared with the normal pancreatic tissues in 7 patients, while the solid part of tumor had a high enhancement compared with the normal pancreatic tissues in 3 patients. ③ In delayed phase of CT examination, the tumor density was slightly lower than or equal to density of normal pancreatic parenchyma in 7 patients, showing slightly progressive enhancement, while the tumor density was slightly higher than or equal to density of normal pancreatic parenchyma in 3 patients. (3) Imaging features on MRI. ① MRI plain scan of 14 patients showed that 8 patients demostrated slightly longer T2 and slightly longer T1 signals in lesions, while 6 patients demostrated mixed signals dominated by long T2 and equal T1 signals. The area of cystic necrosis was observed in lesions of 4 patients and was not observed in 10 patients. No antiphase signal reduction was observed in the 14 patients. ② MRI dynamic enhanced scan of 12 patients showed that 11 patients presented mild progressive enhancement in lesions and 1 patient presented obvious confounding enhancement and clearance in the delayed phase. Compared with adjacent normal pancreatic parenchyma, diffused weighted imaging showed high signals in 6 cases, slightly high signals in 6 cases, and high signal halo in 2 cases. The apparent diffusion coefficient in 14 lesions was (1.22±0.14)×10 -3 mm 2/s. (4) Pathological examination and immunohistochemistry staining. Results of pathological examination in the 21 patients: acinic cell carcinoma, mixed ductal-acinic cell carcinoma, acinar-endocrine carcinoma, and atypical hyperplasia inacinus were detected in 14, 5, 1, and 1 patients, respectively. Of the 21 patients, 10 had invasion of adjacent organ, 3 had invasion of bile duct, 2 had invasion of lymph node. Results of immunohistochemistry staining in 17 patients: 17 patients had proliferation index of Ki-67 as 1%-80%; 10 out of 16 patients were positive for synaptophysin; 6 out of 16 patients were positive for CD56 protein; 2 out of 14 patients were positive for Chromogranin A; 12 out of 13 patients were positive for α-antitrypsin; 9 out of 11 patients were positive for cytokeratin; 8 patients were positive for β-catenin; 2 patients were positive for B lymphoma-10 protein. (5) Treatment and follow-up. Of the 21 patients, 10 cases underwent pancreatico-duodenectomy, 6 cases underwent pancreatic body and tail pancreatectomy combined with splenectomy, 2 cases underwent pancreatic body and tail pancreatectomy, 1 case underwent pancreatic tail tumor enucleation, 1 case underwent liver metastasis resection, and 1 case underwent ultrasound-guided pancreatic lesion puncture biopsy. All the 21 patients were followed up for (30±16)years, with a range from 2 to 52 months. There were 13 patient surviving and 8 cases of death. They had survived for (19±13)months, with a range from 2 to 35 months. Conclusions:The CT and MRI enhanced scan of ACCP showed slightly progressive enhancement, with cystic necrosis seen in the center and high signals in diffused weighted imaging. Dilation of bile duct and pancreatic duct is common in patients with pancreatic head tumors, and invasion of splenic artery and vein is common in pancreatic body and tail tumors. Calcification and cyst are rare and lesions of pancreatic head and body cause atrophy in pancreatic tail.

Health communication aims to improve public health attitudes and behaviors by propagating health information. It plays an important role in promoting public health literacy and "Healthy China Initiative". The basic theories of health communication include "7 W" and Theory of Planned Behavior. Clinicians with profound medical expertise and a wealth of clinical practice play key roles in the communication, and they hold an unparalleled advantage in health communication by delivering authoritative and trustworthy information to the public. The capacity of health communication among clinicians in the nation is determined by various factors including professional characteristics, policy support, dissemination platforms and pathways, time and effort. Meanwhile, some problems in the research on the health communication capacity of clinicians remain, such as lack of well-established motivation systems, limited dissemination pathways, and imperfect evaluation frameworks. In some regions of China, health communication performance has been considered as part of the professional title evaluation for clinical physicians. Medical institutions and universities have also initiated relevant training and practice programs. It is crucial to improve evaluation frameworks, strengthen training pathways and effectiveness assessment, promote interdisciplinary integration, and enhance the role of clinicians in health communication in the future.

Objective:To investigate the clinical efficacy of modified biliary-intestinal anasto-mosis by pancreaticoduodenectomy and influencing factors of postoperative biliary leakage.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopatholo-gical data of 165 patients with benign and malignant diseases around the ampullary who underwent pancreaticoduodenectomy in the Affiliated Hospital of Inner Mongolia Medical University from June 2014 to October 2020 were collected. There were 92 males and 73 females, aged (59±10)years. Of the 165 patients, 44 patients undergoing modified biliary-intestinal anastomosis within pancreatico-duodenectomy were divided into the modified group, and 121 patients undergoing traditional biliary-intestinal anastomosis within pancreaticoduodenectomy were divided into the traditional group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative situations; (3) analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the corresponding statistical methods based on data type. All indicators in univariate analysis were included in multivariate analysis. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 165 patients, 72 cases were successfully matched, including 36 cases in the modified group and 36 cases in the traditional group, respectively. The elimination of jaundice, preoperative reduction of jaundice and hypertension confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. All patients in the two groups underwent surgery successfully. The operation time, postoperative pathological type (lower bile duct cancer, pancreatic head cancer, pancreatic cystic tumor, chronic pancreatitis, duodenal cancer), time of no drainage fluid in the drainage tube around biliary-intestinal anastomosis were 371(270,545)minutes, 6, 12, 1, 2, 15, (12±7)days in patients of the modified group, versus 314(182,483) minutes, 13, 14, 1, 4, 4, (16±8)days in patients of the traditional group, showing significant differences in the above indicators between the two groups ( Z=-3.54, χ2=10.01, t=-2.34, P<0.05). Cases with postoperative grade A biliary leakage was 0 in patients of the modified group, versus 6 in patients of the traditional group, showing a significant difference between the two groups ( P<0.05). Cases with postoperative grade B biliary leakage, cases with postoperative grade B pancreatic fistula, cases with postoperative bleeding, cases with abdominal infection, cases with incision infection, cases with delayed gastric emptying, cases undergoing unplanned readmission were 1, 0, 1, 4, 1, 5, 1 in patients of the modified group, versus 0, 1, 2, 5, 2, 5, 2 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with postoperative grade A pancreatic fistula, cases with overall complications, cases with Clavien-Dindo grade Ⅰ-Ⅱ complications, cases with Clavien-Dindo grade Ⅲ-Ⅳ complications were 6, 12, 6, 6 in patients of the modified group, versus 7, 14, 8, 6 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.09, 0.24, 0.36, 0.00, P>0.05). None of patient in the two groups had postoperative grade C biliary leakage and postoperative grade C pancreatic fistula. (3) Analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Results of multivariate analysis showed that preoperative reduction of jaundice and traditional biliary-intestinal anastomosis were independent risk factors for biliary leakage after pancreaticoduodenectomy ( odds ratio=11.37, 12.27, 95% confidence interval as 1.76-73.35, 1.14-131.23, P<0.05). Conclusions:Compared with traditional biliary-intestinal anastomosis, modified biliary-intestinal anastomosis within pancreaticoduodenectomy is safe and feasible. Preoperative reduction of jaundice and traditional biliary-intestinal anastomosis are independent risk factors for biliary leakage after pancreaticoduodenectomy.