Objective:To evaluate diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) for pancreatic cystic lesions.Methods:Endoscopic and clinical follow-up data of patients with pancreatic cystic lesions diagnosed by EUS in Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University with CEH-EUS video from March 2013 to April 2020 was retrospectively analyzed.Results:A total of 36 patients were included. There were 16 cases of serous cystadenomas (SCA), 10 cases of mucinous cystic neoplasm (MCN), 5 cases of intraductal papillary mucinous neoplasms (IPMN, 3 with complex type, 2 with main pancreatic duct type) and 5 cases of pancreatic pseudocyst (PPC). 87.5%(14/16) of SCA and 86.7%(13/15) of MCN+ IPMN had hyperenhanced cystic wall with obvious peak and similar washout as surrounding tissue, whereas only 20%(1/5) PPC had hyperenhanced cystic wall. The hyperenhancing effect of PPC was significantly lower than that of SCA and MCN+ IPMN ( P=0.0035 and P=0.0048, respectively ). Mural nodules were detected in 17 cases of pancreatic cystic lesions by EUS, of which 3 cases had hyperenhanced mural modules and 14 cases had hypoenhanced mural nodules by CEH-EUS. Patients showing hyperenhanced mural modules were all finally diagnosed as pancreatic malignancy (1 IPMN, 2 MCN), and the accuracy was 100%. Conclusions:CEH-EUS can have a obvious advantage of differentiating pseudocyst and other pancreatic cystic lesions, while not very useful for differentiating SCA and MCN. Pancreatic cystic lesions showing hyperenhanced mural nodules under CEH-EUS may imply malignancy potential.

Objective To evaluate the efficacy and tolerability of EUS-guided intra-tumoral injection of E1B gene-deleted adenovirus (H101) combined with intravenous gemcitabine for unresectable pancreatic carcinomas. Methods Nineteen patients with advanced adenocarcinoma of the pancreas who were not resectable and never to anti-cancer treatment were enrolled in this study. Each patient underwent two sessions of EUS-guided H101 intra-tumoral injection in combination with gemcitabine (i. v. , 1000 mg/m2, d3, 10, 17). The tumor size before and after H101 intra-tumoral injection were recorded for efficacy assessment. The changes of pain score and KPS, adverse effects and complication rates, survival were estimated. Results The tumor size decreased in twelve patients by5.3% ~ 69.7% , but the difference was not statistically significant (P =0.275). All of nineteen patients completed two cycles of combination treatment. Among them, 3 (15. 8% ) achieved partial response, 10 (52.6% ) had stable disease, and none had complete response. The mean pain score after injection was significantly lower than that before injection (3.1 ±1.7 vs. 3.9±1.6, P = 0.004). KPS after injection was significantly increased more than that before injection [ (68.4 ± 12.1)% vs. (61.1 ±9.9)%, P =0.003)]. There was no complication associated with the procedure. Major adverse effects associated with H101 injection were fever and diarrhea. The survival time was 2.5 to 10 months. Nine patients were still alive. Conclusions EUS-guided E1B gene-deleted adenovirus intra-tumral injection in unresectable pancreatic carcinomas is feasible and well tolerated in combination with intravenous gemcitabine, which can improve the quality of life and decrease the pain score.

Objective To investigate the clinical benefit response (CBR) in treating the unresectable pancreatic carcinoma by applying the EUS guided iodine-125 seed implantation combined with chemotherapy of gemeitabine and comparing chemotherapy of gemcitabine alone. Methods Forty-one patients with unresectable pancreatic carcinoma were randomly divided into two groups, one group (Group A) included 21 cases which underwent EUS-guided iodine-125 seed implantation combined with gemcitabine chemotherapy, the rest 20 cases (Group B) were treated with gemcitabine chemotherapy alone. EUS-guided iodine-125 seed implantation were carried according to the treatment plan system (TPS), following chemotherapy after 1 week. Gemcitabine was administered at the dose of 1 000 mg/m2, through intravenous administration once a week for 3 consecutive weeks every 4 weeks. CBR was assessed. Results CBR of Group A was 57.1% and median time to CBR was 1 week and median duration of CBR was 21 weeks, while CBR of Group B was 25%, and median time to CBR was 4 weeks and median duration of CBR was 15 weeks (P<0.01). Conclusions EUS-guided iodine-125 seed implantation combined with chemotherapy of gemcitabine was superior to gemcitabine chemotherapy alone in the term of CBR in patients with unresectable pancreatic carcinoma.

Objective To investigate the expression of miRNAs in endoscopic ultrasound (EUS)-guided fine needle pancreatic aspirates (FNA) and its clinical significance. Methods The expression of miRNA-210, miRNA-21, miRNA-196a, miRNA-181a, miRNA-181b, miRNA-155 and miRNA-16 in EUS-FNA specimen of 23 pancreatic cancer and 13 benign pancreatic masses was detected with quantitative real-time polymerase chain reaction (qRT-PCR) assays and its clinical significance was analyzed. Results The relatively expression quantity of miRNA-210, miRNA-21,miRNA-196a, miRNA-181a and miRNA-181b (0.86±1.10, 0.69±0.64, 0.32±2.50, 0.16±0.83and 0.56 ±0.88, respectively) was significant higher in pancreatic cancer than those in the benign pancreatic masses (-0.11±0.98,-0.03±0.97,-1.50±1.40,-0.53±1.10 and -0.28±1.10,respectively) (P value was 0. 012, 0. 011, 0. 024, 0. 036 and 0.015, respectively). The relatively expression quantity of miRNA-16 and miRNA-155 in pancreatic cancer and benign pancreatic masses was - 0.11 ± 0.69, 0.08 ± 1.04, - 0.73 ± 1.26 and - 0.19 ± 1.19 respectively, no statistic difference (P value was 0. 067 and 0. 467). The high expression of miRNA196a was positively correlated with pancreatic cancer lymphatic metastasis and clinical TNM staging. Conclusion There were multi miRNAs with abnormal high expression in the pancreatic cancer. Of those, miRNA-196a was associated with the clinical malignant features of pancreatic cancer.

Objective To compare the efficacy and safety of E1B gene-deleted adenovirus (H101)and ethanol in treating advanced pancreatic carcinomas by intratumoral injection combined with intravenous gemcitabine.Methods We constructed an orthotopic nude mouse model of pancreatic carcinoma through cancer cell injection into pancreas.A total of 54 nude mice were randomly allocated to 6 groups to accept H101,ethanol or saline (control) intratumoral injection,combined with or without intravenous gemcitabiein.The animals were sacrificed 4 weeks after the treatment and the pancreatic tumors were collected to determine the size,existence of metastasis,distribution of virus by indirect immunofluorescence and apoptosis in tumor by TUNEL and electron microscope.Results All mice completed the scheduled treatment,while 3 died in 48 hours after ethanol injection resulting in a mortality of 16.7％ (3/18).On the contrary,no mice died in the adenovirus injcction group.The average tumor size in group of H101 intratumoral injection combined with intravenous gemcitabie was significant smaller than that in group of saline injection with or without systemic gemcitabie (P =0.008,0.040,respectively).Similar differences were observed between ethanol intratumoral injection and control groups (P =0.012,0.041).Meanwhile,the H101 was absent in all the other organs except the pancreas,which meant that the selectivity of the H101 was tremcndous.The virus combine gemcitabie group had higher apoptosis rate in tumor (83.2 ± 35.7) ％,determined by TUNEL.Conclusion E1B gene-deleted adenovirus intratumral injection in combination with intravenous gemcitabine treating pancreatic carcinomas is efficient and safe,in spite of its lower effectiveness than ethanol.

Objective To investigate the relations and evaluation value of serum thymidine kinase 1 (sTK1) in the treatment of patients withacute exacerbation of chronic obstructive pulmonarydisease (AECOPD). Methods The retrospective treating studies were performed on 104 patients with AECOPD , sTK1 level was de-tected by chemiluminescence dot-blot assay before and after treatment , and the correlation between the expression of sTK1 and CRP after treatment in the two groups was analyzed. Results The levels of sTK1 and CRP in the ef-fective group significantly lowered after treatment (P < 0.05). The expression of sTK1 in the effective group and in the ineffective group after treatment was significantlycorrelated with CRP (P < 0.05). Conclusion sTK1 can be used as a valuable indicator to evaluate the severity of AECOPD and to estimate the efficacy of AECOPD thera-py.

Objective To investigate the diagnostic value of the K-ras mutations in FNA samples for early detection of pancreatic cancer. Methods FNA samples of 27 patients with pancreatic cancers, 9 patients with other malignant tumors and 14 patients with non malignant pancreatic mass (NMPM) were collected. DNA was extracted, and K-ras gene was amplified through PNA-mediated PGR clamping, the products were sequenced to determine the mutation type. Results The positive rate of K-ras mutations in pancreatic cancers,other malignant tumors and NMPM were 88.9%, 44.4%, 35.7%. There was significant difference in K-ras gene mutations in FNA samples between pancreatic cancer and other malignant tumors ( P = 0. 013 ) and NMPM ( P = 0. 001 ). The sensitivity, specificity, positive predictive value, negative predictive value,accuracy of K-ras mutations in FNA samples of pancreatic cancers were 88.9%, 55.6%, 85.7%, 62.5%,80.6% when compared with other malignant tumors, and the difference between the two groups was significant (P =0. 013) ;Those were 88.9%, 64.3%, 82.8%, 75.0%, 80. 5% when compared with NMPM, and the difference between the two groups was significant ( P = 0. 001 ). When cytology of FNA samples and K-ras mutations was combined, the positive rate of pancreatic cancer was up to 96.3%. Conclusions The detection of K-ras mutations in EUS-FNA samples helped improve the positive diagnostic rate of pancreatic cancer.

Objective To analyse the clinical characterization of intraductal papillary mucinous neoplasm of pancreas (IPMNs) and to improve the understanding of IPMNs.Methods Three hundred and sixty-one patients with IPMN at Shanghai Changhai Hospital between 1993 and 2012 were retrospectively analyzed.Results Among 361 cases of IPMNs,241 were men and 120 were female,with a female to male ratio of 2.6∶1.Mean age of the patients was 62 years old (16 ～ 87 years old).The duct type included the main duct in 102 patients (28.3％),a branch duct in 109 (30.2％),and mixed ducts in 150 (41.6％).The most common symptom at presentation is pancreatitis,which occur in 167 patients (46.3％).The sensitivity for the detection of IPMN was 80.2％ by ERCP,76.9％ by MRCP,63.9％ by CT,and 50.5％ by EUS.One hundred and twenty-nine patients (35.7％) were operated and diagnosed with 87 (67.2％) IPMA,21 (16.4％) IPMB,10(8.2％) IPMC(CIS) and 10 (8.2％) had invasive carcinomas.The 5-year survival rates of IPMA,IPMB,IPMC,and invasive carcinomas were 100％,100％,66.5％,and 44.7％,respectively.Conclusions IPMNs were fregrently occured is 60 years old,half of patients had acute pancreatitis history and the frequtly attack,mixed type is most anatomy type,and the outcome after surgery is good.

Objective:To explore whether Internet continuous nursing can reduce anxiety and depression, chemotherapy-induced peripheral neuropathy, improve treatment compliance and reduce adverse reactions in patients with colorectal cancer undergoing oxaliplatin chemotherapy.Methods:A total of 69 patients with colorectal cancer in the Department of oncology, General Hospital of Northern War Zone from July 2019 to June 2020 were selected and divided into the observation group (34 cases) and the control group (35 cases) by random digits table method. The control group was given conventional nursing mode, and the observation group was given Internet continuity nursing mode. All patients were followed up to 3 months after the end of chemotherapy. The basic information, treatment anxiety and depression, chemotherapy-induced peripheral neuropathy, compliance, incidence of adverse reactions and patient satisfaction of the two groups were compared.Results:There was no significant difference in the anxiety and depression before and after chemotherapy, chemotherapy-induced peripheral neuropathy after chemotherapy( P>0.05). After 3 months of chemotherapy, the anxiety and depression and chemotherapy-induced peripheral neuropathy were (20. 97± 3.46),(14.27 ± 1.14) points in the observation group, and (24. 99 ± 1.11),(18.16 ± 2.55) points in the control group, the differences were statistically significant ( t values were 3.80, 5.09, P<0.05). In the control group, there were 19 cases of regular review, 20 cases of persistent chemotherapy, 21 cases of disease awareness, 21 cases of scientific diet, 19 cases of psychological compliance and 19 cases of self-protection. In the observation group, there were 28 cases of regular review, 29 cases of persistent chemotherapy, 30 cases of disease awareness, 28 cases of scientific diet, 30 cases of psychological compliance and 28 cases of self-protection. The treatment compliance in the observation group were significantly higher than those in the control group (χ 2 values were 4.186-9.657, P<0.05). In the control group, there were 7 cases of peripheral neurotoxicity, 2 cases of acute laryngopharyngeal paresthesia, 18 cases of gastrointestinal reaction and 4 cases of hematotoxicity. Fourteen cases of gastrointestinal reaction in the observation group. The incidence of adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant ( χ2 value was 8.26, P<0.05). In the control group, 6 were very satisfied, 27 were satisfied and 2 were good.The observation group was very satisfied and satisfied with 16 people and 18 people. The satisfaction in the observation group was higher than that in the control group, and the difference was statistically significant ( Z value was 1.853, P<0.05). Conclusions:Internet continuous nursing can effectively reduce the anxiety and depression of patients and chemotherapy-induced peripheral neuropathy, improve the treatment compliance of patients, reduce the adverse reactions after medication, and improve the quality of life of patients, which is worthy of application and promotion.

AIM: To study the inhibitory effect of Xihuang Pill on H