Objective:To explore the indications and effect of surgical treatment of autoimmune pancreatitis.Methods:Clinical data of these 15 patients with autoimmune pancreatitis diagnosed and treated at the Department of General Surgery, the First Hospital of Peking University from 2010 to 2021 were retrospectively analyzed.Results:The main clinical symptoms were obstructive jaundice, abdominal pain, distension and weight loss. The diagnosis of AIP was confirmed by EUS-FNA in 6 patients,among them, 4 did not relapse after oral hormone treatment, 2 did not receive relevant treatment, and 1 developed gastric cancer one year later. Under a suspicion of malignancy, 9 patients underwent surgical laparotomy ,and the diagnosis was established by pathology. There was no recurrence after oral hormone therapy in 1 patient who underwent laparotomy and pancreatic biopsy. One out of the 3 patients with choledochojejunostomy relapsed after 3 years. Of the 5 patients who underwent pancreatectomy, 4 had no obvious recurrence, and 1 had recurrence after 3 years.Conclusions:Untypical autoimmune pancreatitis is likely to be misdiagnosed as pancreatic cancer. For patients with suspicious malignancy, operational management and biopsy may benefit.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human's health. With the passing of time, the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumu-lates. To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China, the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission. This recommendations includes the epidemiology, diagnosis, management, maternal care, medication treatment, care of birth and newborns, and psychological support associated with maternal SARS-CoV-2 infection. It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.

Objective:To investigate the clinical imaging features and prognosis of von Hippel-Lindau (VHL) syndrome associated with pancreatic lesions.Method:The retrospective case-control study was conducted. The clinicopathological data of 161 patients with VHL syndrome who were admitted to Peking University First Hospital from September 2010 to August 2022 were collected. There were 83 males and 78 females, with age of onset as 27.0(range, 8.0-66.0)years. Observation indicators: (1) imaging results of VHL syndrome associated with pancreatic lesions; (2) clinical characteristics of VHL syndrome associated with pancreatic lesions; (3) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions; (4) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic neuroendocrine neoplasms (pNENs). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Results:(1) Imaging results of VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, there were 151 patients associated with pancreatic lesions and 10 patients not associated with pancreatic lesions. Of the 151 patients with VHL syndrome associated with pancreatic lesions, there were 136 patient with pancreatic cystic lesions and 34 patients with pNENs, 22 patients with both pNENs and pancreatic cystic lesions, and the type of pancreatic lesions could not be accurately determined in 3 cases. (2) Clinical characteristics of VHL syndrome associated with pancreatic lesions. The age of onset in 151 patients with VHL syndrome associated with pancreatic lesions was 33.0(range, 14.0-68.0)years. Cases with gene site mutation of exon 1, exon 2, exon 3 and other types of gene site was 51, 16, 43 and 41, respectively. There were 116 patients of VHL type 1 and 35 patients of VHL type 2. There were 92 patients with family history of VHL syndrome and 59 patients without family history of VHL syndrome. There were 127 patients combined with renal cell carcinoma, 112 patients combined with central nervous system lesions, 46 patients combined with retinal hemangioblastoma. Patients may combined with multiple lesions. (3) Comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions. The age of onset, VHL syndrome type (VHL1 type, VHL2 type) and cases combined with renal cell carcinoma were 32.5(range, 14.0-68.0)years, 110, 26 and 115 in 136 patients with VHL syndrome associated with pancreatic cystic lesions, versus 22.0(range, 8.0-64.0)years, 13, 12 and 14 in 25 patients with VHL syndrome not associated with pancreatic cystic lesions, showing significant differences in the above indicators between them ( Z=-3.384, χ2=9.770, 10.815, P<0.05). (4) Comparison of clinicopathological factors in patients with VHL syndrome associated with pNENs. The age of onset, gene mutation sites (exon 1, exon 2, exon 3, other types of gene site) and VHL syndrome type (VHL1 type, VHL2 type) were 33.5(range, 14.0-64.0)years, 12, 5, 14, 3 and 18, 16 in 34 patients with VHL syndrome associated with pNENs, versus 27.0(range, 9.0-66.0)years, 41, 12, 32, 42 and 105, 22 in 127 patients with VHL syndrome not associated with pNENs, showing significant differences in the above indicators between them ( Z=-4.030, χ2=8.814, 13.152, P<0.05). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, 3 patients underwent surgical treatment, and the remaining patients were followed up. All 161 patients with VHL syndrome were followed up for 6 (range, 1-12)years, in which 15 patients died and 146 patients alive during the follow-up. The follow-up time of 3 patients undergoing surgical treatment was 4, 14, 9 years, respectively, and all of them were alive. Conclusions:The clinical imaging features of pancreatic lesions related to VHL syndrome are cystic lesions and pNENs, which with the characteristics of multiple lesions and benign tumors. Such patients usually do not requiring surgical treatment and have good prognosis.

Objective:To compare the clinical efficacy of two-dimensional (2D) fluoroscopic guided robot-assisted and conventional TESSYS surgery in the treatment of lumbar disc herniation, the feasibility and precautions of 2D fluoroscopic guided robot-assisted TESSYS surgery were discussed.Methods:A retrospective analysis was performed on 34 male and 36 female patients aged 44.57±6.10 years (range 27 to 60 years) who received 2D guided robot-assisted TESSYS surgery and conventional TESSYS surgery from July 2019 to April 2020. 2D guided robot assisted TESSYS surgery group (the robot group) 32 cases, conventional TESSYS surgery (the conventional group) 38 cases. The number of puncture, number of fluoroscopy, puncture-channel time, operation time, visual analogue scale (VAS) and Oswestry disability index (ODI) before and after surgery and at the last follow-up were compared between the two groups to verify the clinical efficacy, and the complications were analyzed.Results:There were no significant differences in age, gender, body mass index, surgical level, Michigan State University (MSU) grading and average follow-up time between the robot group and the conventional group (all P>0.05). All patients completed surgery. The number of puncture times was 1.22±0.79 in the robot group and 4.66±1.86 in the conventional group, and the difference was statistically significant ( t=10.320, P<0.001). The number of fluoroscopy in the robot group was 10.97±1.96 times, and that in the conventional group was 17.45±4.30 times, the difference was statistically significant ( t=8.313, P<0.001). The puncture-channel time of the robot group was 10.66±3.62 min and that of the conventional group was 20.21±5.47 min, and the difference was statistically significant ( t=8.446, P<0.001). The operation time of the robot group was 62.25±6.68 min, and that of the conventional group was 72.89±10.48 min, the difference was statistically significant ( t=4.956, P<0.001). VAS scores of the robot group were 6.91±0.93 points before surgery, 2.97±0.65 points 1 d after surgery, and 1.53±0.51 points at the last follow-up, while those of the conventional group were 7.29±1.14 points before surgery, 2.89±0.56 points 1 d after surgery, and 1.42±0.50 points at the last follow-up. The ODI index of the robot group was 40.13%±1.54% before surgery, 17.28%±1.69% 1 day after surgery, and 10.84%±1.25% at the last follow-up, while that of the conventional group was 40.03%±1.46% before surgery, 17.42%±2.45% 1 day after surgery, and 10.92%±1.17% at the last follow-up. There were no statistically significant differences (all P>0.05). Two patients (6.3%) in the robot group and four (10.5%) in the conventional group had residual disc, there was no significant difference ( P>0.05). Conclusion:2D guided robot assisted TESSYS surgical treatment of lumbar disc herniation, which can plan puncture path in the stage of percutaneous target puncture, rigid guidance and accurate puncture target, and has obvious advantages in reducing puncture times and fluoroscopy times.

Objective:To investigate the clinicopathological characteristics and treatment strategies of undifferentiated carcinoma with osteoclast-like giant cells of pancreas (UCOGCP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients with UCOGCP who were admitted to Peking University First Hospital from January 2004 to January 2019 were collected. There were 1 male and 4 females, aged from 33 to 71 years, with a median age of 56 years. Patients underwent preoperative laboratory test, imaging and histopatho-logical examinations. Patients with pancreatic head tumors underwent pancreaticoduodenectomy, and those with tumors in the body or tail of pancreas underwent distal pancreatectomy combined with splenectomy. All patients underwent standard lymph node dissection. Postoperative adjuvant therapy was individually decided by a multidisciplinary team. Observation indicators: (1) preopera-tive examination and treatment; (2) postoperative histopathological situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence of patients up to January 2020. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers. Results:(1) Preoperative examination and treatment: of the 5 UCOGCP patients, CA19-9 was elevated as 65.43 U/mL in only 1 patient preoperatively, while the CA19-9 was normal in other 4 patients. Four patients showed a solid cystic mass on preoperative contrast-enhanced computed tomography (CT) scan, and 1 patient showed a delayed peripheral enhancement of the solid tumor with central necrosis. The magnetic resonance imaging (MRI) scan showed hypointense signals on T1, T2 and weighted diffusion sequences in all 5 patients. Three of the 5 patients were resectable according to imaging data, 1 patient had locally advanced tumor, infiltrating the transverse colon, stomach, and partial small intestine, with the portal vein thrombus, and 1 patient had pancreatic head tumor with a liver metastatic lesion of 0.4 cm diameter which was detected on position emission tomography CT and was diagnosed as UCOGCP by endoscopic ultrasound-guided fine-needle aspiration biopsy. All patients underwent radical resection. Of the 3 patients with resectable tumors, 2 patients underwent pancreaticoduo-denectomy and 1 patient underwent distal pancreatectomy combined with splenectomy. One patient with locally advanced tumor in the body and tail of pancreas underwent distal pancreatectomy + transverse colostomy + partial gastrectomy + portal vein thrombectomy, and 1 patient with pancreatic head tumor and liver metastasis underwent pancreatoduodenectomy combined with left lateral hepatectomy. Of the 5 patients, 2 received postoperative adjuvant chemotherapy with single-agent gemcitabine, 1 received albumin-paclitaxel+gemcitabine combination chemotherapy, 1 received S1 as single agent chemotherapy, and 1 did not receive adjuvant chemotherapy. (2) Postoperative histopathological situations: of the 5 patients, 4 cases showed a cystic solid appearance of gross specimens, and 1 case had a solid appearance with central hemorrhagic necrosis. The tumor diameter was 5.2 cm(range, 2.0?14.0 cm). All the 5 patients achieved negative margins. Of the 5 patients, there was 1 case with portal vein invasion, 2 cases with vascular invasion, 3 cases with perineural invasion, and 2 cases with regional lymph node metastasis. One patient may had multiple tumor invasion and metastasis. Four of 5 patients had paraffin specimens available for immuno-histochemical staining. Four patients were positive for both CD68 and vimentin stains, while 3 patients were positive for programmed death ligand-1 (PD-L1), including 2 samples with 5% positive cells and 1 sample with 25% positive cells. Postoperative pathological examination showed a large number of spindle histiocytoid sarcoma cells scattered with osteoclast like giant cells and pleomorphic carcinoma giant cells. The tumor mutation burden in the 4 patients was 3.23 Muts/Mb(range, 2.61?21.77 Muts/Mb). Microsatellite status was stable in 4 patients. The next generation sequencing of 4 patients showed that all patients had KRAS mutation which was the most frequently mutation in pancreatic ductal adenocarcinoma. Of the 4 patients, 1 case had germline pathogenic mutation in TP53, 1case had somatic mutation in TP53, 1 case had somatic mutation in TP53, BLM, CDKN2A, and 1 case had somatic mutation in ARID1A. (3) Follow-up: 5 patients were followed up for 14?173 months, with a median follow-up time of 46 months. During the follow-up, 4 patients achieved disease-free survival and 1 patient had local recurrence at postoperative 11 months.Conclusions:UCOGCP is a rare variant of pancreatic tumor that exhibits a cystic solid mass in imaging examinations. High expression of PD-L1 is common in UCOGCP. The prognosis for UCOGCP is favorable following radical surgery. Patients may benefit from extended radical surgery even if the tumor has locally progression or distant metastasis.

Objective    To investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve. Methods    The clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed. Results    There was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients. Conclusion    Our findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.

Objective    To discuss the diagnosis and treatment of culture-negative aortic infective endocarditis. Methods    The clinical data of 73 patients with infective endocarditis of the aortic valve whose results of bacteria culture were negative from January 2013 to January 2018 were retrospectively analyzed, including 59 males and 14 females aged 14-71 (39.2±14.8) years. Results    Sixty seven (91.8%) patients received aortic valve replacement, 2 (2.7%) patients received the second operation in hospital, and 12 (16.4%) patients had concomitant mitral valvuloplasty. In-hospital death occurred in 8 (11.0%) patients. Postoperatively, 11 (20.7%) patients had a low cardiac output and 4 (11.0%) patients had heart block, and 1 patient required implantation of a permanent pacemaker. The 1- and 5- year survival rates were 92.3%±2.3% and 84.5%±4.5%, respectively. Conclusion    There are difficulties in the diagnosis and treatment of culture-negative infective endocarditis. Most of the affected patients are in a healed status, which could be a cause of negative culture results. In-hospital mortality in the patients is associated with a history of previous cardiac surgery, whereas the long-term survival rate is good for the patients after surgery.

OBJECTIVETo investigate changes over time in the shape and signal intensity of high intensity zone (HIZ) in the lumbar intervertebral discs on magnetic resonance images in patients with low back pain.

METHODSThe imaging data were collected from 27 patients with low back pain, who underwent lumbar magnetic resonance (MR) imaging examinations that identified HIZ lesions and received follow-up MR examinations at least 1.5 years later over the period from January 2009 to January 2017. The initial and follow-up MR T2WI images of the patients were read by two experienced radiologists to categorize the changes in the shape of the HIZ lesions into enlarged, unchanged, shrunk, and disappeared. The volume and signal/cerebrospinal fluid signal intensity (T2/CSF) ratio of the HIZ were measured on sagittal MR images using ImageJ software.

RESULTSOf the 43 HIZ lesions found in the initial examinations, 22 (51.2%) remained unchanged in the follow-up examinations, 10 (21.3%) were enlarged, 9 (20.9%) shrank, and 2 (23.3%) disappeared. The follow-up examinations revealed 4 new HIZ lesions in the intervertebral discs. The volumes of these lesions did not vary significantly in the follow-up examinations (=0.653), but the T2/CSF ratio was significantly higher in the follow-up than in the initial examinations (=0.043).

CONCLUSIONSAfter observation for an average of 3 years and 3 months, most of the HIZ lesions in the lumbar intervertebral discs of the patients with low back pain remained stable in shape, but their signal intensity on MR images increased.

PurposeConventional gastric CT provides poor contrast for gastric cancer lesions, the purpose of this study is to investigate the application value of dual energy CT image fusion technology in the improvement of lesion contrast in gastric cancer.Materials and Methods Abdominal dual energy contrast-enhanced CT images of 30 gastric cancer patients were retrospectively analyzed, dual-energy images were reconstructed with different linear and nonlinear fusion settings, contrast between lesions and normal gastric wall, lesion contrast to noise ratio (CNR) were compared among 100 kVp, 140 kVp and different fusion groups, and image quality was evaluated subjectively.Results There were statistically significant differences among the gastric cancer contrast and CNR of 100 kVp, 140 kVp and three linear blending images (F=29.6 and 26.1,P<0.001), with M=0.7 linear fusion group showing the highest CNR. The gastric cancer contrast and CNR was signiifcantly higher with a bandwidth (BW) of 0 HU when compared among the three groups of nonlinear blending images (F=268.5 and 49.5,P<0.001). Moreover, the nonlinear group with a width of 0 HU had a 36% and 47% increase in lesion contrast and CNR over that of a linear blending image. In the subjective evaluation of images, the BW=0 HU nonlinear fusion image was most frequently estimated as the most preferred images for lesion observation of gastric cancer.Conclusion Nonlinear blending with a BW of 0 HU improves display of gastric cancer, and has the potential clinical value to increase the accuracy of staging.

Objective To investigate the differences of protein and mRNA expression of matrix metalloproteinase 9 (MMP-9) in osteoclasts (OC) and osteoclast-like cells (OLC) obtained by mechanical and inducement methods. Methods Mechanical separation method was used to separate mature osteoclasts from long bones of SD rats aged one-day;and inducement culture method was applied to induce OLC by using RANKL (100 ng/mL) and M-CSF (100 ng/mL) . The protein expression of MMP-9 was measured by immunocytochemistry and mRNA expression of MMP-9 was assayed by in situ hybridization. Results The integral optical density (IOD) and average optical density (AOD) of positive cells in the visual field were higher in the 12-d group of inducement method as compared with the 3 d-group of mechanical method. Conclusions It is suggested that the protein and mRNA expression of MMP-9 in OLC obtained by 12 d inducement method is much high than in OC obtained by 3 d mechanical method. OLC obtained by inducement method can be applied in the study of osteoporosis.