Objective:To investigate the clinical manifestations ,diagnosis and treatment of autoimmune pancreatitis (AIP).Methods:The clinical data of 17 AIP patients admitted at the First Affiliated Hospital of Soochow University from Apr 2021 to Jan 2023 were retrospectively analyzed.Results:Among the 17 AIP patients, 12 were male (70.6%). Ten complained abdominal pain (58.8%), and 8 had jaundice (47.1%). Fifteen patients had elevated IgG4 levels more than twice the normal value (88.2%), and 14 patients had elevated liver enzymes (82.3%). The imaging manifestations of 17 patients were all diffuse or limited enlargement of the pancreas. All patients had diffuse or limited enlargement of the pancreas, some were accompanied by a dilatation of the pancreatic duct or bile duct. Fourteen patients were diagnosed by combining the clinical manifestations, imaging examination, laboratory examination, and puncture pathology, and in 3 cases the diagnosis was confirmed by postoperative pathology. Fourteen patients showed significant improvement in clinical symptoms and imaging manifestations after hormone therapy, 2 patients stopped hormone medication on their own after the improvement of the imaging, and 1 suffered recurrence,which was responsible to hormone readministration.Conclusions:AIP, as a rare and easily misdiagnosed immune disease, involves the pancreas leading to an inflammatory response and often encroaches peri-pancreatic areas such as the bile ducts, causing biliary stenosis and jaundice. Most patients respond well to glucocorticoid therapy and surgery was usually not indicated in those with definite AIP diagnosis.

Objective: To evaluate the clinical characteristics and outcomes of very high risk patients with primary immunoglobulin light-chain amyloidosis (pAL) at a single center in China. Method: Clinical data, treatment and outcome of 205 pAL patients in Peking Union Medical College Hospital from January 2009 to February 2016 were retrospectively analyzed. A 'very high risk’ group includes patients with Mayo 2004 stage Ⅲb and Mayo 2012 stage 4. Results: Of 205 patients, 34 (16.6%) were defined as very high risk pAL patients. The median age at diagnosis was 57 (20-84) years, and 22 patients (64.7%) were male. All 34 patients were diagnosed with cardiac involvement, multi-organ involvement was observed in 15 patients (44.1%) , and 27 (81.8%) had New York Heart Association Class Ⅲ or Ⅳ. Median values of serum cTnI, NT-proBNP, and free light chains difference were 0.25 μg/L, 11 733 ng/L, and 403 mg/L, respectively. Eight (24.2%) had more than 10% plasma cell on the bone marrow aspirate. Sixteen (47.1%) patients received bortezomib based chemotherapy and overall hematologic response rate was 58.3%. Median overall survival (OS) was 4 months. The estimated OS at 3, 6, 12, and 24 months was 51.3%, 44.0%, 35.2%, and 29.6%, respectively. Fourteen (41.2%) patients died within 3 months after the diagnosis. The estimated 1-year survival rate for the patients who got hematologic response, without hematologic response, and palliative treatment was 90.9%, 11.1%, and 0, respectively (P<0.001) . Conclusion Patients with very high risk pAL had very poor prognosis and the early death rate remained high. Those patients who obtained hematologic remission would have significantly better outcomes.

Objective To explore the risk factors for lung cancer-related cerebral infarction . Methods The hospitalized active lung cancer patients on anti-cancer therapy with no traditional stroke risk factors, who experienced an acute cerebral infarct in the First Affiliated Hospital of Guangxi Medical University from January 2005 to December 2015, were consecutively collected as the LCRS ( lung cancer-related stroke) group.The active lung cancer patients without cerebral infarction hospitalized at the same peroid matched with the LCRS group for age and gender were collected as the LC ( lung cancer ) group. Clinical data from the two groups were analyzed .Results A total of 139 LCRS patients and 139 LC patients were enrolled in the study , with 110 male and 29 female in each group , and there were no significant difference for the mean age between the LCRS group (52.1 ±10.4 years old ) and the LC group (52.1 ± 10.1 years old).Two or more acute ischemic lesions of the brain were showed by MRI in most patients in the LCRS group (117 cases, 84.2%).Compared with the LC group, more patients in the LCRS group were found with adenocarcinoma , metastasis, elevated plasma D-dimer, CA125 and CA199 levels [ 88 cases (63.3%) vs 47 cases (33.8%);98 cases (70.5%) vs 56 cases (40.3%);(468.38 ±291.37) μg/L vs (277.59 ±191.22) μg/L;(221.42 ±146.34) U/ml vs (106.84 ±69.97) U/ml;(254.68 ±185.84) U/ml vs (97.15 ±63.64) U/ml;with all P<0.001].By logistic regression analysis of multiple factors , the elevated plasma D-dimer, CA125 and CA199 levels were showed to be independent risk factors for the cerebral infarction (OR=1.003, 95%CI 1.001 -1.004; OR=1.006, 95%CI 1.003 -1.010; OR=1.011, 95%CI 1.007-1.015).Conclusions The elevated plasma D-dimer, CA125 and CA199 levels are the risk factors for the lung cancer related cerebral infarction , which may lead to hypercoagulation and induce cerebral infarction eventually .

Objective To explore the efficacy,safety and short-term effects of endovascular therapy in the treatment of the symptomatic high-grade basilar artery stenosis.Methods Two hundred thirteen patients with the symptomatic high-grade basilar artery stenosis (＞90％) confirmed by MRA,CTA or DSA was treated by endovascular intervention,the changes of clinical symptoms,the success rate and short-term follow-up results was analyzed.Results Endovascular stent was successfully placed in 209 patients with symptomatic high-grade basilar artery stenosis and the success rate was 98.12％.The degree of vascular stenosis was significantly reduced after stenosis (Before vs After:93.70％±2.51％ vs 11.60％±3.90％).Eight patients had complications (3.76％) including 7 cases of ischemic stroke and 1 case of subarachnoid hemorrhage.The average follow-up duration was 18.70±3.80 months.Two hundred two patients underwent a second DSA and the mean vascular stenosis was (13.80％±4.20％).Five patients developed in-stent restenosis (ISR),of which one was symptomatic.Conclusion Endovascular therapy of the symptomatic high-grade basilar artery stenosis is safety and efficacy.The 1.5 years follow-up results reveal good patency rate and excellent prevention of posterior circulation ischemia.

Objective To explore the efficacy and safety of endovascular therapy in the treatment of symptomatic M1 stenosis of middle cerebral artery as well as the causes of perioperative complications.Methods Two hundred fifty-six patients with symptomatic M1 stenosis of middle cerebral artery (＞90％) confirmed by TCD,cerebral CT angiography and DSA was treated by endovascular intervention.The success rate,the changes of stenosis,longterm vascular patency rate,in-stent restenosis rate were analyzed.Results endovascular stent was successfully placed in 251 patients with the M1 part of symptomatic middle cerebral artery stenosis and the successful rate was 98.05％.Fifteen patients had complications (5.86％) which caused neurology deficits and deaths.The degree of vascular stenosis was significantly reduced after stenosis (Before vs After:92.26％±2.11％ vs 15.40％±2.60％).The mean mRS and NIHSS scores was decreased significantly.The average follow-up duration was (21.70±0.80) months,249 patients underwent a second DSA and the mean stenosis was (21.70％±0.80％).Twenty-three patients developed instent restenosis (ISR) and ISR rate was 9.24％.Recurrence ischemic stroke and transient ischemic attacks occurred in 5 patients and recurrence rate was 2.01％.Conclusion Endovascular therapy of symptomatic M1 stenosis of middle cerebral artery is safety and efficacy with low complications.The follow-up results reveal good patency rate and excellent prevention of anterior circulation ischemia.

It remains a great challenge to achieve sufficient cancer classification accuracy with theentire set of genes, due to the high dimensions, small sample size, and big noise of gene expressiondata. We thus proposed a hybrid gene selection method, Information Gain-Support Vector Machine(IG-SVM) in this study. IG was initially employed to filter irrelevant and redundant genes. Then,further removal of redundant genes was performed using SVM to eliminate the noise in the datasetsmore effectively. Finally, the informative genes selected by IG-SVM served as the input for theLIBSVM classifier. Compared to other related algorithms, IG-SVM showed the highest classificationaccuracy and superior performance as evaluated using five cancer gene expression datasetsbased on a few selected genes. As an example, IG-SVM achieved a classification accuracy of90.32% for colon cancer, which is difficult to be accurately classified, only based on three genesincluding CSRP1, MYL9, and GUCA2B.

OBJECTIVETo evaluate the usage of Mayo staging system in Chinese patients with primary light chain (LC) amyloidosis.

METHODClinical data, treatment and outcome of 162 primary LC amyloidosis patients with Mayo Clinic staging in Peking Union Medical College Hospital from January 2009 to June 2015 were retrospectively analyzed.

RESULTSThe median age of 162 patients with Mayo Clinic 2004 stage was 57 (20-81) y, of them 62.3% were male. The number of patients with stage I to III were 44 (27.2%), 69 (42.6%), and 49 (30.2%), respectively. The median overall survival was not reached, 23 months and 12 months in patients with Mayo Clinic 2004 stage I, II, and III, respectively (P<0.001). Among 128 patients with Mayo Clinic 2012 stage, 48 patients (37.5%), 32 patients (25.0%), 32 patients (25.0%) and 16 patients (12.5%) were staged as Mayo Clinic 2012 stage 1 to 4, and the median OS was not reached, not reached, 13 months and 3 months, respectively (P<0.001).

CONCLUSIONMayo Clinic staging systems had important prognostic value in patients with primary LC amyloidosis.

Adult ; Aged ; Aged, 80 and over ; Amyloidosis ; diagnosis ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Young Adult

Objective To investigate the diagnosis and treatment of severe MT patients,and to add a reference for similar cases.Methods From March 2014 to September 2015,the clinical data of 53 patients with severe MT in Liu'an First People's hospital were retrospectively analyzed.Results Four out of 53 cases of severe MT were missed diagnosis (missed diagnosis rate:7.5％);51 cases (96.2％) received surgical treatment;2 cases (3.8％) were treated by non operation,45 cases (84.9％) were treated successfully,and 8 cases (15.1％) died.Among the 8 patients,3 died of severe craniocerebral injury,2 cases died of MODS and sepsis,and 1 cases died of shock.Fifteen cases of primary thoracic and abdominal trauma patients with DCS after treatment were cured and discharged,among which PCT in the treatment of 2 d increased only at the beginning then gradually reduced after.CRP,IL-6 and IL-10 all showed a trend of decline.Compared with 7 d and 1 d,significant difference was shown (P＜0.01).Conclusion By clearly knowing the clinical characteristics of severe MT,accurate diagnosis should be made to avoid misdiagnosis.At the same time,we should pay more attention to the emergency treatment and the treatment of fatal injury.

OBJECTIVETo analyze the clinical characteristics and prognostic factors in patients with primary gastrointestinal non-Hodgkin lymphoma (PGI-NHL).

METHODSThe pathological data of 104 PGI-NHL patients diagnosed in our hospital between 2003 and 2013 were analyzed retrospectively.

RESULTS104 patients with PGI-NHL were enrolled, including 58 males and 46 females with a median age of 53 (range:15 to 83) years. 51(49%) cases derived from stomach and the other 53 (51%) patients originated in intestine. The median survival was 35 (range:1 to 30) months. The 1- year, 3- year, and 5-year overall survival (OS) were 88.4%, 80.7% and 78.8%, respectively. Both progress free survival and OS were significantly higher in B-cell GPI-NHL than T- cell GPI-NHL (P=0.000).

CONCLUSIONThe survival of gastric NHL is superior to intestinal NHL. The sites of origin and pathological type are prognostic factors for survival in PGI-NHL patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Gastrointestinal Neoplasms ; diagnosis ; Humans ; Lymphoma, Non-Hodgkin ; diagnosis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Young Adult