Background and Purpose:Accurate differentiation of pancreatic ductal adenocarcinoma(PDAC)from mass-forming chronic pancreatitis(MFCP)is clinically significant.The application of dual-layer spectral detector CT(DLCT)in pancreas has been explored.This study aimed to investigate the value of DLCT in distinguishing resectable PDAC from MFCP.Methods:We retrospectively collected data of 33 patients with resectable PDAC and 19 patients with MFCP admitted to Fudan University Shanghai Cancer Center from September 1,2021 to May 31,2023.Prior to surgery,patients underwent enhanced DLCT scans,including arterial phase(AP),parenchymal phase(PP)and venous phase(VP).DLCT quantitative parameters,including attenuation enhancement fraction(AEF),lesion-to-parenchyma ratio(LPR)and iodine enhancement fraction(IEF)were calculated.Difference analysis was conducted using independent sample t-test or chi-square test.Univariate and multivariate analyses were performed using binary logistic regression.Receiver operating characteristic(ROC)curves were used for performance evaluation.P＜0.05 was considered statistically significant.Results:Statistically significant differences were observed between PDAC and MFCP in AEF_AP/PP,LPR40_VP,IEF_PP/VP,carbohydrate antigen 19-9(CA19-9)and double-duct sign(all P＜0.05).The spectral combined model composed of LPR40_VP and IEF_PP/VP exhibited the best discriminatory efficacy,surpassing CA19-9,double-duct sign and AEF_AP/PP(all P＜0.05).The combined model demonstrated an area under curve(AUC)of 0.841,sensitivity of 90%,specificity of 73%,and accuracy of 79%.Conclusion:DLCT has certain potential in differentiating resectable PDAC from MFCP.Spectral quantitative parameters can complement CA19-9 and outcome shortcomings of conventional CT in distinguishing resectable PDAC from MFCP.

Objective To observe the effects of electroacupuncture on the learning and memory abilities of Alzheimer disease(AD)rats;To explore its potential mechanism based on proteomics.Methods Totally 36 SD male rats were randomly divided into sham-operation group,model group and heart meridian acupoints group,with 12 rats in each group.Aβ1-42 were injected into the bilateral hippocampus to establish AD rat model,the sham-operation group was injected with an equal volume of normal saline.The heart meridian acupoints group received electroacupuncture treatment,accompanied by a stimulation time of 20 minutes,rest for 1 day after 6 days of electroacupuncture for 7 consecutive weeks.The Morris water maze experiment was used to evaluate the learning and memory abilities of AD rats,tandem mass tag(TMT)labeling technology and bioinformatics analysis were used to screen core differentially expressed proteins in important typical pathways,and key differentially expressed protein was verified by parallel reaction monitoring(PRM).Results There was no statistically significant difference in swimming speed between each group of rats(P>0.05).Compared with the sham-operation group,the escape latency of Morris water maze experiment in the model group increased significantly(P<0.01);compared with the model group,the escape latency of heart meridian acupoints group was significantly shortened on the 2-4th day(P<0.01).A total of 209 differentially expressed proteins were identified in different groups using TMT labeling quantification,among which 12 proteins showed significant changes among the 3 groups.GO annotation involved biological processes such as metal ion transport,sodium ion transport,and sodium ion transmembrane transport,as well as cellular components such as synapses,presynapse,and synaptic vesicle,involving solute:sodium symporter activity,organic acid:sodium symporter activity,amino acid:cation symporter activity,amino acid:sodium symporter activity,and other molecular functions;KEGG analysis significantly enriched the synaptic vesicle pathway.The PRM validation results indicated that electroacupuncture at the heart meridian acupoints could reduce the expressions of sodium and chloride dependent GABA transporter protein 3(GAT3),which was consistent with the quantitative detection results of TMT labeling quantification.Conclusion Electroacupuncture at the heart meridian acupoints can improve the learning and memory abilities of AD rats,possibly by regulating the expression of synaptic transporter GAT3 on the synaptic vesicle pathway to exert neuroprotective effects.

Objective:To investigate the value of CT-radiomics based machine learning model in predicting the abundance of tumor infiltrating CD8 +T cells and the prognosis of pancreatic cancer patients. Methods:A total of 150 pancreatic cancer patients who underwent surgical excision and confirmed by pathology from Fudan University Shanghai Cancer Center between December 2011 and January 2017 were retrospectively enrolled. The patients were randomly divided into the training set ( n=105) and the validation set ( n=45) in a 7∶3 ratio with simple random sampling. The immunohistochemical method was used to assess the abundance of tumor infiltrating CD8 +T cells, and the patients were then divided into high infiltrating group ( n=75) and low infiltrating group ( n=75) according to the median. The prognosis between the 2 groups was evaluated using Kaplan-Meier method and log-rank test. Radiomic features were extracted from preoperative venous-phase enhanced CT images in the training set. The Wilcoxon test, the max-relevance and min-redundancy algorithm were used to select the optimal feature set. Three supervised machine learning models (decision tree, random forest and extra tree) were established based on the optimal feature set to predict the abundance of tumor infiltrating CD8 +T cells. Performance of above-mentioned models to predict the abundance of tumor infiltrating CD8 +T cells in pancreatic cancer was tested in the validation set. The evaluation parameters included area under the receiver operating characteristic curve (AUC), F1-score, accuracy, precision and recall. Results:The median overall survival time of patients in high infiltrating group and low infiltrating group were 875 days and 529 days, respectively (χ2=11.53, P<0.001). The optimal feature set consisted of 10 radiomic features in training set. In the validation set, the decision tree, random forest and extra tree model showed the AUC of 0.620, 0.704 and 0.745, respectively; corresponding to a F1-score of 0.457, 0.667 and 0.744, the accuracy of 57.8%, 68.9% and 75.6%, the precision of 66.7%, 73.7% and 80.0%, the recall of 34.8%, 60.9% and 69.6%. Conclusions:Pancreatic cancer patients with high tumor infiltrating CD8 +T cells have better prognosis than those with low tumor infiltrating CD8 +T cells. The radiomics-based extra tree model is valuable in predicting the CD8 +T cells infiltrating level in pancreatic cancer.

OBJECTIVE: To explore the protective effect of electroacupuncture against acute lung injury (ALI) in septic rats and explore the mechanism. METHODS: Sixty male SD rats were randomly divided into cecal ligation and puncture (CLP)-induced sepsis group ( RESULTS: Compared with those in the sham operation group, the rats in ALI group showed obvious lung pathologies with significantly increased lung W/D ratio ( CONCLUSIONS Electroacupuncture can inhibit the release of inflammatory mediators and cell apoptosis via the JAK1/STAT3 pathway to reduce lung injuries in septic rats.
Acute Lung Injury/therapy* ; Animals ; Electroacupuncture ; Lung ; Male ; Rats ; Rats, Sprague-Dawley ; Sepsis/therapy* ; Tumor Necrosis Factor-alpha

Objective Investigate the effect of gestational diabetes mellitus (GDM)on the neonatal metabolism and prognosis.Methods A total of 265 singleton pregnancy GDM patients were collected as the observation group,while 260 cases of healthy singleton pregnant women were chosen as the control group.Detected the levels of adiponectin,insulin,C-peptide,glycated hemoglobin and blood glucose,compared the prognosis of two groups.Results Compared with the control group,adiponcetin and blood glucose in 2 hours after birth in observation group were lower,insulin,C-peptide and glycated hemoglobin were higher,the number of cesarean section was more,the difference was statically significant (P＜0.05).The incidence of low birth weight infant,macrosomia,neonatal asphyxia,neonatal hypoglycemia,neonatal hyperbilirubinemia,neonatal pneumonia,fetal death and newborn teratogenesis in the observation group was higher than that in the control group,the difference was statically significant (P＜0.05).Conclusion GDM could cause metabolic disorder and affect fetal growth and development,leading to poor prognosis.

Objective To study the efficacy of percutaneous transhepatic cholangiodrainage (PTCD),percutaneous gallbladder drainage,and percutaneous transhepatic biliary stent implantation for the treatment of malignant obstructive jaundice in patients who are observed to fail endoscopic drainage. Methods We retrospectively analyzed 17 patients diagnosed with obstructive jaundice between August 2015 and July 2017 who were observed to have failed endoscopic drainage. Percutaneous puncture drainage had been performed in all patients-different methods were chosen based on the type of lesion and the patient's intraoperative condition. Among these patients, 9 underwent percutaneous transhepatic biliary stent implantation (53％),5 underwent PTCD (29％),and 3 underwent percutaneous gallbladder drainage (18％). The serum levels of total bilirubin (TBIL) and alanine aminotransferase (ALT) were assessed a day preoperatively and a week postoperatively. The postoperative decrease (or drop) in the serum TBIL and ALT levels was used as a parameter to assess the efficacy of treatment. Patients were divided into a stent and a tube group. The therapeutic effects were compared between the groups in terms of the drop in the serum TBIL and ALT levels and the survival time of patients. Results The postoperative serum TBIL and ALT levels were significantly decreased in all patients (P < 0. 05). No statistically significant difference was observed between the stent and the tube group in terms of the decrease in serum TBIL and ALT levels (P > 0. 05). However,a statistically significant difference was observed between the stent and the tube group in terms of the survival time of patients (P < 0. 05). Conclusion Percutaneous puncture is an effective treatment modality to manage malignant obstructive jaundice in patients who fail endoscopic drainage. Compared to tube drainage,stent placement can prolong patient survival time. Regarding the decrease in serum TBIL and ALT levels,we conclude that stent implantation is not significantly better than tube drainage.

Objective To investigate the clinical value of percutaneous gallbladder drainage in the treatment of severe acute pancreatitis(SAP). Methods A total of 65 patients treated for SAP in our hospital between January 2014 and April 2017 were analyzed retrospectively. The patients were divided into a gallbladder puncture group and a control group. Follow-up was performed for at least 6 months to monitor mortality and the incidence of complications, including pancreatic abscess, pseudocyst, renal failure, respiratory failure, heart failure, gastrointestinal bleeding, sepsis, and disseminated intravascular coagulation (DIC), The differences in mortality and complication rates between the two groups were statistically analyzed. Results Mortality in the gallbladder puncture group was significantly lower than in the control group (P ＜ 0. 05); the incidence of renal failure, respiratory failure, heart failure, gastrointestinal bleeding, and sepsis in the gallbladder puncture group was lower than in the control group (P ＜ 0. 05); the incidence of pancreatic abscess and pseudocyst in the gallbladder puncture group was similar to that in the control group, showing no significant difference (P ＞ 0. 05); the incidence of DIC in the gallbladder puncture group was lower than in the control group, but the difference was not statistically significant (P ＞ 0. 05). Conclusion Percutaneous gallbladder drainage can effectively reduce the incidence of renal failure, respiratory failure, heart failure, gastrointestinal bleeding, and sepsis in SAP, thereby reducing mortality. However, the incidence of DIC, pancreatic abscess, and pseudocyst is not reduced.

Objective To investigate the correlation between human papilloma virus(HPV) 16/18 infection and the expression of Rb and p16 protein in bladder cancer tissue,and to analyze the relationship between HPV infection and the incidence of bladder cancer.Methods The expression of HPV16/18 E6 and E7 gene encoded protein,RB and p16 were detected by immunohistochemical method in 40 cases of bladder cancer and 40 cases of normal bladder tissues,and the correlation between them and pathological grading,stage of international union of cancer(UICC),whether recurrence or not after receiving surgery was analyzed.Results In bladder cancer tissues,HPV16/18 E6 and E7 gene encoded protein,RB and p16 positive rates were 65%,47.5%,42.5%,compared with the positive rate of normal bladder tissue samples(22.5%,92.5%,87.5%),the differences were statistically significant(P<0.05).The expression of HPV16/18 E6 and E7 gene encoded protein,Rb and p16 proteins were associated with pathological grading and staging of bladder cancer(P<0.05),but were not related to the tumor recurrence(P>0.05).The expression of HPV16/18 E6 and E7 gene encoded protein and Rb,p16 protein were not significantly correlated(P>0.05),The expression of Rb and p16 protein were negatively correlated(P<0.05).Conclusion HPV 16/18 infection is related to the occurrence and development of bladder cancer,but its mechanism might not be related to the abnormal expression of Rb and p16 protein.

Objective To explore the clinical curative effect of recombinant human endostatin injection combined with chemotherapy in the treatment of patients with advanced gastric cancer and malignant ascites,and its influence on the quality of life.Methods 62 patients with advanced gastric cancer from July 2012 to July 2015,were randomly divided into observation group (31 cases)and control group (31 cases).The control group was treated with FOLFOX6 chemotherapy,the observation group was given recombinant human endostatin injection on the basis of the treatment of the control group.The two groups were treated for 3 weeks.The curative effect,QOL score,Karnofsky score,the change of serum CEA and CA19 -9 levels and drug adverse reaction incidence before and after treatment were compared in the two groups.Results The RR of the observation group was higher than that of the control group (54.84 vs 29.03%,χ2 =4.239 3,P <0.05).The QOL score and Karnofsky score in the two groups were increased after treatment (P <0.05).The QOL score and Karnofsky score after treatment in the observation group were higher than the control group(t =6.512 7,5.669 0,all P <0.05).The serum CEA and CA19 -9 levels of the two groups decreased significantly after treatment (P <0.05).The serum CEA and CA19 -9 levels of the observation group were lower than the control group after treatment (t =5.276 0,6.310 8,all P <0.05).The leukopenia,thrombocytopenia, peripheral neurotoxicity,decreased hemoglobin,diarrhea,nausea and vomiting adverse reaction rate of the two groups had no significant differences (P >0.05).Conclusion The clinical efficacy of recombinant human endostatin injec-tion combined with malignant ascites in the treatment of patients with advanced gastric carcinoma is significant,and can significantly improve the quality of life of patients,has the important research value.

Objective To detect the expression of DBC2 and the methylation status of its gene promoter region in gastric cancer,so as to analyze their correlation. Methods Gastric cancer tissues and adjacent normal tissues were collected from 92 cases as research subjects. The DBC2 mRNA expression and the methylation status of DBC2 gene promoter region in gastric cancer were detected by using RT?PCR and MS?PCR respectively. In addition,the correlation of DBC2 gene methylation status with clinicopathological parameters was analyzed. Results In comparison with adjacent normal tissues,gastric cancer tissues displayed a low expression level of DBC2mRNA and a high methylation level of gene promoter region. Besides, the methylation level was significantly correlated with tumor invasion depth,differentiation and TNM staging(P<0.05). With deep invasion,poor differentiation or higher TNM staging,methylation level of gene promoter region was more significant in gastric cancer tissues. Conclusion High methylation of DBC2 gene promoter region may be a significant contributing factor leading to low DBC2 expression.