Spontaneous remission of autoimmune pancreatitis: Four case reports

BACKGROUND Autoimmune pancreatitis(AIP)is a particular type of chronic pancreatitis,and steroid treatment of AIP is effective.Spontaneous remission(SR)of AIP without steroids is relatively rare.The international consensus for the treatment of autoimmune pancreatitis suggests that patients with AIP with obstructive jaundice,abdominal pain,and back pain related to the pancreas or the bile duct should be treated with steroids;most asymptomatic patients with AIP may improve without steroids.However,in our clinical work,we found that the clinical characteristics of AIP patients with SR vary.Four of these cases are described here.In addition,to our knowledge,there is no previously published report of dynamic imaging before and after SR of AIP at present.CASE SUMMARY We present the cases of four patients with AIP(two females and two males)in which the AIP improved spontaneously without steroid treatment.Two patients were asymptomatic,one patient had abdominal pain with obstructive jaundice,and one patient had intermittent right upper abdominal pain.Three patients presented with localized pancreatic enlargement and one with diffuse pancreatic enlargement.In addition to the pancreatic lesions,bile duct involvement was seen in two patients,and no extra-pancreatic organ involvement was found in the other two patients.The serum IgG4 level of all patients was more than twice the normal level.After SR in the four patients,the affected pancreases exhibited three types of image features:Return to normal,progressive fibrosis,and atrophy and calcification.CONCLUSION The clinical features of SR in our four patients with AIP differ,but the imaging findings share some characteristics.After SR,in some cases the affected pancreas could return to normal,although some patients suffer from progressive fibrosis and atrophy as well as calcification.

针刺对轻度至中度阻塞性睡眠呼吸暂停综合征患者的疗效:一项随机对照临床试验方案

Introduction:Obstructive sleep apnea syndrome(OSAS) is considered a major public health issue due to its high prevalence and severe consequences.Several published studies have revealed that electroacupuncture may relieve OSAS symptoms.However,the mechanism of electro-acupuncture in the treatment of patients with OSAS remains unclear.Methods and analysis:We evaluated the efficacy and mechanism of electro-acupuncture in the treatment of patients with OSAS.This was a two-group parallel randomized controlled trial.Sixty patients with OSAS will be randomly divided into an electro-acupuncture or shallow acupuncture group in a proportion of 1:1,and the patients will be administered 36 sessions of electro/shallow acupuncture treatment(three times a week for 12 weeks,20 min for each session).The Epworth Sleepiness Scale(ESS) will be used as the primary outcome.Secondary outcomes will include polysomnography(PSG),sleep quality,emotional state,and cognitive function.In addition,patients will receive neuroimaging scanning before and after the entire acupuncture treatment to evaluate neuroplasticity changes,including gray matter density,white matter integrity,and functional connections.Expected outcomes:We believe that the use of electro-acupuncture will be more effective in patients with mild to moderate OSAS and that the cognitive and emotional status of patients will improve after acupuncture treatment.In addition,we aim to clarify which brain areas can be altered by acupuncture in patients with OSAS.Discussion:This randomized clinical trial aims to explore the curative effect and central mechanism of acupuncture treatment for OSAS.We will explore gray matter density,white matter integrity,and functional connections of the brain using fMRI technology.The results of this study will be significant to the guidelines for clinical OSAS treatment.