Magnetic resonance imaging of pancreatitis: An update

Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as nonionizing nature and higher safety profile of intravascular contrast media,making it particularly valuable in radiosensitive populations such as pregnant patients,and patients with recurrent pancreatitis requiring multiple follow-up examinations.Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis.This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis,pancreatitis complications and other important differential diagnoses that mimic pancreatitis.

Autoimmune pancreatitis in the context of IgG4-related disease:Review of imaging findings

Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the “capsule” and “penetrating duct” signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.

Elusive liver factor that causes pancreatic α cell hyperplasia: A review of literature

Tumors and cancers of the gastrointestinal tract and pancreas are commonly derived from precursor lesions so that understanding the physiological, cellular, and molecular mechanisms underlying the pathogenesis of precursor lesions is critical for the prevention and treatment of those neoplasms. Pancreatic neuroendocrine tumors(PNETs) can also be derived from precursor lesions. Pancreatic α cell hyperplasia(ACH), a specific and overwhelming increase in the number of α cells, is a precursor lesion leading to PNET pathogenesis. One of the 3 subtypes of ACH, reactive ACH is caused by glucagon signaling disruption and invariably evolves into PNETs. In this article, the existing work on the mechanisms underlying reactive ACH pathogenesis is reviewed. It is clear that the liver secretes a humoral factor regulating α cell numbers but the identity of the liver factor remains elusive. Potential approaches to identify the liver factor are discussed.

Association of cholesterol with risk of pancreatic cancer:A meta-analysis

AIM: To evaluate the effect of dietary cholesterol and serum total cholesterol(TC) on the risk of pancreatic cancer. METHODS: A literature search was performed up to June 2014 in Pub Med, EMBASE, China National Knowledge Infrastructure and China Biology Medicalliterature database for relevant articles published in English or Chinese. Pooled relative risks(RRs) with 95% confidence intervals(CIs) were calculated with a random-effects model. RESULTS: We included 14 published articles with 439355 participants for dietary cholesterol, and 6 published articles with 1805697 participants for serum TC. For the highest vs lowest category of dietary cholesterol, the pooled RR(95%CI) of pancreatic cancer was 1.308(1.097-1.559). After excluding two studies(RR > 3.0), the pooled RR(95%CI) was 1.204(1.050-1.380). In subgroup analysis stratified by study design, the pooled RRs(95%CIs) were 1.523(1.226-1.893) for case-control studies and 1.023(0.871-1.200) for cohort studies. The association of dietary cholesterol with the risk of pancreatic cancer was significant for studies conducted in North America [1.275(1.058-1.537)] and others [2.495(1.565-3.977)], but not in Europe [1.149(0.863-1.531)]. No significant association [1.003(0.859-1.171)] was found between the risk of pancreatic cancer and serum TC. CONCLUSION: Dietary cholesterol may be associated with an increased risk of pancreatic cancer in worldwide populations, except for Europeans. The results need to be confirmed further.

Splanchnic vein thrombosis in necrotizing acute pancreatitis: Detection by computed tomographic venography

AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.

Acute mediastinitis arising from pancreatic mediastinal fistula in recurrent pancreatitis

Acute mediastinitis is a fatal disease that usually originates from esophageal perforation and surgical infection.Rare cases of descending necrotizing mediastinitis can occur following oral cavity and pharynx infection or can be a complication of pancreatitis.The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia,while rare complications include thoracic conditions,such as pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum.There have been no reports of acute mediastinitis originating from pancreatitis in South Korea.In this report,we present the case of a 50-year-old female suffering from acute mediastinitis with pleural effusion arising from recurrent pancreatitis that improved after surgical intervention.

Stent displacement in endoscopic pancreatic pseudocyst drainage and endoscopic management

A pancreatic pseudocyst(PPC)is a collection of pancreatic fluid enclosed by a non-epithelialized,fibrous or granulomatous wall.Endoscopic pancreatic pseudocyst drainage(PPD)has been widely used clinically to treat PPCs.The success and complications of endoscopic PPD are comparable with surgical interventions.Stent displacement is a rare complication after endoscopic PPD.Almost all the complications of endoscopic PPD have been managed surgically,and there is rare report involving the endoscopic treatment of intraperitoneal stent displacement.We report here a case of stent displacementafter endoscopic ultrasound-and fluoroscopy-guided PPD in a 41-year-old female patient with a PPC in the tail of the pancreas.The endoscopic treatment was successfully performed to remove the displaced stent.The clinical course of the patient was unremarkable.The cyst had significantly reduced and disappeared by 12 wk.We found that both endoscopic ultrasound and fluoroscopy should be used during endoscopic PPD to avoid stent displacement.The displaced stent can be successfully treated by endoscopic removal.

Congenital choledochal cyst with pancreatitis

Objective To understand the relationship among congenital choledochal c yst, anomalous junction of pancreaticobiliary duct (AJPBD) and pancreatitis Methods 25 children with choledochal cyst treated in our hospital were included in this study Their ages ranged from 2 months to 14 years Intraoperative cho la ngiography was performed in 24 children Pancreatic samples obtained from the h e ad and body of the pancreas at operation were observed under light and electron microscope Serum amylase was analyzed one week before and after operation resp e ctively Bile amylase in the cyst and gallbladder was measured at operation Results The incidence of AJPBD was 70%. Inflammatory cell infiltration and fibro us hyperplasia were seen in the pancreatic specimens of 5 children, of whom 4 ha d AJPBD No ultrastructural changes were found in 2 children without AJPBD, whi l e different changes were seen in 6 with AJPBD, including those showing no pathol ogical changes under light microscope All the changes became more severe as th e age of the patient increased The bile and serum amylase levels were higher in children with AJPBD than those without AJPBD ( P <005) Conclusion Congenital choledochal cyst has a close relationship with AJ PBD and pancreatitis Pancreatic pathological changes have a long and chronic c o urse from ultrastructural changes to macroscopic changes for the developing of p ancreatitis

大黄多糖的提取及其抗氧化和降血糖活性研究

目的从中药大黄中提取大黄多糖(Rhubarb polysaccharide,RPS),并研究其体外对2,2-联氮-二(3-乙基-苯并噻唑-6-磺酸)二铵盐(ABTS)与1,1-二苯基-2-苦基肼(DPPH)的自由基清除能力,以及对α-葡萄糖苷酶和胰α-淀粉酶的抑制作用,进而评估RPS在治疗抗氧化及糖尿病等方面的潜在价值。方法通过水提醇沉法提取RPS,用苯酚-硫酸比色法测定多糖含量,并通过分光光度法和酶联免疫检测法评定其抗氧化能力及降血糖活性。结果大黄中多糖的平均含量值为5.01%±1.44%、蛋白质含量约为7.17%,平均回收率为96.41%±1.08%。体外抗氧化实验显示,RPS具有很好的AB TS与DPPH自由基清除活性,且优于维生素C(Vc)。降血糖实验结果表明,当RPS浓度在0.25 mg·mL^(-1)、0.50 mg·mL^(-1)、1.00 mg·mL^(-1)时,在以4-硝基-α-D-呋喃葡萄糖苷溶液(p-Nitrophenyl-α-D-Galactopyranoside,PNPG)为底物的α-葡萄糖苷酶-抑制剂模型上,和以可溶性淀粉为底物的胰α-淀粉酶-抑制剂模型上,RPS的抑制率分别为25.6%,31.2%,38.0%和28.62%,34.50%,50.73%,且有一定的量效关系。结论RPS具有良好的抗氧化和降血糖活性,这为其在医药和食品领域的应用提供了有力支持。

S100A12’s Application Value in the Assessment of Severe Acute Pancreatitis’s Severity and the Evaluation of Curative Effect

S100A12 plays a key role in regulating the inflammation.It is mainly expressed in neutrophils.In early acute pancreatitis,neutrophils are activated and release a large number of cytokines and inflammatory medium—this is a central link of the systemic inflammatory response caused by severe acute pancreatitis.S100A12 could real-timely reflect the severity of acute pancreatitis and can be used for monitoring the development and prognosis of the disease.

Pancre

2010229 Expression and significance of phosphtidylinositol 3-kinase/protein kinase B signal transduction pathway in severe acute pancrceatitis-associated lung injury. KANG Xin(康新),et al. Dept Emerg Med,Zhongshan Hosp,Dalian Univ, Dalian 116001.Natl Med J China 2010;90(11):732-777.

ERCP在慢性胰腺炎诊治中的作用

慢性胰腺炎是一种慢性进行性疾病,可不同程度影响胰腺内、外分泌功能,严重影响病人生活质量。创伤小、安全性高、疗效较好的内镜逆行胰胆管造影(endoscopic retrograde cholangio⁃pancreatography,ERCP)介入治疗已成为慢性胰腺炎的一线治疗手段,除胰管结石、胰管狭窄外,还可用于慢性胰腺炎的并发症治疗。

扩散加权成像在胰腺癌诊断中的价值初探

目的探讨MR扩散加权成像(DWI)在胰腺癌诊断中的价值。资料与方法健康自愿者20名,经手术病理和随访证实的胰腺癌患者21例、慢性胰腺炎患者12例,分别行常规MRI和DWI检查。应用自旋回波-回波平面成像(SE-EPI)并采用采集空间敏感性编码技术(ASSET),取b=0和600s/mm2获得DWI图像。分别测量感兴趣区(ROI)的表观扩散系数(ADC)值,行配对t检验。结果健康自愿者胰腺DWI呈中等信号,胰头、胰体尾部ADC值分别为(1.535±0.247)×10-3mm2/s、(1.643±0.375)×10-3mm2/s。21例胰腺癌肿瘤区DWI呈均匀或稍不均匀高信号,ADC值为(1.192±0.117)×10-3mm2/s。健康自愿者胰头与胰体尾部ADC值差异无统计学意义(P>0.05),胰头及胰颈部肿瘤患者胰体尾部ADC值与健康自愿者间差异有统计学意义(P<0.001),胰腺肿瘤ADC值与胰头及体尾部之间差异有统计学意义(P<0.001)。慢性胰腺炎DWI呈不均匀等或稍高信号,ADC值为(1.437±0.385)×10-3mm2/s,与胰腺癌间差异有统计学意义(P<0.05)。结论DWI可以清楚显示肿瘤病灶及范围,ADC值的测定在一定程度上有助于胰腺癌的诊断。

Hippo通路中Yes相关蛋白在胰腺癌中的表达及意义

目的:检测Hippo-YAP信号通路中主要效应蛋白Yes相关蛋白(Yes-associated protein,YAP)在正常胰腺组织和胰腺癌组织中的表达,探讨其表达强度与临床病理因素之间的关系及意义.方法:应用免疫组织化学EnVision法测定Hippo信号通路中YAP蛋白在45例胰腺癌及15例正常胰腺组织中的表达,应用RT-PCR方法检测YAP mRNA在45例胰腺癌及15例正常胰腺组织中的表达.结果:胰腺癌组织中YAP蛋白主要表达于胰腺导管上皮细胞,45例胰腺癌组织中YAP的阳性表达率为93.33%(42/45),15例正常胰腺组织中YAP阳性表达率为26.67%(4/15),两组间的表达差异具有统计学意义(2=27.95,P<0.01).在胰腺癌组织中YAP的表达与肿瘤分化程度密切相关(P=0.048),与年龄、性别、吸烟、饮酒、肥胖、糖耐量异常、糖尿病、慢性胰腺炎及临床分期等无关(P值分别是0.577、0.565、0.541、0.224、1.000、0.542、0.555、0.571、0.926).胰腺癌患者血清CA19-9水平与胰腺癌组织中YAP阳性程度呈正相关.YAP m R N A在胰腺癌组织中的表达较正常胰腺组织明显升高(0.3682±0.0783 vs 0.0394±0.0091,P<0.01).结论:Hippo-YAP通路可能在胰腺癌的发生、发展中发挥重要作用.并有可能成为胰腺癌治疗中新的靶点.

1型自身免疫性胰腺炎的流行病学及临床特点

目的总结自身免疫性胰腺炎(AIP)的流行病特征、临床表现和诊断经验,提高诊治水平。方法回顾性分析了北京协和医院自1998年1月至2016年12月所有确诊为AIP的临床资料。结果共纳入194例1型AIP。该病发病的男女比例为3.51/1,平均发病年龄为(57±15)岁。最常见的症状是黄疸和腹痛等。最常见的胰腺外受累疾病是硬化性胆管炎、涎腺炎和IgG4肾病。36.68%AIP患者合并糖尿病。IgG4、ANA、ESR、C反应蛋白和CA199均有助于疾病诊断和病情判断。病理、pet-CT和激素治疗反应均有助于AIP的诊断。结论作为一种系统性疾病的胰腺表现,1型AIP有特殊的临床特点和实验室检查特点。AIP的诊断可应用多种检测手段和方法。

多胺类似物BENS和TBP对胰腺癌PANC-1细胞增殖、凋亡和迁移能力的影响

为探讨多胺类似物BENS和TBP对胰腺癌PANC-1细胞生长的影响、促进细胞凋亡的机制以及迁移能力的影响,运用MTT法检测药物对细胞生长的影响;亚凋亡峰流式细胞分析法及TUNEL法检测细胞凋亡;Western blotting法测定Bax蛋白、细胞色素C蛋白的表达变化;Ranswell技术检测细胞迁移能力的改变。分析发现,两种多胺类似物均可显著抑制PANC1癌细胞增殖,抑制作用随药物浓度加大而增加,其细胞毒性大小依次为BENS>TBP。细胞凋亡分析发现,BENS和TBP均可诱导PANC1发生细胞程序性凋亡,导致亚凋亡峰出现和明显的DNA断裂现象。胞浆中Bax蛋白和细胞色素C含量显著增加,同时显著性抑制PANC1细胞的迁移能力。表明BENS和TBP能够抑制人胰腺癌PANC1细胞增殖;阻止PANC1细胞迁移的能力;同时诱导细胞发生凋亡,其作用机制可能与改变肿瘤细胞正常的细胞周期,活化线粒体参与的细胞凋亡途径相关。

胰腺癌nm23基因产物NDPK的表达及其临床意义

作者应用免疫组化技术，检测４７例胰腺癌组织中ｎｍ２３基因产物ＮＤＰＫ的表达，以探讨ｎｍ２３基因与胰腺癌病理特征及生物学行为的关系。结果：４７例胰腺癌ＮＤＰＫ阳性率为５９．６％（２８／４７）。组织学为Ⅰ级的病例ＮＤＰＫ阳性率（７３．３％）明显高于Ⅲ级者（４１．７％，Ｐ＜０．０５）；无淋巴结转移者ＮＤＰＫ阳性率高于有转移者（分别为８０．８％和３３．３％），有非常显著性差异（Ｐ＜０．０１）；ＮＤＰＫ表达阳性者术后１年生存率为２５．０％，而阴性者为０，有显著性差异（Ｐ＜０．０５）；ＮＤＰＫ阳性率与胰腺癌病理类型无关（Ｐ＞０．０５）。结果表明：ｎｍ２３基因对胰腺癌转移具有抑制作用，ＮＤＰＫ表达状况可反映胰腺癌的分化程度及生物学行为。

内镜下胰胆管减压并清创治疗胆源性胰腺炎的价值

目的探讨内镜下胰胆管减压清创治疗胆源性胰腺炎（acute biliary pancreatitis，ABP），可减少胆源性胰腺炎并发症的发生。方法总结我院2005—2009以来102例胆源性胰腺炎的临床资料。结果早期内镜下胰胆管减压并清创手术56例（54．9％），46例（45％）择期手术（胰腺炎控制后1—3周），住院时间3～110d，治疗费用从平均0．7—15万元。结论内镜下胰胆管减压并清创治疗胆源性胰腺炎（ABP）方面的作用越来越得到重视，尤其是在减少胆源性胰腺炎并发症的发生方面效果显著，同时在减轻患者住院时间及治疗费用的方面效果也是明显的。

加味柴芩承气汤联合穴位贴敷治疗急性胰腺炎的临床观察

目的探讨加味柴芩承气汤联合穴位贴敷治疗急性胰腺炎的临床疗效。方法随机选取2015年5月~2017年5月我院收治的急性胰腺炎患者40例,依据治疗方法分为西医基础治疗联合加味柴芩承气汤及穴位贴敷组(观察组,n=20)和单纯西医基础治疗组(对照组,n=20),患者入组后均给予急性胰腺炎西医基础治疗,观察组在上述基础上加用加味柴芩承气汤及穴位贴敷,比较两组患者治疗后效果。结果观察组患者的血淀粉酶恢复正常时间、胃肠减压时间、住院时间均显著短于对照组(P<0.05),治疗总有效率95.0%(19/20)显著高于对照组85.0%(17/20)(P<0.05),但两组患者的并发症发生率、转ICU率的差异均不显著(P>0.05)。结论加味柴芩承气汤联合穴位贴敷能够缩短急性胰腺炎患者的血淀粉酶恢复时间、胃肠减压时间及住院时间,提升临床疗效,值得推广。

感染性胰腺坏死内镜治疗失败后的微创外科策略探讨

目的探讨感染性胰腺坏死(infected pancreatic necrosis,IPN)内镜治疗失败后的微创外科处理策略。方法回顾性分析2015年6月至2018年6月首都医科大学宣武医院普外科收治的17例初始内镜治疗失败后接受微创外科清创处理的IPN患者的临床资料,根据疗效评估治疗策略的可行性。入组患者中男12例,女5例,平均年龄(51.3±12.6)岁。结果入组患者ICU住院时间和总住院时间分别为7 d(0～25 d)和23 d(4～52 d)。平均手术次数为(2.38±0.74)次,术中出血量12 mL(2～100 mL),术后支架或猪尾巴管平均取出时间为12 d(8～36 d)。无中转开腹患者,术后发生并发症(Clavien-Dindo Ⅲ级及以上)2例(11.8%),包括腹腔出血1例(5.9%)和胰瘘1例(5.9%);死亡1例(5.9%),死于肺部感染及菌血症。结论感染性胰腺坏死内镜治疗失败后应用微创外科清创治疗安全有效。