Over-the-scope clip as a rescue treatment for massive bleeding due to Dieulafoy lesion at the colorectal anastomosis: A case report.

RATIONALE: The bleeding of Dieulafoy lesion predominantly involves the proximal stomach and leads to severe gastrointestinal bleeding. However, these lesions have also been reported in the whole gastrointestinal tract. Bleeding of Dieulafoy lesions at the anastomosis was seldomly reported and was very easy to be ignored clinically. PATIENT CONCERNS: We describe a 72-year-old woman with a past history of surgery for rectal carcinoma hospitalized with chief complaint of massive rectal bleeding. No gross bleeding lesion was found during the first emergency colonoscopy. Despite multiple blood transfusions, her hemoglobin rapidly dropped to 5.8 g/dL. DIAGNOSIS: She was diagnosed with Dieulafoy lesion at the colorectal anastomosis during the second emergency colonoscopy. INTERVENTIONS: Primary hemostasis was achieved by endoscopic hemostatic clipping. However, she experienced another large volume hematochezia 3 days later, and then received another endoscopic hemostatic clipping. She was improved and discharged. However, this patient underwent hematochezia again 1 month later. Bleeding was arrested successfully after the over-the-scope clip (OTSC) was placed during the fourth emergency colonoscopy. OUTCOMES: This patient underwent 4 endoscopic examinations and treatments during 2 hospitalizations. The lesion was overlooked during the first emergency colonoscopy. The second and third endoscopes revealed Dieulafoy lesion at the colorectal anastomosis and performed endoscopic hemostatic clippings, but delayed rebleeding occurred. The bleeding was stopped after the fourth emergency colonoscopy using OTSC. There was no further rebleeding during hospitalization and after 2-year of follow-up. LESSONS: As far as we know, there is no reported case of lower gastrointestinal bleeding caused by Dieulafoy lesion at the colorectal anastomosis, OTSC is a safe and effective rescue treatment for Dieulafoy lesions.

Evaluation of Prebiotic Glycan Composition in Human Milk and Infant Formula: Profile of Galacto-Oligosaccharides and Absolute Quantification of Major Milk Oligosaccharides by UPLC-Cyclic IM-MS and UPLC-MS/MS.

Prebiotic oligosaccharides have attracted immense interest in the infant formula (IF) industry due to their unique health benefits for infants. There is a need for the reasonable supplementation of prebiotics in premium IF products. Herein, we characterized the profile of galacto-oligosaccharides (GOS) in human milk (HM) and IF using ultrahigh-performance liquid chromatography-cyclic ion mobility-mass spectrometry (UPLC-cIM-MS) technique. Additionally, we further performed a targeted quantitative analysis of five essential HM oligosaccharides (HMOs) in HM (n = 196), IF (n = 50), and raw milk of IF (n = 10) by the high-sensitivity UPLC-MS/MS method. HM exhibited a more abundant and variable HMO composition (1183.19 to 2892.91 mg/L) than IF (32.91 to 56.31 mg/L), whereas IF contained extra GOS species and non-negligible endogenous 3'-sialyllactose. This also facilitated the discovery of secretor features within the Chinese population. Our study illustrated the real disparity in the prebiotic glycome between HM and IF and provided crucial reference for formula improvement.

Levels and Health Risk Assessment of Inorganic Arsenic, Methylmercury, and Heavy Metals in Edible Mushrooms Collected from Online Supermarket in China.

Chromium (Cr), total arsenic (As), inorganic arsenic (iAs), cadmium (Cd), mercury (Hg), methylmercury (MeHg), and lead (Pb) were analyzed in in Agaricus blazei, Tricholoma matsutake, Pholiota nameko, agrocybe aegirit, Boletus edulis, Auricularia auricula, and Lentinus edodes collected from online supermarket in China from 2015 to 2017. The order of mean concentrations for the five heavy metals in edible mushrooms was As > Cd > Cr > Pb > Hg. No positive correlation was found between total As and iAs, nor between total Hg and MeHg. The contents of iAs were at a low level except for A. blazei samples. The contents of MeHg were at a low level in all test mushroom samples. And Cr, Cd, and Pb pollution were common problems in the test mushroom samples. The comprehensive factor pollution index was between 0.569 (A. auricula) and 3.056 (B. edulis). The THQ values for the five heavy metals from P. nameko, A. auricula, A. aegirit, and L. edodes samples were less than 1. The hazard index (HI) values of A. blazei, T. matsutake, and B. edulis samples for adults and children were greater than 1, indicating significant health hazard to the adults and children consumers. The cancer risk (CR) values for iAs ranged from 3.82 × 10- 6 (T. matsutake) to 8.61 × 10- 5 (A. blazei), indicating no potential carcinogenic risk to the consumers. The order for carcinogenic risk of each edible mushroom species was A. blazei > L. edodes > P. nameko > A. aegirit > A. auricula > B. edulis > T. matsutake.

The Effect of Using Premedication of Simethicone/Pronase With or Without Postural Change on Visualization of the Mucosa Before Endoscopy: A Prospective, Double Blinded, Randomized Controlled Trial.

INTRODUCTION: To investigate the efficacy and safety of preprocedural simethicone (S) and pronase (P) for optimal mucosal visualization during esophagogastroduodenoscopy with sedation. The effect of postural change combined with premedication on mucosal visibility was also examined. METHODS: The study randomized 496 patients into 8 groups based on the type of premedication provided and whether a postural change occurred. The premedication in the control group was 100 mL of normal saline solution (NS). The remaining 3 intervention groups were administered 100 mL of simethicone alone (S), pronase solution alone (P), and simethicone plus pronase solution (S + P). Each group was classified into subgroups according to whether there was a postural change (PC). The mucosal visibility score (MVS), total mucosal visibility score (TVS), procedure time, water consumption for mucosal cleansing, and proportion of patients with diminutive lesions <5 mm were recorded. RESULTS: The P and S groups had a significantly better TVS than the NS group (11.86 ± 3.36 in group P vs 14.52 ± 2.57 in group NS, P < 0.001; 12.36 ± 2.93 in group S vs 14.52 ± 2.57 in group NS, P = 0.006). The TVS was better in the P group than in the S group (11.86 ± 3.36 vs 12.36 ± 2.93, P = 0.037). The MVS was significantly better in the esophagus and duodenum and worse in the upper and lower gastric body in the S group than in the P group. The P + S group had a significantly better TVS than the P and S groups (9.81 ± 2.90 in group P + S vs 11.86 ± 3.36 in group P and 12.36 ± 2.93 in group S, respectively, P < 0.001),\ and had a reduced amount of flushing water during the procedure (0 [interquartile range [IQR]: 0-33] mL in group P + S vs 40 [IQR: 0-70] mL in group P, P < 0.01; 0 [IQR: 0-33] mL in group P + S vs 50 [IQR: 20-98] mL in group S, P < 0.001). The TVS was significantly better in the P + S + PC group than in the P + S group (8.44 ± 2.10 vs 9.81 ± 2.90, P = 0.003). The MVS was significantly better in the gastric antrum, fundus, and upper and lower gastric body in the P + S + PC group than in the P + S group. There was no significant difference in the detection rate of diminutive lesions among the different groups during an endoscopic examination ( P > 0.05). DISCUSSION: The combination of preprocedural administration with simethicone and pronase achieved superior mucosal visualization compared with saline, simethicone, or pronase alone in patients receiving upper endoscopy. Postural change maneuvers performed before endoscopy further improved the mucosal visibility in most parts of the stomach when used with preprocedural simethicone and pronase.

[Determination of 80 pesticide residues in milk using NH_2-MWNTs by liquid chromatography-time of flight mass spectrometry].

OBJECTIVE: A method for the determination of 80 pesticide residues in milk by liquid chromatography-time-of-flight mass spectrometry(LC-QTof-MS) was developed. METHODS: The target compounds in milk were extracted with acetonitrile-methanol(9∶1, V/V) containing 1% acetic acid, and purified by aminated multi-walled carbon nanotubes(NH_2-MWNTs). The chromatographic column was Waters Acquity UPLC BEH C_(18 )(100 mm×2.1 mm, 1.7 µm). The 80 pesticides were detected by liquid chromatography-time-of-flight mass spectrometry and quantified using an external standard method by matrix matched calibration curve. RESULTS: The purification method showed a good linearity(r~2≥ 0.99) over the concentration range from 5 to 100 µg/L for the 80 pesticides in this study. The limits of detection(LODs) and quantification(LOQs) of the 80 pesticides in milk ranged from 0.01 to 0.50 µg/L and 0.03 to 1.50 µg/L, respectively. The mean recoveries of the three spiked levels ranged from 71.5% to 116.9% with the relative standard deviation ranging from 1.2% to 18.1%, indicating that the accuracy and precision of the method were good. Among the milk samples, no residues of the 80 pesticides in this study were found after screening. CONCLUSION: The method has good linearity, good sensitivity, accuracy and precision and is suitable for the simultaneous and rapid determination of 80 pesticide residues in milk.

Staphylococcus cohnii infection diagnosed by metagenomic next generation sequencing in a patient on hemodialysis with cirrhotic ascites: a case report.

Background: Patients with spontaneous bacterial peritonitis (SBP) often just receive empirical antibiotic therapy, as pathogens can be identified in only few patients using the techniques of conventional culture. Metagenomic next generation sequencing (mNGS) is a useful tool for diagnosis of infectious diseases. However, clinical application of mNGS in diagnosis of infected ascites of cirrhotic patients is rarely reported. Case presentation: A 53-year-old male with cirrhosis on regular hemodialysis presented with continuous abdominal pain. After treatment with empiric antibiotics, his inflammatory parameters decreased without significant relief of abdominal pain. Finally, based on ascites mNGS detection, he was diagnosed as infection of Staphylococcus cohnii (S.cohnii), a gram-positive opportunistic pathogen. With targeted antibiotic treatment, the bacterial peritonitis was greatly improved and the patient's abdominal pain was significantly alleviated. Conclusions: When conventional laboratory diagnostic methods and empirical antibiotic therapy fail, proper application of mNGS can help identify pathogens and significantly improve prognosis and patients' symptoms.

Severe lower gastrointestinal bleeding caused by rectal Dieulafoy's lesion: Case reports and literature review.

RATIONALE: Dieulafoy's lesion are relatively rare and can cause severe gastrointestinal bleeding. A Dieulafoy's lesion is defined as an artery that erodes the overlying epithelium without the presence of an ulcer. Bleeding in Dieulafoy's lesion predominantly involves the proximal stomach and upper gastrointestinal tract and is rarely observed in the lower gastrointestinal tract. PATIENT CONCERNS: Case 1 was a 58-year-old woman complaining of sudden headache and vomiting who was diagnosed with subarachnoid hemorrhage. She underwent transcatheter embolization for intracranial aneurysm treatment but had an acute profuse hematochezia on the 11th day of admission. Case 2 was a 63-year-old man admitted to the respiratory intensive care unit because of fever with altered consciousness level for a week. He was diagnosed with advanced lung cancer that had metastasized to multiple organs one month prior. On the third day of admission, he had an attack of profuse hematochezia, and quickly developed shock and apathy. DIAGNOSIS: Both patients were diagnosed with actively bleeding rectal Dieulafoy's lesion by bedside emergency colonoscopy. INTERVENTIONS: Endoscopic hemostatic clipping was performed in 2 patients. OUTCOMES: Hemostasis was successfully achieved in these 2 patients, and there was no recurrence of symptoms during follow-up. CONCLUSIONS: We propose that hemostatic clipping is one of the options in the treatment of rectal Dieulafoy's lesions.

[Role of ß2-Adrenergic Receptor Agonist in the Cognitive Impairment Associated with Neurodegenerative Diseases].

Studies have revealed the neuropathological mechanism of the cognitive impairment associated with neurodegenerative diseases.However,the therapies for these cognitive disorders are limited,and the prevalence of cognitive impairment is expected to increase significantly in the future,which proves the necessity of new therapeutic agents.In recent years,the pharmacological activity of ß2-adrenergic receptor(ß2-AR)has been extensively studied,which has demonstrated that ß2-AR agonist has therapeutic effects on the cognitive impairment associated with several common neurodegenerative diseases,including Alzheimer's disease,vascular dementia,Parkinson's disease with dementia,and Lewy body dementia.We reviewed the neuropathological features of cognitive impairment in several common neurodegenerative diseases and expounded the pharmacological effects of ß2-AR on related diseases.

The effect of farmland on the surface water of the Aral Sea Region using Multi-source Satellite Data.

BACKGROUND: The improper land utilization has brought tremendous pressure on the surface water of the Aral Sea Region in the past decades. It was seriously hindered for construction of the Green Silk Road Economic Belt by the fragile environment. Therefore, it is of great necessity for environmental protection and social development to monitor the change of surface water in the Aral Sea Region. METHODS: In this study, LandTrendr algorithm was used on Landsat time-series data to characterize the change in farmland on the Google Earth Engine platform. Based on multi-source data, the water area changes of the Aral Sea were extracted based on the Google Earth Engine, and the mean method was utilized to extract the changes in water level and water storage. Finally, a water-farmland coupling degree model was utilized to evaluate the impact of farmland changes on the surface water in the Aral Sea Region. RESULTS: As a result, the change of farmland is as follows: the farmland area of the Aral Sea Region has abandoned 3,129 km2 from 1987 to 2019, with overall accuracy of 85.3%. The farmland change had increased the drainage downstream of the Amu Darya River and the Syr Darya River. It has led area of the Aral Sea to decrease each year continuously. The area of the Aral Sea shrank by 1,606.36 km2 per year from 1987 to 2019. Furthermore, Aral Sea's water level decreased by 0.13 m per year from 2003 to 2009. The amount of water storage in the Aral Sea Region also showed a downward trend from 2002 to 2016. There was a high-quality coupling coordination 0.903 relationship between surface water and farmland. It will increase the burden of water for people's normal daily life by the water loss resources caused by abandoned farmland. This study emphasized threat of unreasonable farmland management to surface water of the Aral Sea Region. The findings contributed for decision makers to formulating effective reasonable policies to protect surface water and use land of the Aral Sea Region. Meanwhile, the application of coupling degree model can provide a new method for studying the connection of independent systems in the farmland, water, environment and more.

Construction of a Degradation-Free DNA Conjugated Nanoprobe and Its Application in Rapid Field Screening for Sulfur Mustard.

Sulfur mustard (SM) is a notorious blistering chemical warfare agent. Rapid field screening for trace SM is of vital significance for the detection of antiterrorism and timely treatment. Here, a visual assay for SM was constructed on the basis of its inhibition for the G-quadruplexes/hemin DNAzyme. Specifically, multiple guanine (G)-rich single stranded oligonucleotides (ssODN) named S1 (80% of G in the total bases), i.e., the precursor for G-quadruplex, which could oxide tetramethylbenzidine (TMB) to its green product, were conjugated on the nonfouling polymer brush grafted magnetic beads (MB@P(C-H)). SM could specifically alkylate the N7 and O6 sites of G in the S1; thus, it failed to form the DNAzyme based signal reporter. It was demonstrated that the nonfouling P(C-H) interface on the magnetic bead (MB) could protect the conjugated ssODN from nuclease degradation, thus ensuring its well sensing performance in complex samples. Under the optimized conditions, this method achieved good sensitivity and selectivity with a limit of detection (LOD) as low as 0.26 µmol L-1, and the recoveries ranging from 86% to 117% were obtained for different SM spiked real samples. Above all, this method combining low cost and ready operation could be suited for rapid field SM screening in a wide range of environmental matrices.

Development of a high-throughput method for the comprehensive lipid analysis in milk using ultra-high performance supercritical fluid chromatography combined with quadrupole time-of-flight mass spectrometry.

Milk lipids are one of the most complex materials in nature and are associated with many physiological functions, hence it is important to comprehensively characterize lipids profiles to evaluate the nutritional value of milk. A quick method was developed by ultra-high performance supercritical fluid chromatography coupled to electrospray ionization quadrupole time-of-flight mass spectrometry (UHPSFC-ESI-QTOF-MS) to analyze the non-polar and polar lipids profiles of cow, goat, buffalo, human milk, and infant formulas in 7 min. All chromatographic conditions were carefully optimized and their effect on the chromatographic behavior of lipid classes and species was discussed. Under optimized conditions, 12 lipid classes (triacylglycerols, diacylglycerols, monoglyceride, fatty acids, phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine, phosphatidylglycerol, sphingomyelin, lyso-phosphatidylcholine, and lyso-phosphatidylethanolamine) were separated and each class was further separated in single analysis to facilitate the identification. 250 lipid species in real samples were characterized and quantified. This result demonstrates the applicability of the UHPSFC-ESI-QTOF-MS method in the high-throughput and comprehensive lipid analysis of milk, and will hopefully help to provide nutritionists with the lipid distribution in different types of milk, as well as help in the design of more suitable infant formula for babies.

Environmental risk analysis of surface water based on multi-source data in Tianjin Binhai New Area, China.

The study on environmental risk of surface water is of great practical significance for the ecological security of water environment and water pollution treatment, and it can provide a certain reference basis for risk prevention and control of water environment. The Tianjin Binhai New Area faces severe water shortage and serious water pollution, but few studies have been reported on surface water environment risk in this area. Therefore, in this study, based on Gaofen-6 remote sensing image, the factors including land use, landscape index, population density, and enterprise source are integrated to develop the evaluation model of surface water environment risk index. It is developed using analytic hierarchy process from two aspects of hazard of risk source and sensitivity of risk receptor. The comprehensive risk of Tianjin Binhai New Area is classified using mean standard deviation method. The result indicates that the developed model could better quantify the impact of various factors on the surface water environment, and comprehensively and accurately depict the spatial distribution of surface water environmental risk. Generally, the areas of higher and high risk grades are mainly concentrated on the west of Binhai Street, Beitang Street, and Hangzhou Road Street. The risk grade in most other areas is medium, and it is low in coastal and northernmost areas. This study not only clarifies the distribution of surface water environmental risks in Binhai New Area, but also develops an evaluation model, which can provide reference for the evaluation of water environmental risks in other areas. Through the investigation and research on the current situation of water pollution, social and economic development, and other factors of the streets and towns in Binhai New Area, it is found that in recent years, the urbanization of Binhai Street, Beitang Street, and Hangzhou Road Street has developed rapidly, and the intensity of human activities is high, which has a great impact on the water environment. The research results are consistent with the actual situation, which can provide theoretical and technical support for the prevention, control, and management of water environmental risks in Binhai New Area.

Management of gastrointestinal endoscopy unit during post covid-19 endemic outbreak: A report from Wuhan epicenter.

The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 and causing a global public health emergency. During the outbreak, Wuhan was the first reported and hardest-hit city. With the dramatic drop in number of confirmed cases and subsequent ending of Wuhan lock down, asymptomatic carriers and patients in their recovery period still pose an increased risk. Strict and effective infection control protocols should be established and followed.

Performing EUS during COVID-19 postendemic period: A report from endoscopy center in Wuhan.

In early April 2020, the 3-month-long city-wide lockdown was lifted in Wuhan, the epicenter of China during Coronavirus Disease 2019 (COVID-19) global pandemic. However, continuing precautions are still practiced considering the risk of transmission from asymptomatic carriers. Given that COVID-19 is spread via airborne droplets, including aspiration of oral and fecal material through endoscopes, our endoscopy center has strategically assigned health-care providers to ensure triage workflow and to minimize concomitant exposure from potential asymptomatic carriers. Here, we share the experience of performing EUS-FNA during the COVID-19 pandemic and postendemic periods. We illustrate our workflow using a patient with a left adrenal mass as an example and followed a biosafety level-2 standard. We believe all endoscopy centers need to focus on these three directions: (1) pre-EUS patients risk assessment and triage, (2) Personal protective equipment (PPE), and (3) dressing code modalities. We fully adopted them in our hospital to reduce COVID-19 resurgence risk.

[Non-targeted screening of triazole fungicides in tomatoes by ultra-high performance liquid chromatography-quadrupole-time of flight mass spectrometry].

In order to cope with the differences in international trade regulations, it is necessary to establish a rapid non-targeted screening method for triazole fungicides in food. Therefore, a non-targeted method based on ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) was established for the rapid screening of triazole fungicides in tomatoes. Tomato samples were extracted with acetonitrile and then purified by QuEChERS. The purified solution was separated on a BEH C18 column (100 mm×2.1 mm, 1.7 µm) using a gradient mobile phase consisting of acetonitrile and water (both containing 0.1% formic acid). Full information tandem mass spectrometry (MSE) acquisition using electrospray ion source under positive ion mode was performed. The 19 triazole fungicides were divided into eight groups based on their structural differences. The secondary mass fragments of eight typical standards in the eight groups of triazole fungicides were analyzed, and then, the regularities of the characteristic fragment ions and neutral loss fragments produced by collision-induced dissociation of the triazole fungicides were summarized. The fragmentation regularity was further verified by the other 11 triazole fungicides. A total of 16 tomato samples collected from local supermarkets in Beijing were screened using this non-targeted method. Diniconazole was identified and confirmed in one sample, which demonstrated that the method could achieve rapid and accurate non-targeted screening of triazole fungicides in tomatoes. The proposed method is highly efficient, sensitive, and accurate, thus providing a reference for screening triazole fungicide residues in food.

Intensity and Stationarity Analysis of Land Use Change Based on CART Algorithm.

Land use directly reflects degree of human development and utilization of land. Intensity analysis of land use is a quantitative method to analyze land use changes. In this paper, land use changes in Tianjin were studied using Thematic Mapper (TM) remote sensing images in 1995, 2000, 2005, 2010 and Operational Land Imager (OLI) remote sensing image in 2015. Land use information was extracted using decision tree classification method based on CART (Classification and Regression Trees) algorithm. This paper introduced land use intensity analysis to analyze its change intensity and stationarity, respectively at interval, category and transition levels. Based on the theory, new models were developed in the transition level to analyze land use change pattern. The analysis quantifies the contribution of a certain land categories to land use change during a specific time interval. The change of land use during 1995-2015 indicated that Tianjin experienced rapid urban development with the area of urban land increased by about 7.5%. This study provided a reference for the sustainable development of land use in Tianjin.

Cytotoxic comparison of macrolide antibiotics and their chlorinated disinfection byproduct mixtures.

Erythromycin (ERY), azithromycin (AZI) and telithromycin (TEL) are widely-used macrolide antibiotics that are frequently detected in various water environments, including resource water and drinking water. In the performed chlorination disinfection process, at least 10, 20 and 200 new disinfection byproducts of ERY, AZI and TEL, respectively, were observed (the mixtures of the disinfection byproducts of ERY, AZI and TEL were named ERY-M, AZI-M and TEL-M, respectively). There is limited information available regarding their comparative toxicities, and their potential health risks are still unknown. In this study, the Jurkat cell line was used to compare the toxicities of the disinfection byproduct mixtures and their precursor compounds. The cell viability results indicated that the toxicity of ERY-M may not be enhanced after disinfection by chlorination. In contrast, at the same concentrations, AZI-M and TEL-M induced more significant inhibitory effects on cell viability than their parent compounds. Additionally, the total antioxidant capacity (T-AOC) and cell cytokine release (including interleukin-2, interleukin-8 and tumor necrosis factor-α) analyses of AZI-M and TEL-M further verified these results. Our findings demonstrate that the cytotoxicity of AZI and TEL was enhanced during the chlorination disinfection process. This investigation will provide substantial new details related to the toxicity of the mixed disinfection byproducts (DBPs) of ERY, AZI and TEL generated in the chlorination disinfection process.

The role of EUS-guided fine needle aspiration in autoimmune pancreatitis: a single center prospective study.

OBJECTIVES: Histopathological examination is pivotal in diagnosing autoimmune pancreatitis (AIP). The usefulness of EUS-guided fine needle aspiration (EUS-FNA) in diagnosing AIP remains controversial worldwide. The authors conducted this study to evaluate the efficacy of EUS-FNA for AIP diagnosis using a 22-gauge needle. METHODS: Between January 2013 and May 2017, 37 patients had imaging studies suggestive of AIP at Tongji Hospital, and 27 patients of them were enrolled in this study. Tissue specimens acquired through EUS-FNA were analyzed for periductal lymphoplasmacytic infiltrate (LPI), storiform fibrosis (SF), obliterative phlebitis (OP) and immunoglobulin G4 (IgG4)-positive plasma cell counts. Clinical Trials.gov no: TJ-C20121220. RESULTS: LPI and SF were present in 18 (66.67%) and 18 (66.67%) of 27 patients, respectively. Abundant IgG4-positive plasmacyte infiltration >10/high-power field (HPF) was detected in 8 of 27 patients (29.63%). OP and the characteristic findings of idiopathic duct-centric chronic pancreatitis (IDCP) and granulocytic epithelial lesion (GEL) were not detected in this study. According to the International Consensus Diagnostic Criteria (ICDC) for AIP, 5 and 12 of 27 patients were assessed as having level 1 and level 2 histological findings, respectively, suggesting that 17 of 27 patients (62.96%) had lymphoplasmacytic sclerosing pancreatitis (LPSP) based on the ICDC. CONCLUSIONS: In 92.6% of patients, pancreatic tissues with >5 HPFs were obtained by EUS-FNA using a 22-G needle. In 63% of patients, histology was evaluated to be ≥ level 2 according to the ICDC. The study indicates that EUS-FNA with a 22-G needle is valuable in the histopathological diagnosis of AIP.