Endoscopic ultrasound features of autoimmune pancreatitis: The typical findings and chronic pancreatitis changes.

BACKGROUND: Few studies have fully described endoscopic ultrasound (EUS) features of newly diagnosed autoimmune pancreatitis (AIP) involving both typical findings and chronic pancreatitis (CP) features. The typical EUS findings are prevalent in the diffuse type AIP but may not be as common for the focal type, and the differences between the diffuse and focal AIP need to be specified. AIM: To demonstrate the EUS features of newly diagnosed AIP and the difference between diffuse and focal AIP. METHODS: This retrospective single center study included 285 patients of newly diagnosed type 1 AIP following the international consensus diagnostic criteria, with the EUS procedures accomplished before corticosteroid initiation. We explored the EUS features and compared the typical AIP and CP features between the diffuse and focal AIP cases. The Rosemont criteria were employed for CP features definition and CP change level comparison. RESULTS: For the typical AIP features, there were significantly more patients in the diffuse group with bile duct wall thickening (158 of 214 cases, 73.4% vs 37 of 71 cases, 52.1%, P = 0.001) and peripancreatic hypoechoic margin (76 of 214 cases, 35.5% vs 5 of 71 cases, 7.0%, P < 0.001). For the CP features, there were significantly more patients in the focal group with main pancreatic duct dilation (30 of 214 cases, 14.0% vs 18 of 71 cases, 25.3%, P = 0.03). The cholangitis-like changes were more prevalent in the focal cases with pancreatic head involvement. The CP change level was relatively limited for newly diagnosed AIP cases in both groups. CONCLUSION: This study demonstrated the difference in the typical AIP and CP features between diffuse and focal AIP and indicated the limited CP change level in newly diagnosed AIP.

Feasibility of using narrow band imaging international colorectal endoscopic classification for diagnosing colorectal neoplasia in China: A multicenter pilot observational study.

OBJECTIVE: We aimed to investigate whether Chinese endoscopists without narrow-band imaging (NBI) experiences could achieve high accuracy in the real-time diagnosis of colorectal polyps using NBI International Colorectal Endoscopic (NICE) classification after web-based training. METHODS: Altogether 15 endoscopists from five centers with no NBI experiences followed a short, web-based training program on the NICE classification and took web-based test. Their performances were compared with 15 matched experienced endoscopists with no NBI experience who received no NBI training. These 15 trained endoscopists then made real-time diagnoses of colorectal neoplasia. A logistic regression was used to assess potential predictors of diagnostic performance. RESULTS: Compared with those who received no training, trained endoscopists achieved comparable overall accuracy (85.3% vs 83.1%, P = 0.408) and accuracy at a high-confidence level (87.0% vs 86.0%, P = 0.670), but had a higher confidence rate (86.1% vs 83.7%, P = 0.004) for the diagnosis of neoplasia. Real-time diagnostic accuracy, sensitivity and specificity were 94.3% (95% confidence interval [CI] 91.5%-96.2%), 96.2% (95% CI 93.4%-97.9%) and 85.3% (95% CI 74.8%-92.1%) at high-confidence level. The high-confidence level was the strongest predictor of real-time diagnostic accuracy (odds ratio 12.66, P < 0.001). CONCLUSIONS: Web-based training can improve the confidence level of endoscopists in accurately diagnosing colorectal polyps using the NICE classification. Chinese endoscopists can achieve high accuracy in diagnosing colorectal neoplasia at a high confidence level (ClinicalTrials ID: NCT02033980).

Microstructure transformation of PDMS-E grafted gelatin polymers induced by SDS and SDBS.

Inorganic-organic hybrid materials with tunable chemical and physical properties were prepared from mono epoxy terminated polydimethylsiloxane (PDMS) macromonomer and gelatin for improving their flexibility and hydrophobicity. Sodium dodecyl sulfate (SDS) and sodium dodecyl benzene sulfonate (SDBS) were used to enhance the compatibility of two polymers phases. Measurement of grafting density indicated that anionic surfactants played a crucial role in deciding the detailed microstructure of PDMS-E grafted gelatin (PGG) polymers in alkaline solution. The interaction between gelatin and SDS/SDBS was investigated by viscosity and SEM. Viscosity analysis showed a regular increase in SDS system and a steeper change in the case of SDBS. SEM micrographs displayed a series of structural transitions (spherical, spindle, irregular granular and spherical aggregates) with the increase of SDS concentration, but spindle and granular aggregates appeared alternately as varying SDBS concentrations. The results demonstrated that both the electrostatic and hydrophobic interactions between anionic surfactant and gelatin controlled the aggregate structure of gelatin-SDS/SDBS, which affected the compatibility between gelatin and PDMS. Thermal properties of PGG polymers had changed with the modification of polymer microstructure. The results above revealed that microstructure transformation of PGG polymers was determined by the compatibility of two polymers in anionic surfactant aqueous solution and the chemical nature of their monomers.

Effect of aggregation behavior of gelatin in aqueous solution on the grafting density of gelatin modified with glycidol.

The effect of aggregation behavior of gelatin in aqueous solution on the grafting density of glycidol grafted gelatin polymers (GGG polymers) was investigated. The grafting density was measured using the Van Slyke method by calculating the conversion rate of free - NH(2) groups of gelatin. The conversion rate reached peak values at 6% and 14% of the gelatin aqueous solution. SEM micrographs displayed a series of structural transitions (i.e., spherical, spindle, butterfly, irregular and dendritic aggregates) at varying concentrations from 2% to 16% (w/w) at an interval of 2% (w/w). The spindle aggregates reappeared at the concentrations of 6% and 14%. Viscosity measurements indicated that the physicochemical properties of the gelatin solution had changed with increasing concentration. UV and CD analysis indicated that hydrophobic interactions competed with hydrogen bonding, and the random coils partly transformed to ß-sheet structure by changing the concentration. Zeta potential and pH data confirmed the increasing electrostatic repulsion associated with increasing the hydrophobic region. XPS analysis revealed that the elemental composition of the gelatin particle surface changed with variation in the aggregate structure, determining the monotonic variation of the grafting density with increasing concentration. Results demonstrate that aggregation behavior of gelatin in aqueous solution plays a crucial role in deciding the grafting density of gelatin modified products.

Recombinant activated factor VII in hemophagocytic lymphohistiocytosis with disseminated intravascular coagulation.

Hemophagocytic lymphohistiocytosis (HLH) is a lifethreatening disorder due to hyperinflammation resulting in infiltration of different organs with extensive hemophagocytosis. Severe coagulopathy was one of the main reasons for death in HLH. Over secretion of plasminogen activator by activated macrophages leads to hyperfibrinolysis. We reported a 36-year-old woman who was diagnosed as HLH probably secondary to lymphoma. Massive bleeding from gut and retroperitoneal area were not able to be controlled by conventional hemostatic treatments. This patient received one dose recombinant activated factor VII (rFVIIa) 3.6 mg (70 µg/kg). Hemostatic effect was achieved in 0.5 hour and lasted 24 hours. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were quickly corrected to normal ranges. Fibrinogen level elevated from 0.5 g/L before using rFVIIa to 1.8 g/L 20 hours after. Although dexamethasone and etopside were administrated to treat HLH, this patient died from septic shock after persistent neutropenia. This suggests that rFVIIa may be effective in the management of intractable hemorrhage in patients with HLH.