Objective To compare the value of bedside index for severity in acute pancreatitis (BISAP),Ranson score and Balthazar computed tomography severity index (CTSI) in predicting the severity and prognosis of acute pancreatitis (AP).Methods From 2005 to 2011 in Shanghai,the clinical data of 1004 AP cases from seven hospitals was collected and retrospectively analyzed.The value of BISAP score,Ranson score and Balthazar CTSI in predicting the severity and prognosis of AP were assessed with receiver operator characteristic (ROC) curve.Results Among 1004 patients,the main cause of AP was biliary disease (580 cases),about 57.77％.The incidence of pancreatic necrosis,mortality and SAP increased along with BISAP score.The risk of pancreatic necrosis in patients with CTSI ≥ three was significantly higher than that of ＜ three.The risk of pancreatic necrosis and SAP in patients with BISAP score ≥ two was significantly higher than that of ＜ two (OR:4.93,95％CI 3.62-6.70; OR 2.62,95％CI 1.59-4.31,respectively).There was no significant difference in the accuracy of predicting the progression and mortality of AP among these three score systems.However the sensitivity of BISAP score (OR:61.54,95％CI 35.09-87.99) in predicting the progression and mortality of AP was better than that of Ranson (OR:46.15,95 ％ CI 19.05-73.25) and CTSI (OR:46.15,95％CI 19.05-73.25).Conclusions BISAP score is easy to perform and when combined with CTSI,it helps to make the diagnosis and classification of AP in time,predict the prognosis accurately.Compared with Ranson score,BISAP score has higher clinical value.

Objective To compare the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for solid pancreatic masses performed with three different needle types through the cytological results.Methods All patients with solid pancreatic masses larger than 2cm from December 2010 to May 2011 were enrolled,and divided into two groups according to different access of EUS-FNA,trans-gastric approach with 19-,22-and 25-gauge needles (n =42) and trans-duodenal approach with 22-and 25-gauge needles (n =10).In both groups,EUS-FNA was performed with randomization of needle types.During the puncture,the suction,the number of movements,and the depth of insertion were fixed.At the end of the puncture,a liquid-based cytological (LBC) preparation was used to fix the specimen.One cytopathologists was assigned to make the diagnosis and comparison.Results Technical success was 100％ and no procedure related complications occurred.No statistically significant differences were observed in different needles in terms of all cytological parameters between two groups (P ＞ 0.05).However,the 25-gauge needle showed a trend towards a higher sensitivity,specificity,positive predictive value,negative predictive value and accuracy.Conclusion There is no significant difference in yield of cytological results between different needle types,although 25-gauge needle shows a relative superiority.

Background: Increased visceral adiposity is a key feature of obesity and metabolic syndrome. Previous studies have generated controversial results regarding visceral fat (VF) removal as a therapy for obesity and metabolic syndrome.Objective: To study the effect of surgical VF removal on metabolic profiles in a mouse model of diet-induced obesity and metabolic syndrome and to evaluate for the first time the feasibility of endoscopic omentectomy using natural orifice transluminal endoscopic surgery (NOTES) technique as treatment for obesity and metabolic syndrome in a feline model.Setting: The Johns Hopkins Hospital.Design: Sham-controlled study in a mouse model of metabolic syndrome and then pilot endoscopic sham-controlled study in cats.Interventions: Partial or total surgical VF removal was performed in a high-fat diet-induced mouse model of obesity and metabolic syndrome, followed by measurements of metabolic profiles, and endoscopic omentectomy was performed in a feline model using the NOTES approach.Main Outcome Measurements: Weight loss and metabolic profiles.Results: In a mouse model of obesity, total but not partial VF removal significantly improved obesity and metabolic syndrome, including insulin resistance and hepatic steatosis (all P < .05 vs sham surgery). The improved metabolic syndrome was associated with significantly decreased inflammatory cytokines. In a feline model, endoscopic omentectomy was feasible and safe and resulted in a net weight loss compared with sham surgery (-387 +/- 437 g vs 233 +/- 351 g, P = .1, respectively).Limitations: Animal experiments.Conclusions: Endoscopic omentectomy is safe and feasible and has the potential to treat obesity and metabolic syndrome. Near-total VF removal is required to achieve net weight loss and improvement of metabolic syndrome. (Gastrointest Endosc 2011;74:637-44.)

This article reviewed the endoscopic features of rectal carcinoid tumors,evaluated usefulness of endoscopic ultrasonography in the preoperative staging and prognosis of the tumors postoperatively,introduced the progresses of molecular dignosis,analyzed the therapeutic different sizes of tumors,compared the characteristic of ESD with EMR and the prognostic factors for 5-year survival rates of the tumors.

Objective To investigate the difference of tumor stem cells in HT29 and HCT116 cell lines and evaluate the model of colon cancer stem cell research.Methods HT29 and HCT116 cells were cultured in serum-free medium(SFM) to develop spheres.The growth states of spheres in two cell lines were observed and the rate of spheres' formation was obtained by limiting dilution analysis.The expression of CD44±/CD24± cells were detected by flow cytometry.The tumorigenicity of spheres originated from HT29 and HCT116 was investigated in vivo by tumorigenicity assays.Results The average time of spheres' formation generated from HCT116 was shorter than HT29((5 days vs 7 days) in SFM,the rate of spheres derived from HCT116 was significantly higher than HT29 [(11.4±1.15)% vs(3.31±0.27)%].There was significant difference in the expression of CD44±/ CD24± between HT29 and HCT116.The expression of CD44+/CD24-were(9.23±2.15)% and(60.33±5.75)% in HT29 and HCT116,separately(t=13.939,P0.05).HT29 spheres were less tumorigenic compared with HCT116 spheres when transplanted in nude mice.Conclusion HCT116 is more appropriate for colon cancer stem cell research than HT29.

Objective To assess the role of endoscopic ultrasound guided fine needle aspiration (EUS-FNA)for diagnosis of gastrointestinal tract lesions.Methods Sixty-eight patients underwent endoscopic uhrasonagraphy and EUS-FNA between May 2007 and Dec.2008.The result of cytology and/or pathology was compared with that of surgical finding and follow-up study.Results EUS-FNA was successfully performed on 62 patients with lesiorm in oesophagus(4 eases),stomach(19 case),rectum(19 cases),liver(3 case),mediastinum(4 cases)and lymph node(13 cases),and had a successful rate of 91.18%(62/68).Among them,the lesions in 40 patients(64.52%)were cytologically confirmed.The lesions in 10 out of 22 patients(35.48%)were pathologically confirmed.Compared with the results of pathology and long-term followe-up study,the sensitivity,specificity and positive predictive value of EUSFNA in diagnosis of lesions in gastrointestinal tract was 85.48%,100.00%and 90.91%,respectively,The positive predictive value and negative predictive value was100.00%and 57.14%,respectively.Conclusion EUS-FNA is a safe,effective and accurate method for diagnosis of lesions in gastrointestinal tract,and has an important role in cytological diagnosis.

Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.

Objective To evaluate contrast-enhanced endoscopic uhrasonography(CE-EUS)in the differential diagnosis of pancreatic diseases.Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis,which would be finally affirmed with EUS-FNA or histophathologic examinations,as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic contrast agent(sonovue,Bracco Co.,Italy).Characteristics of enhancement including form,echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones.Results By CE-EUS,five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhancement pattern with homogeneous distribution(type Ⅰ-Ⅱ);while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition(type Ⅱ-Ⅲ).In addition,thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement(typeⅠ-Ⅱ)partially with border enhancement and with slow enter-in and fast wash-out phase.However,three benign insulinomas were presented as holo-plaquelike enhancement(type Ⅲ),and 2 with fast enter-in and fast washout phase.Besides,different enhancement intensity was identified in different diseases.Conclusion CEEUS,from which different enhancement pattern,phase and intensity would be shown in various pancreas,is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.