目的 筛选二维超声及多普勒超声诊断胡桃夹现象(NCP)的指标,并比较单一指标及联合指标对NCP的诊断价值.方法 回顾性分析行左肾静脉超声检查的患者82例.以对比增强计算机断层扫描(CECT)作为诊断金标准,采用受试者工作特征(ROC)曲线分析并获得二维超声及多普勒超声的诊断指标,比较单一指标及联合指标诊断NCP的诊断价值.结果 二维超声及多普勒超声诊断NCP的指标分别为:腹主动脉与肠系膜上动脉之间夹角(AMA)≤18°、左肾静脉扩张段内径(D2)/AMA内左肾静脉受压段内径(D1)＞2.9、AMA内左肾静脉受压段血流速度(V1)/左肾静脉扩张段的血流速度(V2)＞3.6.AMA≤18°、D2/Di＞2.9、V1/V2＞3.6单一指标及3项指标中满足任意两项或以上诊断NCP的灵敏度分别为:80％、90.9％、87.3％和 94.5％,特异度分别为:51.9％、63％、63％和 74.1％,准确度分别为:70.7％、81.7％、79.3％和 87.8％,AUC 分别为 0.659、0.769、0.751 和 0.843.结论 AMA≤18°、D2/Di＞2.9及V1/V2＞3.6 3项指标中满足任意两项或以上诊断NCP价值优于单独任意一项指标,推荐作为筛查NCP的诊断方法广泛应用于临床.

Objective To compare the value of power doppler imaging (PDI),advanced dynamic flow (ADF) and superb microvascular imaging (SMI) in evaluation of disease activity of Crohn's disease (CD).Methods A total of 40 CD patients were recruited in this retrospective study.All the inflamed bowels were examined and graded by gray scale ultrasound,PDI,ADF and SMI.The physician's diagnosis was set as the standard to differentiate disease activity.The results observed respectively by senior and junior doctor were compared for consistency.Results PDI,ADF and SMI evaluated the disease activity with sensitivity of 60.0％,60.0％ and 90.0％,specificity of 80.0％,90.0％ and 80.0％,and diagnostic accuracy of 65.0％,67.5％ and 87.8％,respectively.SMI was more sensitive and accurate to evaluate disease activity of CD compared with PDI and ADF.The result observed by junior doctor was consistent with that by senior doctor (Kappa value:0.907,0.755 and 0.720,P＜ 0.001).Conclusion SMI can evaluate the disease activity of CD with higher sensitivity and accuracy in comparison with traditional PDI and ADF.

To assess the value of endorectal ultrasonography ( ERUS ) in predicting the pathological response to neoadjuvant chemoradiotherapy( NCRT ) for locally advanced rectal cancer( LARC) . Methods Ninety‐nine patients with LARC received NCRT and total mesorectal excision in our hospital were retrospectively analyzed . T he maximum length and thickness of rectal tumor were measured by ERUS both before NCRT ( ERUS1 ) and after NCRT following sugery ( ERUS2 ) ,and the length and thickness reduction rate were calculated . T he patients were classified into good responder group ( n ＝ 47 ) and poor responder group( n ＝ 52 ) ,or pathological complete response ( pCR) group ( n ＝ 25 ) and non‐pCR group ( n＝74) according to pathological tumor regression grade ( T RG ) . T he differences of various parameters were compared between groups . T he correlations between these parameters and T RG grading were analyzed by Spearman correlation analysis . T he ROC curve was used to evaluate the diagnostic efficacy of the parameter . Results T he length and thickness of ERUS2 were significantly shorter than that of ERUS1( all P ＜0 .05) . T he length and thickness of ERUS2 in good responder group were shorter than those in poor responder group ,while the length and thickness reduction rate were higher than those in poor responder group with significant difference ( all P ＜ 0 .05 ) . T he length and thickness of ERUS2 in pCR group were shorter than those in non‐pCR group ,w hile the length and thickness reduction rate were higher than those in non‐pCR group with significant difference ( all P ＜ 0 .05 ) . T he length and thickness of ERUS2 were positively correlated with T RG grading ( r ＝ 0 .577 ,0 .605 ; all P ＜ 0 .01 ) and the length and thickness reduction rate were negatively correlated with T RG grading ( r ＝ －0 .681 ,－0 .598 ; all P ＜0 .01 ) . ROC curve showed the cut‐off value of the length and thickness reduction rate to predict good responder were 41 .34% ,46 .46% , with corresponding AUC areas of 0 .843 ,0 .796 , sensitivity of 74 .5% ,70 .2% , and specificity of 76 .9% ,80 .8% ,respectively . ROC curve showed the cut‐off value of the length and thickness reduction rate to predict pCR were 57 .36% ,58 .52% ,with corresponding AUC areas of 0 .851 and 0 .895 , sensitivity of 68 .0% ,76 .0% ,and specificity of 94 .6% ,93 .2% ,respectively . Conclusions T he changes of length and thickness of tumor after NCRT are well correlated with treatment response . T he length and thickness reduction rate measured on ERUS present high accuracy in prediction of good response and pCR in LARC patients .

Objective To investigate the application value of ultrasound (US) and percutaneous drainage in the management of Crohn′s disease (CD) with intra-abdominal inflammatory mass. Methods Clinical data of consecutive 65 patients diagnosed as CD from January 2013 to January 2017 at the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Sensitivity and specificity of imaging technology in diagnoses of intra-abdominal abscess were summarized. The changes of body temperature, white blood cell count and neutrophil ratio of CD patients with intra-abdominal abscess receiving US-guided percutaneous drainage were compared between pre-treatment and post-treatment. Results A total of 76 inflammatory masses were found in 65 patients, including 68 of abscess, 7 of phlegmon and 1 of hematoma. The results of routine US and contrast-enhanced ultrasound (CEUS) were in good (Kappa value: 0.700, P<0.001) and excellent (Kappa value: 0.857, P<0.001) agreement with those of CTE or/and MRE, respectively. Routine US identified the abscess in all inflammatory masses with sensitivity of 94%, specificity of 88%, and diagnostic accuracy of 93%, the corresponding performance of CEUS was 100%, 80% and 95%.Percutaneous drainage was performed in 33 cases with abscess successfully without any complications during therapy.The body temperature, white blood cell count and neutrophil ratio of patients were evidently decreased 1 week after treatment [(36.3±0.7)℃ vs. (38.2±2.1)℃, (6±4) ×109/L vs. (12±6) ×109/L, (64±13)% vs. (80±9)%, all P<0.01]. Conclusion US and CEUS can be applied as accurate methods for diagnosing intra-abdominal inflammatory masses. CEUS may be helpful to distinguish abscess from phlegmon. US-guided percutaneous drainage can be safe and effective to improve the systemic inflammatory condition of CD patients with intra-abdominal inflammatory abscesses. Key words: Crohn′s disease; Abdominal abscess; Ultrasonography

患者女,46岁,因"会阴可复性包块伴排便困难6年余"入院。患者2年前因"子宫肌瘤"接受腹腔镜子宫切除术。查体:腹部肿块未触及,嘱患者蹲立位约5 min,见右侧大阴唇后部一隆起状包块,约3 cm×3 cm,质软,无触痛,可用手回纳,咳嗽后未见包块变大,触之无冲击感,站立后包块消失。直肠指检:未扪及包块。超声检查:右侧会阴部多发无回声管状结构（图1A）,CDFI未探及血流信号（图1B）。CEUS:经外周静脉注入

Objective To investigate the value of endorectal ultrasonography (ERUS) inpreoperative assessment of rectal cancer post neoadjuvant chemoradiation therapy.Methods From Jan.2016 to Dec.2016,90 rectal cancer patients who underwent preoperative neoadjuvant chemoradiation therapy and total mesorectal excision surgery in the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed,and all patients underwent ERUS examination post neoadjuvant chemoradiation therapy.Of these,64 patients were evaluated by ERUS pre and post neoadjuvant chemoradiation therapy and 26 patients were evaluated only post neoadjuvant chemoradiation therapy.Wilcoxon rank sum test for paired sample was performed to compare the distance from inferior margin of tumor to anal margin,the length and thickness of the tumor pre and post neoadjuvant chemoradiation therapy respectively in rectal cancer.Taken pathologic findings as golden standard,the accuracy of T staging assessed by ERUS post neoadjuvant chemoradiation therapy was evaluated.Results Compared with pre neoadjuvant chemoradiation therapy,the distance from inferior margin of tumor to anal margin significantly increased after neoadjuvant chemoradiation therapy [(58.63±21.71) mm vs (51.68± 19.81) mm],and the length [(26.10± 10.07) mm vs (40.82±9.18) mm] and thickness [(9.73±2.50) mm vs (14.92±5.30) mm] of tumor also evidently decreased post neoadjuvant chemoradiation therapy,respectively (Z were 4.996,6.153 and 6.076,all P ＜ 0.01).The final pathological T stage was pathologic complete response (pCR) or pT0 in 15 patients,pT1 in 3 patients,pT2 in 30 patients and pT3 in 42 patients.The diagnostic accuracy of T staging of rectal cancer post neoadjuvant chemoradiation therapy for ERUS was uT0 82.2％ (74/90),uT1 96.7％ (87/90),uT2 66.7％ (60/90),uT3 67.8％ (61/90) and uT4 96.7％ (87/90),and the overall accuracy was 82.2％ (74/90).Conclusion ERUS could effectively record the morphological changes of rectal cancer pre and post neoadjuvant chemoradiation therapy,which may contribute to the re-evaluation of the distance from inferior tumor margin to anal margin and the range and depth of tumor involvement pre surgical resection.

Objective To evaluate the value of endorectal ultrasonography (ERUS) in assessment of mesorectal fascia (MRF) invasion in rectal cancer.Methods Data of 44 patients who accepted preoperative ERUS and total mesorectal excision surgery within a week were retrospective analyzed.There were 18 patients who accepted preoperative neoadjuvant chemotherapy and 26 patients didn't acceped.Taking the pathological diagnosis of circumferential resection margin (CRM) as the "gold standard",the diagnostic efficiency of ERUS for the MRF invasion in rectal cancer was evaluated.Results The final pathological T staging was T1 in 2 cases,T2 in 17 cases and T3 in 25 cases.There were 2 cases of CRM positive results,and 42 cases of CRM negative results.With regard to the location of tumor,there were 16 cases located in low,and 28 cases in mid rectum.There were 26 cases located in anterior or antero-lateral wall of rectum,13 cases in posterior or postero-lateral wall,and 5 cases with a circle of rectum.The diagnostic accuracy were 83.33 ％ (15/18) and 92.31％ (24/26) for cases of accepting and not accepting the preoperative neoadjuvant chemotherapy;80.77％ (21/26) for cases located in anterior or antero-lateral wall,and 100％ (13/13) for cases located in posterior or postero-lateral wall;75.00％ (12/16)and 96.43 ％ (27/28) for low position and mid position tumors.The total diagnostic accuracy was 88.64％ (39/44).Conclusion ERUS can be an effective method in preoperative assessment of the MRF invasion in rectal cancer.

In recent years, studies have found that a variety of chronic diseases are closely associated with nonspecific inflammation, CD26/Dipeptidyl peptidase-4 (DPP-4) involved in nonspecific inflammatory process. DPP-4 inhibitors are a new class of antidiabetic agents that effectively reduce blood glucose by stimulating insulin secretion from β-cells and inhibiting glucagon release. In addition, DPP-4 inhibitors may regulate the inflammatory response, which provide new insights into the treatment of various chronic nonspecific inflammatory diseases. This article reviewed the anti-inflammatory effect of DPP-4 inhibitors.

Objective To investigate the effect of dipeptidyl peptidase-4 (DPP-4) inhibitor on lipopolysaccharide (LPS)-induced changes in the mass and function of pancreatic β-cells.Methods RINm cells were cultured and treated with LPS alone or combined with different concentrations of sitagliptin for 24 h.The proliferation of RINm cells was detected by CCK-8 assay.Apoptotic rate was determined by Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide flow cytometry.Insulin secretion was measured by enzyme-linked immunosorbent assay.The expression of IL-6 mRNA was displayed by RT-PCR.Results LPS significantly stimulated the proliferation of RINm cells (0.89 ± 0.04 vs 1.14 ± 0.08,P＜0.01),while LPS+sitagliptin showed no significant difference compared with LPS group.The cell apoptotic rate in LPS + 10-1 mmol/L sitagliptin group was significantly lower than that in LPS group.There were no significant differences in basal insulin secretion among all groups,but after the high/low glucose stimulation,LPS increased insulin secretion as compared with the control.The IL-6 mRNA expression in LPS+sitagliptin group was significantly lower than that in LPS group (0.77 ± 0.33 vs 1.30 ± 0.41,P =0.006).Conclusions DPP-4 inhibitor has no influence on LPS-induced proliferation of pancreatic β-cell,but it can inhibit LPS-induced apoptosis and insulin secretion,and IL-6 may be involved in the process.

Objective To investigate the effect of DPP4/CD26 inhibitor on LPS-induced inflammation in isletβcells, and to explore the possible mechanism. Methods RINm cells were cultured with LPS alone or combined with sitagliptin in a time, using RT-PCR to detect the level of IL-6 mRNA, and the expression of IL-6 and the phosphorylation of IκBα protein were detected by western blot. Results The level of IL-6 mRNA in LPS+Sitagliptin group obviously declined compared with LPS group (P<0.01); the expression of IL-6 protein in LPS+Sitagliptin group slightly declined compared with LPS group, but with no statistical difference (P>0.05); the phosphorylation level of IκBα protein in LPS+Sitagliptin group significantly decreased compared with LPS group (P<0.01). Conclusion DPP4/CD26 inhibitor can effectively inhibit the expression of IL-6 mRNA and the phosphorylation of IκBα protein which were induced by LPS. The mechanism may be related to DPP4/CD26 involved in LPS-activated NF-κB inflammatory pathway.