AIM: To identify the radiological characteristics of focal autoimmune pancreatitis (f-AIP) useful for differentiation from pancreatic cancer (PC). METHODS: Magnetic resonance imaging (MRI) and triple-phase computed to...AIM: To identify the radiological characteristics of focal autoimmune pancreatitis (f-AIP) useful for differentiation from pancreatic cancer (PC). METHODS: Magnetic resonance imaging (MRI) and triple-phase computed tomography (CT) scans of 79 patients (19 with f-AIP, 30 with PC, and 30 with a normal pancreas) were evaluated retrospectively. A radiologist measured the CT attenuation of the pancreatic parenchyma, the f-AIP and PC lesions in triple phases. The mean CT attenuation values of the f-AIP lesions were compared with those of PC, and the mean CT attenuation values of pancreatic parenchyma in the three groups were compared. The diagnostic performance of CT attenuation changes from arterial phase to hepatic phase in the differentiation between f-AIP and PC was evaluated using receiver operating characteristic (ROC) curve analysis. We also investigated the incidence of previously reported radiological findings for differentiation between f-AIP and PC. RESULTS: The mean CT attenuation values of f-AIP lesions in enhanced phases were significantly higher than those of PC (arterial phase: 60 ± 7 vs 48 ± 10, P < 0.05; pancreatic phase: 85 ± 6 vs 63 ± 15, P < 0.05; hepatic phase: 95 ± 7 vs 63 ± 13, P < 0.05). The mean CT attenuation values of f-AIP lesions were significantly lower those of uninvolved pancreas and normal pancreas in the arterial and pancreatic phase of CT (P < 0.001, P < 0.001), with no significant difference at the hepatic phase or unenhanced scanning (P = 0.4, P = 0.1). When the attenuation value increase was equal or more than 28 HU this was considered diagnostic for f-AIP, and a sensitivity of 87.5%, specificity of 100% and an area under the ROC curve of 0.974 (95%CI: 0.928-1.021) were achieved. Five findings were more frequently observed in f-AIP patients: (1) sausageshaped enlargement; (2) delayed homogeneous enhancement; (3) hypoattenuating capsule-like rim; (4) irregular narrowing of the main pancreatic duct (MPD) and/or stricture of the common bile duct (CBD); and (5) MPD upstream dilation ≤ 5 mm. CONCLUSION: Analysis of a combination of CT and MRI findings could improve the diagnostic accuracy of differentiating f-AIP from PC.展开更多
BACKGROUND: Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China.ME...BACKGROUND: Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China.METHODS: One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients.RESULTS: The median age of the patients at onset was 57 years (range 23-82) with a male to female ratio of 8.1:1. The common manifestations of the patients included obstructive jaundice (49 patients, 49.0%), abdominal pain (30, 30.0%), and acute pancreatitis (11, 11.0%). Biliary involvement was one of the most extrapancreatic manifestations (64, 64.0%). Fifty-six (56.0%) and 43 (43.0%) patients were classified into focaltype and diffuse-type respectively according to the imaging examinations. The levels of serum Ig G and Ig G4 were elevated in 69.4% (43/62) and 92.0% (69/75) patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked (>10 cells/HPF) Ig G4 positive cells were found in 20 (74.1%) patients.Steroid treatment and surgery as the main initial treatments were given to 41 (41.0%) and 28 (28.0%) patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%.CONCLUSIONS: Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.展开更多
AIM:To evaluate 99mTc-ciprofloxacin scintigraphy compared with computed tomography(CT)for detecting secondary infections associated with severe acute pancreatitis(SAP)in swine.METHODS:Six healthy swine were assigned t...AIM:To evaluate 99mTc-ciprofloxacin scintigraphy compared with computed tomography(CT)for detecting secondary infections associated with severe acute pancreatitis(SAP)in swine.METHODS:Six healthy swine were assigned to a normal control group(group A,n = 6).SAP was induced in group B(n = 9)and C(n = 18),followed by inoculation of the resulting pancreatic necroses with inactive Escherichia coli(E.coli)(group B)and active E.coli(group C),respectively.At 7 d after inoculation,a CT scan and a series of analyses using infecton imaging(at 0.5,1,2,3,4 and 6 h after the administration of 370 MBq of intravenous infecton)were performed.The scintigrams were visually evaluated and semi-quantitatively analyzed using region of interest assignments.The differences in infecton uptake and changes in the lesion-background radioactive count ratios(L/B)in the 3 groups were recorded and compared.After imaging detection,histopathology and bacterial examinations were performed,and infected SAP was regarded as positive.The imaging findings were compared with histopathological and bacteriological results.RESULTS:In group A,6 animals survived without infection in the pancreas.In group B,7/9 swine survived and one suffered from infection.In group C,15/18 animals survived with infection.Hence,the number of normal,non-infected and infected SAP swine was 6,6 and 16,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the infecton method were 93.8%(15/16),91.7%(11/12),92.9%(26/28),93.8%(15/16)and 91.7%(11/12),whereas these values for CT were 12.5%(2/16),100.0%(12/12),50.0%(14/28),100.0%(2/2)and 46.2%(12/26),respectively.The changes in L/B for the infected SAP were significantly different from those of the non-infected and normal swine(P < 0.001).The mean L/B of the infectious foci at 0.5,1,2,3,4 and 6 h was 1.17 ± 0.10,1.71 ± 0.30,2.46 ± 0.45,3.36 ± 0.33,2.04 ± 0.37 and 1.1988 ± 0.09,respectively.At 3 h,the radioactive counts(2350.25 ± 602.35 k)and the mean L/B of the infectious foci were significantly higher than that at 0.5 h(P = 0.000),1 h(P = 0.000),2 h(P = 0.04),4 h(P = 0.000)and 6 h(P = 0.000).CONCLUSION:99m Tc-ciprofloxacin scintigraphy may be an effective procedure for detecting SAP secondary infections with higher sensitivity and accuracy than CT.展开更多
The thermal stability of retained austenite(RA)and the mechanical properties of the quenched and intercritical annealed 0.1C-5Mn steel with the starting ultrafine lamellar duplex structure of ferrite and retained aust...The thermal stability of retained austenite(RA)and the mechanical properties of the quenched and intercritical annealed 0.1C-5Mn steel with the starting ultrafine lamellar duplex structure of ferrite and retained austenite during tempering within the range from 200 to 500°C were studied by X-ray diffraction(XRD),transmission electron microscopy(TEM)and tensile testing.The results showed that there was a slight decrease in the RA volume fraction with increasing tempering temperature up to 400°C.This caused a slight increase in the ultimate tensile strength(UTS)and a slight decrease in the total elongation(TE);thus,the product of UTS to TE(UTS×TE)as high as 31GPa·% was obtained and remained nearly unchanged.However,aportion of the RA began to decompose when tempered at 500°C and thus caused a^35% decrease of the RA fraction and a^16%decrease of the value of UTS×TE.It is concluded that the ultrafine lamellar duplex structure is rather stable and the excellent combination of strength and ductility could be retained with tempering temperature up to 400°C.Thus,thermal processes such as galvanization are feasible for the tested steel provided that their temperatures are not higher than 400°C.展开更多
The fracture splitting property of medium carbon steel 37MnSiS microalloyed with V up to 0. 45% was investigated by using simulated fracture splitting test,for the development of new crackable medium carbon steel to m...The fracture splitting property of medium carbon steel 37MnSiS microalloyed with V up to 0. 45% was investigated by using simulated fracture splitting test,for the development of new crackable medium carbon steel to manufacture high performance connecting rod. Conventional high carbon steel C70S6 was used for comparison. The results show that the volume fraction of both ferrite and V-rich M( C,N) particles increases,and the pearlite interlamellar spacing decreases with increasing V content,which in turn results in gradual increase of strength and decrease of ductility and impact energy. The fracture splitting property of the tested steel could be improved significantly due to the increase of V content mainly through the precipitation hardening mechanism of fine M( C,N) precipitates. The fraction of brittle cleavage fracture in the crack initiation area increases noticeably with increasing V content and full brittle cleavage fracture surface could be obtained when V content was increased to 0. 45%. It is concluded that medium carbon steel with V content higher than about 0. 28% possesses not only comparable or even higher mechanical properties with those of conventional steel C70S6,but also excellent fracture splitting property,and therefore,is more suitable to fabricate high performance fracture splitting connecting rod.展开更多
Single compression tests were carried out with a Gleeble-3800 thermal simulator to investigate hot deformation behavior of two vanadium-microalloyed medium-carbon steels for fracture splitting connecting rod.The tests...Single compression tests were carried out with a Gleeble-3800 thermal simulator to investigate hot deformation behavior of two vanadium-microalloyed medium-carbon steels for fracture splitting connecting rod.The tests were performed to a total true strain of 0.92 at true strain rates ranging from 10-2 to 10s-1 and deformation temperature of 900-1 150 ℃.The results show that hot deformation behavior of the tested steels is similar to that of conventional medium-carbon microalloyed steels and dynamic recrystallization is easier to occur at higher deformation temperature and lower strain rate.The austenite deformation resistance and activation energy of deformation increase with increasing vanadium content from 0.15%to 0.28% and thus the starting time of dynamic recrystallization was delayed.Finer recrystallized austenite grain could be obtained at higher strain rate,lower deformation temperature and higher vanadium content.TEM observation of the specimens quenched just before and after deformation reveals that vanadium is mainly in dissolved solute condition in austenite and thus affects the dynamic recrystallization behavior of the tested steels mainly through solute-drag effect.展开更多
基金Supported by National Nature Science Foundation of China No.30970801National Nature Science Foundation of China,No.81170435+1 种基金the China Post-doctoral Science Foundation,No.20100480545the Shanghai Leading Talent Team Construction Special Funds,No.2011-036
文摘AIM: To identify the radiological characteristics of focal autoimmune pancreatitis (f-AIP) useful for differentiation from pancreatic cancer (PC). METHODS: Magnetic resonance imaging (MRI) and triple-phase computed tomography (CT) scans of 79 patients (19 with f-AIP, 30 with PC, and 30 with a normal pancreas) were evaluated retrospectively. A radiologist measured the CT attenuation of the pancreatic parenchyma, the f-AIP and PC lesions in triple phases. The mean CT attenuation values of the f-AIP lesions were compared with those of PC, and the mean CT attenuation values of pancreatic parenchyma in the three groups were compared. The diagnostic performance of CT attenuation changes from arterial phase to hepatic phase in the differentiation between f-AIP and PC was evaluated using receiver operating characteristic (ROC) curve analysis. We also investigated the incidence of previously reported radiological findings for differentiation between f-AIP and PC. RESULTS: The mean CT attenuation values of f-AIP lesions in enhanced phases were significantly higher than those of PC (arterial phase: 60 ± 7 vs 48 ± 10, P < 0.05; pancreatic phase: 85 ± 6 vs 63 ± 15, P < 0.05; hepatic phase: 95 ± 7 vs 63 ± 13, P < 0.05). The mean CT attenuation values of f-AIP lesions were significantly lower those of uninvolved pancreas and normal pancreas in the arterial and pancreatic phase of CT (P < 0.001, P < 0.001), with no significant difference at the hepatic phase or unenhanced scanning (P = 0.4, P = 0.1). When the attenuation value increase was equal or more than 28 HU this was considered diagnostic for f-AIP, and a sensitivity of 87.5%, specificity of 100% and an area under the ROC curve of 0.974 (95%CI: 0.928-1.021) were achieved. Five findings were more frequently observed in f-AIP patients: (1) sausageshaped enlargement; (2) delayed homogeneous enhancement; (3) hypoattenuating capsule-like rim; (4) irregular narrowing of the main pancreatic duct (MPD) and/or stricture of the common bile duct (CBD); and (5) MPD upstream dilation ≤ 5 mm. CONCLUSION: Analysis of a combination of CT and MRI findings could improve the diagnostic accuracy of differentiating f-AIP from PC.
基金supported by grants from the National Natural Science Foundation of China (81270541)Disciplinary Joint Research Projects of Changhai Hospital (CH125510312)
文摘BACKGROUND: Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China.METHODS: One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients.RESULTS: The median age of the patients at onset was 57 years (range 23-82) with a male to female ratio of 8.1:1. The common manifestations of the patients included obstructive jaundice (49 patients, 49.0%), abdominal pain (30, 30.0%), and acute pancreatitis (11, 11.0%). Biliary involvement was one of the most extrapancreatic manifestations (64, 64.0%). Fifty-six (56.0%) and 43 (43.0%) patients were classified into focaltype and diffuse-type respectively according to the imaging examinations. The levels of serum Ig G and Ig G4 were elevated in 69.4% (43/62) and 92.0% (69/75) patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked (>10 cells/HPF) Ig G4 positive cells were found in 20 (74.1%) patients.Steroid treatment and surgery as the main initial treatments were given to 41 (41.0%) and 28 (28.0%) patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%.CONCLUSIONS: Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.
基金Supported by The National Natural Science Foundation of China,No. 81170435 and 30570535Natural Science Foundation of Zhejiang Province,No. LY13H070008+4 种基金Medicine and Health Science and Technology Project of Zhejiang Province,2013KYA182 and 2012KYB176Natural Science Foundation of Ningbo,2010A610052the Dawn Program of the Shanghai Education Committee,06SG41the Scientific Research Foundation of the Shanghai Municipal Public Health Bureau,2007JG0069China Postdoctoral Science Foundation,20100480545
文摘AIM:To evaluate 99mTc-ciprofloxacin scintigraphy compared with computed tomography(CT)for detecting secondary infections associated with severe acute pancreatitis(SAP)in swine.METHODS:Six healthy swine were assigned to a normal control group(group A,n = 6).SAP was induced in group B(n = 9)and C(n = 18),followed by inoculation of the resulting pancreatic necroses with inactive Escherichia coli(E.coli)(group B)and active E.coli(group C),respectively.At 7 d after inoculation,a CT scan and a series of analyses using infecton imaging(at 0.5,1,2,3,4 and 6 h after the administration of 370 MBq of intravenous infecton)were performed.The scintigrams were visually evaluated and semi-quantitatively analyzed using region of interest assignments.The differences in infecton uptake and changes in the lesion-background radioactive count ratios(L/B)in the 3 groups were recorded and compared.After imaging detection,histopathology and bacterial examinations were performed,and infected SAP was regarded as positive.The imaging findings were compared with histopathological and bacteriological results.RESULTS:In group A,6 animals survived without infection in the pancreas.In group B,7/9 swine survived and one suffered from infection.In group C,15/18 animals survived with infection.Hence,the number of normal,non-infected and infected SAP swine was 6,6 and 16,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the infecton method were 93.8%(15/16),91.7%(11/12),92.9%(26/28),93.8%(15/16)and 91.7%(11/12),whereas these values for CT were 12.5%(2/16),100.0%(12/12),50.0%(14/28),100.0%(2/2)and 46.2%(12/26),respectively.The changes in L/B for the infected SAP were significantly different from those of the non-infected and normal swine(P < 0.001).The mean L/B of the infectious foci at 0.5,1,2,3,4 and 6 h was 1.17 ± 0.10,1.71 ± 0.30,2.46 ± 0.45,3.36 ± 0.33,2.04 ± 0.37 and 1.1988 ± 0.09,respectively.At 3 h,the radioactive counts(2350.25 ± 602.35 k)and the mean L/B of the infectious foci were significantly higher than that at 0.5 h(P = 0.000),1 h(P = 0.000),2 h(P = 0.04),4 h(P = 0.000)and 6 h(P = 0.000).CONCLUSION:99m Tc-ciprofloxacin scintigraphy may be an effective procedure for detecting SAP secondary infections with higher sensitivity and accuracy than CT.
基金sponsored by the High-level Scientific Research Foundation for the Introduction of Talent of Beijing Jiaotong University(M14RC00010)the Fundamental Research Funds for the Central Universities(No.2014JBM108)
文摘The thermal stability of retained austenite(RA)and the mechanical properties of the quenched and intercritical annealed 0.1C-5Mn steel with the starting ultrafine lamellar duplex structure of ferrite and retained austenite during tempering within the range from 200 to 500°C were studied by X-ray diffraction(XRD),transmission electron microscopy(TEM)and tensile testing.The results showed that there was a slight decrease in the RA volume fraction with increasing tempering temperature up to 400°C.This caused a slight increase in the ultimate tensile strength(UTS)and a slight decrease in the total elongation(TE);thus,the product of UTS to TE(UTS×TE)as high as 31GPa·% was obtained and remained nearly unchanged.However,aportion of the RA began to decompose when tempered at 500°C and thus caused a^35% decrease of the RA fraction and a^16%decrease of the value of UTS×TE.It is concluded that the ultrafine lamellar duplex structure is rather stable and the excellent combination of strength and ductility could be retained with tempering temperature up to 400°C.Thus,thermal processes such as galvanization are feasible for the tested steel provided that their temperatures are not higher than 400°C.
基金Item Sponsored by National High Technology Research and Development Program of China(2013AA031605)
文摘The fracture splitting property of medium carbon steel 37MnSiS microalloyed with V up to 0. 45% was investigated by using simulated fracture splitting test,for the development of new crackable medium carbon steel to manufacture high performance connecting rod. Conventional high carbon steel C70S6 was used for comparison. The results show that the volume fraction of both ferrite and V-rich M( C,N) particles increases,and the pearlite interlamellar spacing decreases with increasing V content,which in turn results in gradual increase of strength and decrease of ductility and impact energy. The fracture splitting property of the tested steel could be improved significantly due to the increase of V content mainly through the precipitation hardening mechanism of fine M( C,N) precipitates. The fraction of brittle cleavage fracture in the crack initiation area increases noticeably with increasing V content and full brittle cleavage fracture surface could be obtained when V content was increased to 0. 45%. It is concluded that medium carbon steel with V content higher than about 0. 28% possesses not only comparable or even higher mechanical properties with those of conventional steel C70S6,but also excellent fracture splitting property,and therefore,is more suitable to fabricate high performance fracture splitting connecting rod.
基金Item Sponsored by National High Technology Research and Development Program of China(2013AA031605)
文摘Single compression tests were carried out with a Gleeble-3800 thermal simulator to investigate hot deformation behavior of two vanadium-microalloyed medium-carbon steels for fracture splitting connecting rod.The tests were performed to a total true strain of 0.92 at true strain rates ranging from 10-2 to 10s-1 and deformation temperature of 900-1 150 ℃.The results show that hot deformation behavior of the tested steels is similar to that of conventional medium-carbon microalloyed steels and dynamic recrystallization is easier to occur at higher deformation temperature and lower strain rate.The austenite deformation resistance and activation energy of deformation increase with increasing vanadium content from 0.15%to 0.28% and thus the starting time of dynamic recrystallization was delayed.Finer recrystallized austenite grain could be obtained at higher strain rate,lower deformation temperature and higher vanadium content.TEM observation of the specimens quenched just before and after deformation reveals that vanadium is mainly in dissolved solute condition in austenite and thus affects the dynamic recrystallization behavior of the tested steels mainly through solute-drag effect.
