2018年 · 第38卷第06期

colorectal cancer (colorectal cancer) is one of the most common malignant tumors of digestive tract in clinical practice. Its incidence rate ranks third among malignant tumors and its mortality rate ranks fourth among malignant tumors^[1]。 There are more than 250,000 new cases of colorectal cancer and about 140,000 deaths in China every year. Both new cases and deaths account for 20% of the world's colorectal cancer cases in the same period^[2]。 Colorectal cancer mostly develops from colorectal adenoma. Early detection and resection of adenoma can effectively reduce the morbidity and mortality of colorectal cancer. At present, colorectal cancer screening methods include colonoscopy, fecal occult blood test, glycoprotein tumor marker test, etc. Colonoscopy combined with pathological examination is the main method for diagnosing colorectal cancer and adenoma, but adequate intestinal preparation, invasive procedures, privacy exposure and patient's fear limit its wide application in population screening. fecal occult blood examination mainly includes fecal immunochemical test (FIT) and guaiac chemistry. FIT gradually replaces the traditional guaiac chemistry method, and has high sensitivity and specificity in the screening of colorectal cancer^[3]However, the sampling of fecal specimens is inconvenient, and the results are easily affected by many factors, and multiple tests may be required. Commonly used glycoprotein tumor markers include carcinoembryonic antigen, CA19-9, CA125, carbohydrate antigen antigen 72-4 and carbohydrate antigen 211, etc. However, the diagnostic value of single index in colorectal cancer screening is not high. Therefore, a simpler examination method with high diagnostic value and good subject compliance is needed to improve the early detection rate of colorectal cancer.

mass-forming chronic pancreatitis (MFCP) and pancreatic head ductal adenocarcinoma (PDAC) have occult onset and special anatomical location. The clinical and imaging manifestations of the two are overlapping, making early diagnosis and differential diagnosis extremely difficult^[1,2,3]Even surgical exploration and even pathological biopsy are sometimes difficult to distinguish. However, the treatment and prognosis of the two are completely different. Radical surgical resection is the standard and only effective treatment for pancreatic cancer. There are many cases where MFCP is misdiagnosed as a malignant tumor and unnecessary surgical treatment (radical resection, etc.) or PDAC is misdiagnosed as MFCP and the optimal surgical opportunity is delayed^[1,2,3,4,5]Early preoperative definitive diagnosis is the key to implementing effective and precise treatment and improving patient prognosis^[1,3,6]。 Imaging technology plays an important role in the early diagnosis and differential diagnosis of pancreatic lesions, the formulation of personalized treatment plan, and the evaluation of curative effect^[3,4,6,7]However, there are few large-sample clinical studies to confirm that a certain imaging manifestation has high specificity and high sensitivity for the diagnosis of pancreatic lesions. This study retrospectively analyzed the clinical data and imaging manifestations of patients with MFCP and PDAC in the head of pancreas confirmed by clinical operation and pathology, and explored the multimodal imaging characteristics of MFCP and PDAC in the head of pancreas, so as to provide reference and basis for accurate diagnosis and treatment in early clinical stage.

Pancreatic cancer is a malignant tumor of digestive system with extremely high fatality rate, and its incidence is increasing year by year, which seriously threatens human health. pancreatic ductal adenocarcinoma (PDAC) is the most common pathological type of pancreatic cancer, accounting for 80% to 90%; Due to the insidious symptoms, PDAC was found in late stage, and the overall prognosis was poor. The median survival time was only 3~5 months, and the 1-year survival rate<10%^[1]。 CA19-9 is the only PDAC biomarker approved by the US FDA, but its screening power is poor. With the continuous deepening of research on pancreatic cancer, a large number of prognostic markers have been discovered, but all of them are in the research stage and have not been popularized and used clinically. Therefore, the discovery of new potential prognostic markers of PDAC is of great value for early intervention and prognostic judgment of disease. miRNA is a negative regulator of gene expression. It has been found that miRNA expression is dysregulated in many kinds of tumors. It promotes tumorigenesis and development by regulating corresponding target genes, and has become a research hotspot in tumor diagnosis and targeted therapy^[2,3]。

hepatic sinusoidal obstruction syndrome (HSOS), once named as hepatic veno-occlusive disease (HVOD), is a disease with endothelial injury of hepatic sinus as the main pathological basis. The clinical manifestations are similar to Budd-Chiari syndrome (BCS), acute icteric hepatitis and decompensated cirrhosis, so it is easy to be misdiagnosed. In recent years, the number of HSOS cases reported in China due to taking pyrrolidine alkaloid (PA) containing plants has shown an increasing trend, and a considerable number of patients fail to obtain timely diagnosis and appropriate treatment, resulting in poor prognosis^[1]。 In order to improve doctors' understanding of this disease and standardize the diagnosis and treatment of this disease, the Hepatobiliary Diseases Collaborative Group of Gastroenterology Branch of Chinese Medical Association organized experts to formulate the Expert Consensus Opinions on the Diagnosis and Treatment of Pyrrole Alkaloid-Related Hepatic Sinus Obstruction Syndrome (Nanjing, 2017)^[2]。 This study is based on specific case data and combined with consensus opinions, aiming to strengthen the understanding of diagnosis and treatment of PA-HSOS.

The 53-year-old female was admitted to the hospital on January 26, 2017 due to repeated hematochezia for more than one month. The patient has been positive for hepatitis B virus surface antigen for more than 30 years and has not taken antiviral drugs. On 12 Jul 2016, the blood test routine showed that the red blood cell count was 4.53×10¹²/L, the white blood cell count was 7.59×10⁹/L, with platelet count of 157×10⁹/L, the hemoglobin level was 127 g/L, and the neutrophil ratio was 0.823. On 13 July 2016, he was given peginterferon alfa-2a 1.35 million U intramuscular injection once a week for antiviral therapy. During the treatment, he was monitored and followed up every 2 weeks regularly. Within 4 months of treatment, there were no adverse reactions and no three-line cytopenia. On 20 December 2016, the patient suddenly developed bloody stools, which were small in quantity and bright red in color, and occasionally accompanied by abdominal pain.

upper gastrointestinal bleeding (UGIB) refers to gastrointestinal bleeding above the Treitz ligament of the duodenum. It is a common clinical emergency and a common emergency in the elderly. The etiology, risk factors, clinical manifestations, management principles and prognosis of UGIB in the elderly are different from those of young and middle-aged people. It is very important to understand the characteristics of UGIB in the elderly to carry out the prevention and treatment of UGIB in the elderly.

Lemmel, 1934^[1]Cholangitis, obstructive jaundice or pancreatitis caused by compression of the biliopancreatic duct by juxtapapillary duodenal diverticulum (JDD) without choledocholithiasis is reported, which is called Lemmel syndrome. According to anatomical and pathophysiological characteristics, Lemmel syndrome is also known as duodenal diverticulum obstructive jaundice syndrome, duodenal parapapillary diverticulum-biliopancreatic duct syndrome, paraampullary diverticulum syndrome, parapillary diverticulum syndrome, etc. Its main clinical manifestations are intermittent jaundice, fever and epigastric pain, and it is one of the rare causes of obstructive jaundice (about 0.8%)^[2]。 With the rapid development of multi-slice spiral computed tomograpy (MSCT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP), the report of rare cases of Lemmel syndrome has increased year by year. However, at present, there is still insufficient clinical understanding or attention to it, and how to choose the diagnosis and treatment plan in an individualized and standardized way remains to be discussed. The clinical characteristics, diagnosis and treatment of Lemmel syndrome at home and abroad in recent years are summarized as follows, in order to attract clinicians' attention to this disease.